OBJECTIVES: Hospice has historically been underutilized for end-of-life care in hematological malignancies. We aimed to identify hospice enrollment patterns among patients with diffuse large B-cell lymphoma (DLBC) and compare end-of-life cost of care with non-hospice patients. METHODS: Using the SEER-Medicare database from 2002-2012, we identified predictors of hospice enrollment within the last 30 days of life for DLBCL patients >65 years. We evaluated adjusted and unadjusted costs among hospice and non-hospice users. RESULTS: We identified 12,644 DLBCL patients. Hospice users were older than non-users (mean 80 vs. 78 years, p<0.001), more often white (p=0.02), less often married (45.1 vs. 53.7, p<0.001), more often female (p<0.001), and more often had advanced stage disease (p=0.004). There were no significant differences in enrollment by urbanicity, poverty level, hospital type, and Charlson comorbidity index (CCI). Non-hospice patients received more transfusions (p<0.001) and chemotherapy (p<0.001) in the last 30 days of life. During the last month of life, costs continually increased for non-hospice users from $2,063 for days 26-30 prior to death to $3,068 for days 0-5 (p<0.001). Hospice users’ costs decreased from $1,752 to $1,326 (p=0.002). Our results were consistent after adjusting for age, CCI, disease stage, race, marital status, urbanicity, and census poverty level (non-hospice: $2,041 days 26-30 vs. $3,109 days 0-5, p<0.001; hospice: $1,800 days vs. $1,348, p=0.001). For non-hospice patients, inpatient admissions drove costs ($2,289). Our propensity score weighted models provided similar results. CONCLUSIONS: We found age, race, marital status, and sex were associated with hospice use among older DLBCL patients. Those who received transfusions or chemotherapy in the last 30 days of life were less likely to enroll in hospice. Total health care costs were higher in non-hospice patients, primarily driven by inpatient admissions. Earlier hospice intervention may reduce costs of care in the last 30 days of life.