Cancer patients use more aggressive care and more hospice at end of life

PSA Rising /New York/ January 15 2004 -- In the 1990s more cancer patients received aggressive therapy and emergency care in the last few weeks of life. But an even bigger rise occurred in the percentage of cancer patients who turned to hospice.

"Interestingly, the findings suggest that the availability of hospice services and related medical resources may reduce the chance that a patient will receive aggressive treatment at the end-of life," says Craig Earle, MD, of Dana-Farber. "Increasing the availability of hospice may improve the quality of care for many terminally ill patients," Earle said.

Earle and colleagues at Dana-Farber Cancer Institute looked back at end of life care for cancer patients in the mid 1990s when more chemotherapies such a taxol came into use and also the hospice movement was expanding.

Researchers reviewed the records of 28,777 Medicare-eligible patients aged 65 and older who died within one year of being diagnosed with lung, breast, colorectal, and other gastrointestinal tumors between 1993 and 1996. They found that at that time, use of chemotherapy among these older, late-diagnosedpatients increased from 27.9 percent to 29.5 percent. The proportion receiving chemotherapy within two weeks of dying grew from 13.8 percent to 18.5 percent.

"Our research has shown that the treatment of cancer patients near death is becoming increasingly aggressive and that more patients are being admitted to emergency rooms and to intensive care units during their last few weeks of life," Earle said.

The researchers also observed an increase in the number of these patients who, during their last month of life, were seen in the emergency room (7.2 percent in 1993 to 9.2 percent in 1996) or admitted to an intensive care unit (7.1 percent to 9.4 percent).

However, they also found that fewer patients were dying in acute-care hospitals (29.5 percent, down from 32.9 percent).

And the use of hospice grew more dramatically than any other measured factor - 38.8 percent, up from 29.3 percent.

The study was published in the Jan. 15 issue of the Journal of Clinical Oncology.

The study's other authors are Bridget A. Neville, MPH, Susan D. Block, MD, and Jane C. Weeks, MD, Dana-Farber, Mary Beth Landrum, PhD, Harvard Medical School, and John Z. Ayanian, MD, MPP, Harvard Medical School and Brigham and Women's Hospital.

The research was funded in part by the National Cancer Institute.

Dana-Farber Cancer Institute (www.dana-farber.org) is a principal teaching affiliate of the Harvard Medical School and is among the leading cancer research and care centers in the United States. It is a founding member of the Dana-Farber/Harvard Cancer Center (DF/HCC), a designated comprehensive cancer center by the National Cancer Institute.

This page made and last edited by J.Strax, Jan 15, 2004.