Mesothelioma Survival Is Longer in a Hospital, but Hospice Is Cheaper

Let’s say your mesothelioma is very far advanced. Many would suggest you consider entering hospice care. But a new study hints you might survive mesothelioma longer if you stick with hospital treatment. Researchers from Brigham and Women’s Hospital in Boston found that the intensity of care received by cancer patients is greater in the hospital setting than in a hospice environment. As a result, cancer patients remain in hospice care a shorter time than when treated in the hospital, the researchers observed. However, there is a downside to this. A couple of downsides, actually. First, the study found that treatment costs are higher in hospitals. In part that’s because the more aggressive care consists of more things being done for you — the more they do, the more it costs. Second, the study found that those more things done for you are mostly focused on conditions other than the cancer — conditions like organ failure and infections. That means the hospital’s treatments may or may not contribute to a better quality of life for you. Bottom line: trade-offs are involved in choosing hospice over hospital, and vice versa. The choice that’s best for you is one you’ll need to think about carefully before making it.

Hospital Mesothelioma Care More Aggressive

These findings were published in the Nov. 12 issue of the Journal of the American Medical Association. Lead author was Ziad Obermeyer, M.D., M.Phil., who teaches emergency medicine and health care policy at Harvard Medical School. “Our study shows very clearly that hospice matters,” said Obermeyer. “Hospice and non-hospice patients had very similar patterns of health-care utilization, right up until the week of hospice enrollment — then the care started to look very different,” he continued. “Patients who didn’t enroll in hospice ended up with far more aggressive care in their last year of life — most of it not directly related to their cancer diagnosis,” he said. Obermeyer’s team considered the ways in which both hospice and hospital care impact utilizations and costs. They were able to determine that utilizations and total costs during the last year of life are lower for cancer patients treated in hospice settings. The researchers came to these conclusions by measuring utilizations and costs racked up by elderly Medicare patients with advanced cancer. They looked at 18,165 patients with poor-prognosis cancers who had enrolled in hospice and compared them to the exact same number of patients who stayed in a hospital. The grand total of 36,330 patients constituted a nationally representative sample, the researchers indicated.

Shift in Costs for Mesothelioma Care

The researchers observed that hospice and non-hospice costs were about the same at the beginning, but then showed a noticeable shift. According to the study, the typical elderly cancer patient’s care cost $62,819 in a hospice setting and $71,517 in the hospital. In case you don’t feel like doing the math, it turned out to be almost $8,700 more expensive to remain in the hospital. “These findings highlight the importance of honest discussions between doctors and patients about our patients’ goals at the end of life,” said Obermeyer. In addition to his work at Harvard Medical School, Obermeyer also is a researcher at Ariadne Labs, which is jointly operated by Harvard’s School of Public Health and Brigham and Women’s Hospital. This research was funded by a grant from the National Institutes of Health.