The type of care cancer patients receive often has more to do with what hospital they happen to be treated at than their own wishes, according to a new study by researchers at Dartmouth.
About 80 percent of patients who are receiving end-of-life cancer care say they'd prefer to be at home, in familiar settings and close to family, for their last days, Dartmouth says. But the new study of Medicare data found that about 29 percent of cancer patients who died during the period from 2003 to 2007 did so in a hospital, with wide regional variations.
"What we found is that the care for patients varies markedly from region to region and from hospital to hospital," researcher David Goodman said in a conference call with reporters. "The care patients receive has less to do with what they want than with the hospital" they happen to be treated at.
Cancer patients were most likely to die away from home in the Manhattan hospital referral region, where 46.7 percent died in a hospital, according to Dartmouth. That rate is about six times higher than the rate in the Mason City, Iowa, region, where only 7 percent of cancer patients died in the hospital.
Dartmouth also reported wide variations in the use of intensive care in the last days of life, when it does little but add to patients' pain and discomfort.
The new study comes in the wake of two Institute of Medicine studies that documented overly aggressive and invasive treatments in many U.S. hospitals and an under-investment in care that would improve patients' quality of life, such as pain management.
Goodman said there were two main reasons for the disparities.
The first has to do with a variation in investment in hospital beds and Intensive Care Units, which leads to physicians using those resources to their limit rather than relying on palliative care.
Physicians also often have wrong assumptions about what patients and their families want, Goodman said.
"That attitude has caused a lot of harm," he said, because "what it doesn't recognize is that patients hope for a lot of different things.
"What patients really want is for physicians to be honest with them," he said. "Patients want to live long but they also want to live well."