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End-of-life-care for cancer patients varies by region, not patient values, study shows

Consumer Reports News: November 17, 2010 10:55 AM

Cancer patients nearing death often receive aggressive
treatment that can diminish their comfort.

How cancer patients spend their final days and weeks depends more on where they live and the hospital they go to than their preferences, or those of their caregivers. And decisions made by doctors and health-care facilities often emphasize quantity rather than quality of life for patients who have too little left of either. Those are some of the conclusions of an exhaustive study released this week by the Dartmouth Institute for Health Policy and Clinical Practice.

The researchers analyzed the records of 235,821 Medicare patients 65 and older with aggressive or metastatic cancer who died between 2003 and 2007. They found that cancer patients nearing death often receive inappropriate treatment that can diminish their comfort, separate them from their families, and ring up needless costs, even at the nation’s leading academic medical centers. Our previous analysis of Dartmouth data yielded similar findings on how people with serious illnesses such as heart failure are treated during the last two years of their lives.

While aggressive treatments such as chemotherapy and stays in intensive-care units can sometimes prolong the lives of cancer patients, the study notes that such care often has limited or no benefit for frail, elderly patients and those with advanced cancer. Yet doctors and hospitals often fail to inform patients of those limitations or to counsel them about their range of options, including early adoption of palliative care, says Dr. David Goodman, co-principal investigator for the Dartmouth Atlas Project. That failure, “leads many patients to acquiesce to more aggressive care without fully understanding its impact on the length and quality of life,” he says.

The study also found regional differences in care. For example, in New York City nearly half of cancer patients died in hospitals, while in Cincinnati and Ft. Lauderdale, Fla., less than 20 percent did. And more patients were hospitalized in the last month of their lives in areas around Detroit and in southern Texas, and fewer in San Angelo, in west Texas. Similarly, while chemotherapy was used in the last two weeks of life for about 6 percent of all cancer patients, the rate was more than twice as high in Olympia, Wash.

Our previous report found that more aggressive care doesn’t necessarily lead to better results. And this new study shows why it’s important to plan ahead for the day when you face end-of-life decisions. Make sure you let your friends and family know your wishes.  Designate a health-care proxy. Use a living will to inform doctors, insurers, and hospitals about the care you’d like to receive. Learn about hospice.

It’s your life. Live it on your own terms—even at the very end.

Eric Evarts

Read more about how to get better care near the end of life and see our Hospital Ratings, which are based on how aggressively or conservatively hospitals treat serious chronic medical conditions, how well they prevent serious infections after surgery, and other factors.

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