Trends of hospice utilization in Korea before and after the COVID-19 pandemic in patients with cancer: an interrupted time series analysis using nationwide data

Purpose The coronavirus disease (COVID- 19) outbreak has impacted hospice care. This study investigated the impact of the pandemic on the rate and average length of hospice utilization in patients with end-stage cancer. Methods Data from the 2017 to 2022 National Hospice and Palliative Care registry and the cause-of-death statistics were used. The study population included patients with end-stage cancer who received hospice care. Outcome measures were the monthly utilization rate and length of hospice care. An interrupted time series analysis was performed to compare outcome measures before and after the pandemic, set at January 2020. The pre-intervention period was set from August 2017 to December 2019, and the post-intervention period was set from February 2020 to December 2022. Results The study population included 88,753 individuals. Total hospice utilization rate showed an increasing pre-intervention trend, at a rate of 0.2500 per month (p < 0.0001). The post-intervention trend decreased at a rate of - 0.2634 per month (p < 0.0001). However, the post-intervention slope did not show a significant trend. Total length of utilization showed a decreasing pre-intervention trend, at a rate of - 2.2160 days (p = 0.0001). The post-intervention trend decreased at a rate of - 0.0003 (p < 0.0001), and the post-intervention slope also decreased at a rate of - 0.0001 (p < 0.0001). Conclusion The pandemic has led to a general decrease in total hospice utilization and average length of utilization. Policies on end-of-life care should be strengthened to ensure adequate provision of hospice care.