A B S T R A C T PurposeTo determine which hospice patients with cancer prefer to die at home and to define factors associated with an increased likelihood of dying at home. MethodsAn electronic health record-based retrospective cohort study was conducted in three hospice programs in Florida, Pennsylvania, and Wisconsin. Main measures included preferred versus actual site of death. ResultsOf 7,391 patients, preferences regarding place of death were determined at admission for 5,837 (79%). After adjusting for other characteristics, patients who preferred to die at home were more likely to die at home (adjusted proportions, 56.5% v 37.0%; odds ratio [OR], 2.21; 95% CI, 1.77 to 2.76). Among those patients (n ϭ 3,152) who preferred to die at home, in a multivariable logistic regression model, patients were more likely to die at home if they had at least one visit per day in the first 4 days of hospice care (adjusted proportions, 61% v 54%; OR, 1.23; 95% CI, 1.07 to 1.41), if they were married (63% v 54%; OR, 1.35; 95% CI, 1.10 to 1.44), and if they had an advance directive (65% v 50%; OR, 2.11; 95% CI, 1.54 to 2.65). Patients with moderate or severe pain were less likely to die at home (OR, 0.56; 95% CI, 0.45 to 0.64), as were patients with better functional status (higher Palliative Performance Scale score: Ͻ 40, 64.8%; 40 to 70, 50.2%; OR, 0.79; 95% CI, 0.67 to 0.93; Ͼ 70, 40.5%; OR, 0.53; 95% CI, 0.35 to 0.82). ConclusionIncreased hospice visit frequency may increase the likelihood of patients being able to die in the setting of their choice.

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e17591 Background: Recent research has identified a discrepancy between NIH funding in oncology and various measures of disease burden by tumor type. We sought to identify whether this disparity exists in recent high impact publications. Methods: 833 clinical trials published in five high impact general medicine and clinical oncology journals between January, 2009 and October, 2012 were reviewed. 692 trials were included in this analysis after excluding those that studied >1 tumor type. Disease burden was measured as person-years of life lost (YLLs), reported in the Surveillance, Epidemiology, and End Results database, and disability adjusted life years (DALYs), reported by the World Health Organization. We used a chi square goodness of fit test to compare the overall distribution of trials by tumor type to the distribution of annual YLLs and DALYs. Results: Breast cancer was the most published tumor, accounting for 14% of all trials, followed by lung (13%) and colorectal (7%) cancers. More than half of the trials (56%) were for patients with metastatic disease, and most (81%) were phase 2 and 3 clinical trials. Nearly half of all publications studied targeted therapies (45%), and the majority received industry support (61%). 67% of trials with a comparator arm met their primary endpoint. The distribution of trials by cancer site differed significantly from the distribution of both measures of disease burden (YLLs and DALYs) (both p<0.001). The findings were unchanged in analyses that accounted for the total number of subjects enrolled in the trials (both p<0.001). The most underrepresented malignancies based on burden of disease were lung and pancreatic cancers, while the most overrepresented were breast cancer, leukemia, and melanoma. Conclusions: The number of trials published by tumor type does not directly reflect the burden of these diseases in the population as assessed by YLL or DALY. Future studies examining potential confounders such as funding availability by cancer type or number of unpublished clinical trials may further clarify the observed disparities.