Internal medicine hospital ward and free standing hospice costs of care for terminal cancer patients

The majority of terminally ill patients prefer home care at the end of life. Early inclusion in palliative care and advanced care planning reduces the number of unscheduled hospitalisations of patients with advanced cancer/malignancy. Currently, the majority of these patients in the last month of life are admitted to emergency departments, then referred to hospital and die there.

In this paper all 10 patients with far-advanced cancer admitted to the internal medicine ward of district hospital, who died after over one week stay were compared with 10 patients randomly selected among parallel 229 patients in a free standing hospice.

In both groups the elderly were analysed: patients in the hospice stayed longer, did not receive blood transfusions or take X-ray tests, rarely used laboratory tests, consulted and received antibiotics, however they more often received opioids. In the hospice tendency to use higher opioid doses and less severe level of suffering were noted on the scale of Mini Suffering State Examination. Both direct and total costs of hospital and hospice care were similar (median 250.15 vs. 283.78 and 371.08 vs. 389.83 PLN respectively) but direct hospice staff costs were higher (283.41 vs. 197.67 PLN; p < 0.001).

The National Health Fund’s reimbursement in the hospice was insufficient, covering 53.9% (excluding indirect management cost) and 98.7% in the hospital.

In the hospital expensive diagnostic and therapeutic procedures do not translate into quality of life improvement, in the hospice multidisciplinary team and symptomatic management better correspond with terminal patients’ needs.