• Amy Sexauer, M Jennifer Cheng, Louise Knight, Anthony W Riley, Lauren King, and Thomas J Smith.
• 1 Oncology Department, Johns Hopkins School of Medicine , Baltimore, Maryland.
• J Palliat Med. 2014 Feb 1;17(2):195-9.

BackgroundHospice brings substantial clinical benefits to dying patients and families but is underutilized by patients dying of hematologic malignancies (HM); nationwide, only 2% of HM patients use hospice. There are 70,000 deaths among U.S. patients with hematologic malignancies yearly.ObjectiveWe measured the use and length of stay (LOS) in hospice among patients with HMs at a large academic cancer center.DesignThis was a single center retrospective review of adult patients (≥18 years) with lymphoma, leukemia, myelodysplastic syndrome, aplastic anemia, and multiple myeloma referred for hospice.MeasurementsInformation included demographics, transplant, hospice type, LOS, and use of "expanded access" services.ResultsFifty-nine patients were referred to hospice, and 53 utilized hospice services, 25% of 209 HM decedents. Thirty-five received home hospice and 18 used inpatient hospice. The median home hospice LOS was nine days (SD 13) and inpatient hospice six days (SD 10). Nine patients with "expanded access" hospice received only a few blood transfusions, and none received radiation.ConclusionsHM patients are referred late or never for hospice services. Studies evaluating earlier integration of palliative and hospice care with usual HM care are warranted. We present a one-page negotiation form that we have found useful in negotiations among HM physicians, hospice medical directors, and payers.

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