Background No evidence could be found to support the general perception that hospice patients die whereas hospital palliative care patients survive. Such a perception could make patients reluctant to accept hospice support; and lead clinicians to over treat hospital patients and deny beneficial interventions to hospice patients.
Aims and objectives Compare 3 month survival of patients with metastatic cancer admitted to hospice and hospital.
Methods All adults known to have metastatic cancer pre-admission to district general hospital or hospice over a 2 month period were included. Parameters compared: proportions discharged and died; length of in-patient stay; mean survival; survival at 3 months.
Results Total number of patients – 106 (hospital:72; hospice:34). 60% of hospital group women; 65% of hospice men. Hospice patients were significantly younger, mean age – 69.09 vs 75.36 years; p-value 0.006. There was no difference in baseline investigation (FBC; renal and liver functions; serum calcium) results of two groups. There was no difference in proportion of patients discharged (57% hospital vs 59% hospice); proportion dying during admission (43% hospital vs 41% hospice); mean or median length of in-patient stay (hospital vs hospice, mean days: 13.29 vs 14.26, median – 9.5 vs 9.5); and mean survival (22 days) in 2 groups. Forty four percent of hospital patients were alive at 3 months, versus 35% of hospice – but insignificant difference (p-value: 0.121). There was no correlation between age and survival (r=−0.10; p-value: 0.941).
Conclusions This small study demonstrates no survival benefit of invasive (district general) hospital approach against holistic hospice approach in patients with metastatic cancer. Hospital clinicians should not be concerned that hospice approach would shorten survival of their patients and lengthen hospital stay. All clinicians and managers should be aware that a third of hospice patients survive more than 3 months and that there are mechanisms to identify and manage them promptly.
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