New Dartmouth Report Shows End-of-Life Cancer Care Varies Across the Nation


Whether Medicare patients with advanced cancer will die while receiving hospice care or in the hospital varies markedly depending on where they live and receive care, according to the Dartmouth Atlas Project’s first-ever report on cancer care at the end of life. The researchers found no consistent pattern of care or evidence that treatment patterns follow patient preferences, even among the nation’s leading academic medical centers.

Rather, with one in three Medicare cancer patients spending their last days in hospitals and intensive care units, the report’s findings demonstrate that many clinical teams aggressively treat patients with curative attempts they may not want, at the expense of improving the quality of their life in their last weeks and months.

The researchers examined the records of 235,821 Medicare patients age 65 or older with aggressive or metastatic cancer who died between 2003 and 2007. In at least 50 academic medical centers, fewer than half of these patients received hospice services. In some hospitals, referral to hospice care occurred so close to the day of death that it was unlikely to have provided much assistance and comfort to patients.

“The well-documented failure in counseling patients about their prognosis and the full range of care options, including early palliative care, leads many patients to acquiesce to more aggressive care without fully understanding its impact on the length and quality of life,” said David C. Goodman, MD, MS, lead author and co-principal investigator for the Dartmouth Atlas Project and director of the Center for Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice.

Read the full story at DMS News.

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