End-of-Life Costs and Hospice Utilization in Patients with Head and Neck Cancer

Otolaryngol Head Neck Surg. 2019 Sep;161(3):439-441. doi: 10.1177/0194599819846072. Epub 2019 Apr 23.


The Quality Oncology Practice Initiative has several metrics related to end-of life (EOL) care, including hospice enrollment ≤3 days, with lower scores signaling better performance. Of privately insured patients with head and neck cancer, 3.5% were enrolled in hospice prior to death and 21.3% spent ≤3 days in hospice, indicating aggressive EOL care. Patients with late hospice enrollment had higher spending in the last 30 days of life (DOL). Patients in hospice ≤3 days spent $37,426, while those in hospice >3 days spent $24,418 (P = .002). The largest portion of this difference was attributable to inpatient services. Patients in hospice ≤3 days spent $22,089 on inpatient services in the last 30 DOL, while those in hospice >3 days spent $8361 (P < .001). Further research is needed to determine if more high-value care can be provided with earlier hospice enrollment and to ensure that goal concordance is included in defining high-value care.

Keywords: costs; end of life; head and neck cancer; hospice.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Facilities and Services Utilization / statistics & numerical data*
  • Female
  • Head and Neck Neoplasms / therapy*
  • Hospice Care / economics*
  • Hospice Care / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Terminal Care / economics*
  • Time Factors