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End-of-Life Care for Patients With Advanced Ovarian Cancer Is Aggressive Despite Hospice Intervention: A Population-Based Study
  1. Jui-Kun Chiang, MD, MSc*,
  2. Chun-Shuo Hsu, MD,,
  3. Chih-Wen Lin, MD, MBA,§ and
  4. Yee-Hsin Kao, MD
  1. *Departments of Family Medicine and
  2. Departments of Obstetrics and Gynecology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi;
  3. Departments of School of Medicine, Tzu Chi University, Hualien;
  4. §Department of Medical Imaging, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi; and
  5. Department of Family Medicine, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan, Taiwan.
  1. Address correspondence and reprint requests to Yee-Hsin Kao, MD, Tainan Municipal Hospital, 670 Chung Te Rd, Tainan, 70173 Taiwan. E-mail:


Objective To date, few studies have examined end-of-life (EOL) care and healthcare costs for patients with ovarian cancer. We evaluated the effects of hospice care on the quality of EOL care and healthcare costs for patients with ovarian cancer in the final month of life.

Materials and Methods We conducted a population-based study and analyzed data from Taiwan's Longitudinal Health Insurance Database, which contains claims information for medical records of patients, healthcare costs, and insurance system exit dates: our proxy for death between 1997 and 2011.

Results A total of 176 women who died of ovarian cancer were investigated. Of these patients, 32 (18.2%) had received hospice care. Univariate analysis revealed that the patients with hospice care (H group) had lower proportions of intensive care unit admission (0% vs 15.3%) and cardiopulmonary resuscitation (0% vs 18.1%). The mean health care cost per person during the final month of life for H group was approximately 5.5% significantly higher than patients without hospice care (non-H group) (US $3121 ± $376 vs $2957 ± $347). The effects of hospice care on intensive care unit admission, receipt of cardiopulmonary resuscitation, and more than 1 emergency room visit could not be assessed because no cases of these 3 occurrences were observed among the H group by the multivariate regression model. No significant difference was observed between the H and non-H groups in terms of chemotherapy during the final 2 weeks of life. The H group had higher probabilities for more than 1 hospitalization and death in acute hospitals after adjusting for confounders.

Conclusions The aggressiveness of EOL cancer care and healthcare costs could not be offset in the final month of life among women with advanced ovarian cancer who received hospice care. The factors of more hospitalizations and dying in hospital warrant further investigation.

  • end-of-life care
  • hospice care
  • ovarian cancer

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  • J.K.C. received research grants from Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation (DTCRD 103(2)-E-03 and 105(2)-E-22).

  • The authors declare no conflicts of interest.

  • This study was based in part on data from the NHIRD provided by the Bureau of NHI, Department of Health, and managed by the National Health Research Institutes. The interpretation and conclusions contained herein do not represent those of the Bureau of NHI, Department of Health, or National Health Research Institutes.

  • J.K.C., C.W.L., and Y.H.K. designed, conducted, and drafted the article. J.K.C. and C.S.H. analyzed the data. All authors contributed to the article, revised drafts critically for important intellectual content, and read and approved the final manuscript.

  • This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.