Introduction and background

For the more than 500 000 cancer patients who eventually die each year in the US, one of their most meaningful options for care is for them to receive state-of-the-art palliative care without receiving any further cancer-remitting therapy. Such state-of-the-art palliative care for the dying can be made available through use of formal hospice services. For advanced cancer patients to receive formal hospice care in the US, through Medicare and insurance hospice benefits, they must be documented by their physician as having a prognosis of 6 months or less. Given that most cancer deaths come with significant advance knowledge, it is clear that a substantial proportion of individuals within this population have a prognosis which qualifies them to receive formal hospice care. However, it is also clear that hospice care, while it is widely available within third-party payer systems in the US, remains underutilized for advanced cancer patients. Although geographic variation exists, and estimates of utilization vary, 20–50% of the otherwise eligible cancer patient population dies each year while receiving formal hospice care., While these statistics could lead one to believe that hospice care is utilized for many appropriate patients, reviewed Medicare data have shown that the median survival of cancer patients in hospice is only on the order of 2–3 weeks at best, with many dying within days of referral.