How late-stage cancer patients are treated varies widely by region and hospital, according to a new Dartmouth Atlas Project report.
For the study, researchers analyzed records for 236,000 Medicare patients ages 65 and older who had late-stage cancer and died between 2003 and 2007. Among the findings, most Medicare patients who were treated at Westchester Medical Center in Valhalla, N.Y., (57 percent) died in the hospital. At Evanston (Ill.) Northwestern Healthcare, cancer patients fared better, with less than half that share (19 percent) dying in the hospital.
"The care that patients receive has less to do with what they want and more to do with the hospital they happen to seek care from," David Goodman, lead researcher, said during a briefing. "Geography is destiny."
Overall, one-third of patients passed their last days in hospitals and ICUs. But the share of cancer patients who died in a hospital was much higher in Manhattan (47 percent) than in Mason City, Iowa (7 percent).
Rates of aggressive life-sustaining treatment during the last month of life varied widely among hospitals. At New York Methodist Hospital, 27 percent of late-stage cancer patients received such treatment, compared with 7 percent at Massachusetts General Hospital.
The report does not speak to the cost implications of extreme attempts to prolong life that drain Medicare dollars from the federal coffers. What goes unsaid is that higher spending for late-stage care doesn't translate into better care.
Disparities in care may be due to some physicians favoring more aggressive approaches, while others are more open to suggesting hospice care. The latter is less expensive for Medicare, and has been called a more humane approach to dying because emphasis is placed on the quality of life remaining.