Study shows end-of-life care varies widely

A new study released by the Dartmouth Atlas of Health Care finds that "America's hospitals treat patients with life-ending cancers very differently in their final months, with some deploying chemotherapy and other life-prolonging efforts until the end and others directing most of their patients into hospice," reports Kaiser Health News. The aggressive care may not be best for patients, and hospice may be a "more humane way to die," the report argues. A point the report doesn't address: that aggressive treatment "also adds to the drain on Medicare's pocketbook."

"Dartmouth argues that if more patients understood their choices about dying, more would choose hospice," but some "hospitals argue that they provide more aggressive treatments to prolong life" (Rau, 11/16).

WebMD: "Cancer patients were more likely to receive aggressive treatment in the last weeks of life in Manhattan; Los Angeles, Orange County, Calif., and Chicago. By contrast, rates were much lower in Minneapolis, Des Moines, Iowa, and Seattle. Fewer than half of patients in 50 academic medical centers received hospice services" (Mann, 11/16).

The Los Angeles Times: Los Angeles County "had the highest percentage of advanced cancer patients dying in hospitals" of any county in California, with 41 percent mortality. Previous reports from Dartmouth have generated "few policy changes" on Capitol Hill. "The latest report has the potential to spark meaningful conversations about end-of-life care, but it could also fuel concern about rationing healthcare if lawmakers use it to propose Medicare cuts or incentives for doctors to discuss less expensive — and less aggressive — treatment with terminal patients" (Hennessy-Fiske, 11/17).

The Washington Post: On the spectrum of hospital death rates published in the study, "Washington fell in the middle, with about a third" of terminally-ill Medicare patients dying in the hospital. "While chemotherapy and other aggressive procedures can prolong life and enable some cancer patients to return home and to work, studies have shown that these treatments have little or no value for frail elderly patients and those with advanced cancer. But 6 percent of patients received chemotherapy in their last two weeks of life, and the rate was much higher -- more than 10 percent -- in some places, the researchers found" (Stein, 11/16).

The Seattle Times: "Cancer patients in their last month of life in Seattle were much less likely than patients in many other areas to receive CPR or get breathing tubes or feeding tubes — procedures considered 'aggressive life-sustaining treatment' in the study." One explanation for the variation in care revealed by the study was "the number of hospital beds available in a community," because "the system tends to fill them," the lead author said. "Another reason why hospitals focus on aggressive care, he said, is that doctors and nurses are uncomfortable with an end-of-life discussion, and in general don't talk with patients about their wishes early enough" (Ostrom, 11/16).

The Wall Street Journal: "The report comes at a time when policy makers, doctors and researchers are discussing end-of-life care, which is extremely expensive." The American Society of Clinical Oncology "is developing guidelines to help doctors talk with patients earlier in the treatment process about palliative care, which can be used alongside conventional treatments but focuses on reducing pain and symptoms." The study's high profile is in part "driven by research like a 2010 study published in the New England Journal of Medicine, which found that newly diagnosed patients with advanced lung cancer who got chemotherapy and palliative care lived longer and had a higher quality of life than patients who got only chemotherapy" (Dockser Marcus, 11/16).

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This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.