The Dartmouth Atlas has released a report on the wide variation in cancer care at the end of life for Medicare patients. Lots of variation in ICU care and hospitalization -- in some regions, more than a third of the patients with severe, advanced cancer spent their final days in the hospital, some with ventilators, feeding tubes or other intensive life support. The following Dartmouth Atlas graph, for example, shows the percent of cancer patients who died in a hospital across the United States between 2003 and 2007 -- averaging about 29 percent. That's not how the vast majority of Americans say they want to die -- most of those with serious illness say they would prefer to be at home with their families.
Overall, about six percent of the Medicare patients with very advanced cancer got chemotherapy in the last two weeks of life -- but in some areas it was more than 10 percent.
About half overall got hospice, but often just for a few days at the very end, too late to fully benefit from the full range of medical and psychosocial supports that hospice can offer. We'll have more to say (I'm working on a longer article on this and I'll cross post) but here's the bottom line from the report's introduction:
Even among the nation’s leading medical centers, there is no consistent pattern of care or evidence that treatment patterns follow patient preferences. Rather, the report demonstrates that many hospitals and physicians aggressively treat patients with curative attempts they may not want, at the expense of improving the quality of their last weeks and months.
As David Goodman, M.D., M.S., 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, told reporters Tuesday morning on a conference call, "The bottom line is the care patients receive is less to do with what they want, and more [to do] with the hospital they happen to seek care from... The care that patients received largely reflects the health systems they happen to be cared for in."