COPD Patients: While Hospice Use Increases, Experts Call for Earlier Referral to Palliative Care and Hospice

Early palliative care (PC) in patients with severe chronic obstructive pulmonary disease (COPD) may “improve the end-of-life experience and increase hospice use,” state the authors of a letter published in CHEST, in which they report on a retrospective study they conducted on trends and disparities in hospice use among patients dying of COPD.

Noting that “PC involvement should start early in the course of illness to prevent costs and burden associated with end-of-life hospitalizations,” researchers from Cleveland Clinic analyzed the places of death among patients in the U.S. aged ≥ 50 who died of COPD from 2006-2015 (n = 1,242,350).

The research team’s analysis was based on data from the U.S. Mortality Files compiled by the Centers for Disease Control, National Vital Statistics System.

Places of Death for COPD Patients

• 33.6% in a hospital
• 28.6% at home
• 22.5% in a nursing home/long-term care facility
• 5.9% in hospice care (at any location)
• 4.5% other/unknown
• 0.4% dead on arrival at hospital

While the overall percentage of hospice deaths among COPD patients increased from 2.2% to 9.3% from 2006-2015 (P < 0.001), the authors emphasize that “only a minority of patients with COPD die at home or in hospice.”

Hospice Use Findings

Patients more likely to die of COPD in hospice included:

• Whites (6.1% vs 4.2% of African Americans; P < 0.001).
• Older patients (odds ratio, 1.04; 95% confidence interval, 1.03-1.04 per 5 years; P < .001).
• Women (6.1% vs 5.7% of men; P < 0.001).

Significant regional variations in hospice deaths were also found (Northeast, 4.1%; Midwest, 4.7%; South, 8.1%; West, 4.7%; P < 0.001).

The authors note that their findings mirror a number of important trends reported by Rush et al in their COPD study published earlier in CHEST.

In the Rush study, investigators conducted a retrospective analysis of adult COPD patients (n = 181,689). While the percentage of patients receiving a PC referral increased from 0.45% to 2.56% between 2006 and 2012 (P < 0.01), Rush states that “referral to PC remains uncommon,” and they advocate for earlier referral for these patients. In addition, they found significant racial disparities in PC referral, “with white patients referred more often than minorities.” (P < 0.01).

In commenting on the Cleveland Clinic study’s findings, Rush concludes, “Our hope is that this combined work will increase awareness of the benefits that PC can have on this patient population. Future studies need to be undertaken to demonstrate the benefit of PC referral in reducing hospitalizations and improving patient quality of life.”

Sources: Yaqoob ZJ, et al. (2017). Trends and Disparities in Hospice Use Among Patients Dying of COPD in the United States. CHEST (Letter to the editor), 151(5):1183-1184. Rush B, et al. (2017). Use of Palliative Care in Patients with End-Stage COPD and Receiving Home Oxygen: National Trends and Barriers to Care in the United States. CHEST, 151(1):41-46.