Hospice.

How popular is it? Pretty popular among the National Quality Forum who cries “aggressive care” if cancer patients receive hospice services less than 3 days prior to death. Less popular among the nearly one-third of older patients with malignant primary or metastatic brain tumors who fail to meet this metric. Interestingly, rates of chemo and/or radiation use were less than half that of hospitalizations in the final month of life. This indicates these patients are requiring inpatient, emergency department, and intensive care unit settings to manage end-of-life symptoms even after discontinuing all cancer-directed therapies. It remains unclear if this delivery of care is desired by the current era of patients in their final days. What’s more clear: if we choose to continue this trend, we better budget for it.