Head and neck cancer mortality in the United States: Regional differences in hospice use and place of death

Melissa C White; Julia E Canick; Tariq M Omer; Justin M Barnes; William T Reed; Rebecca L Rohde; Dina K Abouelella; Eric Adjei Boakye; Katherine Ramos; Russel R Kahmke; Nosayaba Osazuwa-Peters

doi:10.1038/s44276-024-00101-6

Head and neck cancer mortality in the United States: Regional differences in hospice use and place of death

BJC Rep. 2024 Oct 8;2(1):79. doi: 10.1038/s44276-024-00101-6.

Authors

Melissa C White¹, Julia E Canick², Tariq M Omer¹, Justin M Barnes³, William T Reed⁴, Rebecca L Rohde⁵, Dina K Abouelella⁶, Eric Adjei Boakye^{7

8}, Katherine Ramos^{9

10

11

12

13}, Russel R Kahmke^{6

14}, Nosayaba Osazuwa-Peters^{15

16

17}

Affiliations

¹ Duke University School of Medicine, Durham, NC, USA.
² Department of Otolaryngology - Head and Neck Surgery, NYU Langone Medical Center, New York, NY, USA.
³ Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
⁴ Department of Otolaryngology, The University of Alabama at Birmingham, Birmingham, AL, USA.
⁵ Medical College of Wisconsin, Department of Otolaryngology & Communication Sciences, Milwaukee, WI, USA.
⁶ Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA.
⁷ Department of Otolaryngology - Head and Neck Surgery, Henry Ford Health System, Detroit, MI, USA.
⁸ Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA.
⁹ Durham Center of Innovation to Accelerate Discover and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA.
¹⁰ Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA.
¹¹ Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA.
¹² Department of Medicine Geriatrics, Duke University, Durham, NC, USA.
¹³ Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA.
¹⁴ Duke Cancer Institute, Durham, NC, USA.
¹⁵ Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA. [email protected].
¹⁶ Duke Cancer Institute, Durham, NC, USA. [email protected].
¹⁷ Duke University School of Medicine, Department of Population Health Sciences, Durham, NC, USA. [email protected].

Abstract

Background: With more than 15,000 annual deaths from head and neck cancer (HNC), an important aspect of end-of-life care for these patients is place of death. Recent evidence suggests an increasing preference for home/hospice at end of life; however, it is unclear whether there is variation in home/hospice use based on region or urban status. We described differences in the place of death of HNC patients based on their region and urban status.

Methods: Using the CDC WONDER (Wide-Ranging Online Data for Epidemiologic Research) database for HNC mortality (1999 to 2019), place of death was dichotomized as home/hospice vs. other, by Health and Human Services (HHS) region (Regions 1-10), and by urbanization status. Multivariable logistic regression analyses estimated odds of place of death being home/hospice, and being urban/metro, adjusting for both clinical and nonclinical variables.

Results: Over the study period, there were 260,630 deaths, 47.4% of which were at home or hospice. Compared to patients in New England/Region 1 (CT, ME, MA, NH, RI, and VT), HNC patients were more likely to die at home/hospice in the Pacific Northwest/Region 10 (AK, ID, OR, WA) (aOR (1.73; 95% CI: 1.64, 1.83) and less likely in the Eastern Section/Region 2 (NJ, NY, PR, VI) (aOR 0.93; 95% CI: 0.89, 0.97). Further, large central metro areas had significantly lower rates of dying at home/hospice than did all other settings.

Conclusion: Patients in moderately urban areas were reported to have the greatest use of hospice services and at-home death; patients in the HHS Region representing Alaska, Idaho, Oregon, and Washington were also found to have the highest rates of use. These differences in hospice care should be considered when clinicians counsel patients on their end-of-life options.