Hospice referral patterns in India during COVID-19: A retrospective study on advanced cancer patients

Despite, its benefits, palliative care, especially in oncology, remains underutilized globally. The COVID-19 pandemic posed several challenges that may have further exacerbated the timing of referrals and access to care. This descriptive study examines hospice referral patterns and patient characteristics among advanced cancer patients admitted to an inpatient hospice center in urban India during the COVID-19 pandemic, including demographics, commonly reported cancer types, referral sources, and the timing from referral and admission to death. A retrospective study was conducted using admission records from January to April 2021 (second wave), September to December 2021 (intermediate period), and January to April 2022 (third wave) of the pandemic. Descriptive and quantitative analyses were performed to analyze patient characteristics and the timing of admission and referral to death. The study included 740 new admissions of advanced cancer patients to the hospice across the three pandemic periods. Carcinoma breast was the most common cancer type referred to the hospice with doctors being the primary referral source. The median time from admission to death remained consistent across the three waves, and was less than 30 days. This suggests late transition to inpatient hospice care in the final weeks of life. No significant differences were observed in referral timing by age group or socioeconomic status. Advanced cancer patients in our study sample were consistently referred late to hospice care, irrespective of age or socioeconomic status. This highlights the urgent need for improved and timely referral systems, especially given that advanced cancer patients comprise the majority of cancer patients in India. Addressing gaps in access to care and awareness of the benefits offered by end-of-life care, particularly for younger patients and men, is crucial for ensuring equitable and cost-efficient palliative care delivery.