Trends and Disparities in Hospice Care Utilization in Testicular Cancer in the United States of America From 2003 to 2020: Analysis of CDC WONDER Database

Document Type

Conference Proceeding

Publication Date

2-1-2024

Publication Title

Journal of Clinical Oncology

Abstract

Background: Testicular cancer (TC) is a malignancy with five-year survival reaching up to 95%. It is estimated that 470 deaths from this disease will occur in the United States in 2023. Even with exceptional survival rates, it is important to recognize the need of hospice in these patients. Enrollment in hospice is associated with lower healthcare costs, symptom burden, and psychological distress and improved quality of life. We used publicly available CDC WONDER (Centers for Disease Control and Prevention for Wide-ranging Online Data for Epidemiologic Research) database with the aim to explore the trends of hospice utilization in patients with testicular cancer nationwide in the US. Methods: The search and analysis were conducted using the CDC WONDER database from January 01, 2003, to December 31, 2020. The data for deaths due to TC were pooled using the International Classification of Diseases-10th Revision codes C62, C62.0, C62.1 and C62.9. The inclusion criteria included males aged .15 years. The demographic data was obtained to calculate descriptive statistics using age, census region, and utilization of hospice mortality accordingly over the past two decades. Results: The analysis demonstrated that overall mortality due to TC were 6,969 from 2003-2020. Of these deaths, 520 (7.46%) were recorded in hospice facilities. According to the US census regions, the highest number of hospice deaths were recorded in Census Region 3: South (CENS-R3) 8.99%, followed by Census Region 1: Northeast (CENS-R1) 8.03%, and Census Region 2: Midwest (CENS-R2) 7.23%. While the lowest number of deaths were observed in Census Region 4: West (CENS-R4) at 5.30%. The lowest hospice mortality was 1.9% in 2005 and increased over the years to the highest of 10.4% in 2019, with a slight decline in 2020 which is 7.9%. Moreover, when stratified by age groups, the lowest hospice mortalities are recorded in the age group 15- 34 years (6.32%), 35-54 years (7.08%), 55-74 years (10.10%), 75-85+ years (8.72%). Conclusions: To our knowledge this is the first study utilizing CDC WONDER database to demonstrate hospice care utilization in TC related deaths. We observed a steady increase in hospice utilization from 2005-2019 throughout the US with a decline in 2020 possibly related to COVID pandemic. Age stratification further revealed lower utilization in 15-34 years age group compared to 55-74 highlighting the need to improve hospice discussions early in this age group. This study highlights the disparities in end-of-life care in TC and should promote policy-level changes in the states with lower utilization of hospice services to improve access of care in TC patients.

Volume

42

Issue

4 Suppl

First Page

504

Comments

2024 ASCO (American Society of Clinical Oncology) Genitourinary Cancers Symposium, January 25-27, 2024, San Francisco, CA

DOI

10.1200/JCO.2024.42.4_suppl.504

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