End of Life Care and Cancer
The Dartmouth Atlas Project released a new report with some surprising (and some not so surprising) findings related to Medicare cancer patients and end-of-life treatment.
The authors say, “Our research continues to find that patients with advanced cancer are often receiving aggressive care until their final days, when we know that most patients would prefer care directed toward a better quality of life.”
Here’s a summary of the report:
- While cancer patient referrals to hospice are up from previous years, many are being admitted too late to be of much help to the patient. A large number of Medicare patients with advanced cancer do not receive hospice care until they are within three (3) days of death.
- Even though there was an increase in hospice care for advanced cancer patients in 2010, more patients still received treatment in an ICU in the last month of their life when compared with the same period of time from 2003 to 2007.
- The rate of advanced cancer patients dying in a hospital declined across most regions of the country in 2010. It fell from 28.8% in 2003 -2007 to 24.7% in 2010. The highest rates of hospital deaths for advanced cancer patients in 2010 occurred in Manhattan, New York, Elmira, New York, McAllen, Texas and Meridian, Mississippi. Those regions with the lowest rates of cancer patients dying in a hospital were Mason City, Iowa, Bradenton, Florida, Greeley, Colorado, and Sarasota, Florida.
- The percentage of Medicare patients with cancer who were likely to be admitted to an Intensive Care Unit in the final month of life increased by a startling 22%. It climbed from 23.7% in 2003-2007 to 28.8% in 2010.
- The average number of days spent in an ICU in the last month of life also increased. It climbed from 1.3 days for 2003-2007 to 1.6 days in 2010.
- Area of the country again played a factor in care as it relates to admissions in to an ICU. In 2010, more than half of the advanced cancer Medicare patients who lived in McAllen, Texas and Miami, Florida spent time in an ICU during their last month of life. Those living in Bismarck, North Dakota, Mason City, Iowa, and Appleton, Wisconsin had the lowest rates.
- Overall, Medicare patients with advanced cancer were more likely to be referred to hospice in 2010 than in 2003-2007. But the percentage of patients admitted to hospice during their last three days of life continued to climb going from 8.3% in 2003-2007 to 10.9% in 2010.
- Patients in Bend River, Oregon, Sun City, Arizona, and Cedar Rapids, Iowa were more likely to receive hospice care. Those living with advanced cancer in the Bronx, New York, Anchorage, Alaska, and Manhattan, New York were significantly less likely to receive hospice. Differences ranged from a high of 82.2% of patients dying with hospice in Bend, Oregon to a low of 26.7% in the Bronx.
So when it comes to end of life care, make sure you understand what your options are and be certain your loved ones know your preferences. Hospice is a way of improving quality of life at a time every minute is precious.