Report Finds Disparities Across U.S. for Cancer Care at End of Life
Dartmouth researchers reviewed the records of 235,821 elderly Medicare beneficiaries who died from advanced cancer between 2003 and 2007, finding that 29% of these patients died in the hospital, on average.
The researchers also identified a wide range in regional practice, noting that about 47% of patients in Manhattan died in the hospital, compared with 7% of patients in Mason City, Iowa.
The care delivered near end of life also varied based on location. About 18% of patients in Manhattan received CPR or were placed on a feeding tube in the last two weeks of life, compared with 4% of patients in Minneapolis.
Meanwhile, fewer than half of patients with poor prognosis across 50 academic medical centers received hospice care, and in some cases, patients did not receive the care until they had nearly expired.
Patients also received advanced life support interventions and cancer treatments that offered little or no benefit, according to the study (Stein, Washington Post, 11/16).
According to David Goodman -- the study's lead author and director of the Dartmouth Center for Health Policy Research -- some hospitals find a middle ground between aggressive treatment and palliative care, Bloomberg reports.
For example, the study found that at Baltimore-based Johns Hopkins Hospital, 19% of cancer patients were admitted to the intensive care unit in the last month of life while 59% were placed in hospice care. As a result, 24% died in the hospital, a result of having "conversations with patients early enough in the process to give them to opportunity to die at home or in a hospice," Goodman said (Wechsler, Bloomberg, 11/16).
Goodman suggests that the range in practice is linked to variations among physicians and hospitals.
Goodman said, "The care that patients receive has less to do with what they want and more to do with the hospitals they happen to seek care from," adding, "Geography is destiny" (Washington Post, 11/16).
Goodman also said that the study indicates many patients are not receiving adequate palliative and hospice care, adding that he hopes the report might spark meaningful dialogue about end-of-life care. However, it could also reignite a concern about health care rationing, the Los Angeles Times reports.
Stephen Zuckerman -- a health economist at the Urban Institute -- said, "Having payment for end-of-life conversations was exactly what led people to start screaming about death panels."
According to Susan Negreen, the executive director of the California Hospice and Palliative Care Association, the report highlights a need for hospice awareness (Hennessy-Fiske, Los Angeles Times, 11/17).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.