Quality of end-of-life care in low-income, uninsured men dying of prostate cancer

Background:We sought to assess the quality of end-of-life care in disadvantaged men prospectively enrolled in a public assistance program. We hypothesized that end-of-life care would be aggressive, moreso than recommended by quality-of-care guidelines. Methods:We included all 60 low-income, uninsured men in a state-funded public assistance program who had died since its inception in 2001. To measure quality of end-of-life care, we collected information about timing of the institution of new chemotherapeutic regimens; time from administration of last chemotherapy dose to death; the number of inpatient admissions and intensive care unit stays made in the 3 months preceding death, and the number of emergency room visits made in the 12 months before dying. We also noted hospice use and the timing of hospice referrals. Results:Eighteen men (30%) enrolled in hospice prior to death and the average hospice stay lasted 45 days (SD 32, range 2–143, median 41 days). Two patients (11%) were enrolled for fewer than 7 days, and none were enrolled for more than 180 days. The average time from administration of the last dose of chemotherapy to death was 104 days. Chemotherapy was never initiated within 3 months of death, and in only 2 instances (6%) was the final chemotherapeutic regimen administered within 2 weeks of dying. Use of hospital resources (emergency room visits, inpatient admissions, and intensive care unit stays) was uniformly low (mean 1.0±1.0, 0.65±0.82, 0.03±0.18, respectively). Conclusions:End-of-life care in disadvantaged men dying of prostate cancer, who enroll in a comprehensive statewide assistance program, is high-quality.