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Study: Location determines quality of care for Medicare patients with advanced cancer
November 16th, 2010
05:12 PM ET

Study: Location determines quality of care for Medicare patients with advanced cancer

End of life care for Medicare patients with advanced cancer varies by hospital and state, according to a report by the Dartmouth Atlas Project.  Researchers found the care patients receive has less to do with what patients want and more to do with where they live and the hospitals where they receive care.

"Geography is destiny," says lead study author Dr. David Goodman.  The report looked at the records of 235,821 Medicare patients who were 65 or older. Each had aggressive or metastatic cancer and passed away between 2003 and 2007. 

Researchers found patients were given aggressive treatment  for their disease at end of life but were under-treated when it came to their quality of life such as pain medication and invasive procedures. In addition, they found about 29 percent of patients with advanced cancer died in a hospital setting versus being at home with hospice care. "On average as much as 80 percent of patients who are thinking about the end of life or close to the end of life strongly want to be in more homelike settings," says Goodman.

So why don't physicians send their patients home?

Two things are happening, says Goodman. First, he says physicians have a hard time accepting the reality that they can't cure all patients and fear they are taking away a patient's hope by sending them home. Secondly, Goodman says physicians often make assumptions about their patient's wishes when it comes to where they want to be when they die.

Researchers found one in three Medicare patients with advanced cancer spent their last day in the hospital continuing aggressive treatment. What was lacking researchers say was physicians focus on trying to improve a patients quality of life for the remainder of their time.

"Helping individuals live their final days in comfort and dignity is one of the most valuable and important responsibilities of our profession," Dr. George W. Sledge, Jr., President of the American Society of Clinical Oncology told CNN in a statement.  He adds, "It is critical that we increase medical training in end-of-life patient communication and planning, and that Medicare and other insurers cover the costs of these essential conversations."

Goodman says these conversations need to start earlier in the course of care despite a patient's prognosis. "The burden is much more on the side of the healthcare systems in opening up these conversations, opening up to patients however much they want to talk about it. The conversations will change as patients do well or don't."  He also suggests hospitals provide a guide to patients and families to help them understand the style of care a specific hospital provides.

The Dartmouth Atlas Project is run by the Dartmouth Institute for Health Policy and Clinical Practice and is primarily funded by the Robert Wood Johnson Foundation.


soundoff (10 Responses)
  1. Studdmuffins

    News flash: Healthy people die every single day. Hospitals are not miracle centers. Sick people die. People want so much to believe that going to a hospital offers some sort of get out of atherosclerosis free card - it doesn't. We want magic pills for what ails us then want to sue the pharmaceutical companies when things go wrong. New flash #2: Every single drug has a side effect, some are worse than others and many are worse than the ailment being cured or mitigated. Eat fewer calories, slow the drinking, stop smoking, get off the couch once a day for a couple hours - live healthier. Guess what? You're still going to croak at some point no matter whether you have health care or not.

    November 16, 2010 at 17:52 | Report abuse | Reply
    • StuddMuffins is DUMB

      You are an idiot. Their JOB is to take care of us when we are sick. It is an OATH they take. If you are a heartless troll that does not want to touch icky patients, or comfort them, or administer any other care for them, then DONT WORK IN A HOSPITAL. You sound like one of those people. I hope one day you end up in a one of these hateful hospitals that I PERSONALLY have seen and left to bleed on the floor.

      November 17, 2010 at 15:09 | Report abuse |
  2. GlialBlastomaPatient

    What an empowering article....It is very thought-provoking...I hope the last 3 days of my life I don't i inconvenience any one and have the decency to die at home...I will keep my blood from clotting, my heart from missing a beat, pump out the pulmonary edema,control my seizures and have the pleasure of gasping my last breath at home....Thanks for the health tip CNN!!!

    November 16, 2010 at 18:00 | Report abuse | Reply
  3. Mysterion

    I have been shot, impaled, attacked by a spooky fish , squashed by gnomes and I keep coming back....I CAN'T DIE!!!!!!

    November 16, 2010 at 18:09 | Report abuse | Reply
    • Mint-Berry Crunch

      I don't remember that!

      November 16, 2010 at 18:14 | Report abuse |
  4. Mickey Mouse

    nobody dies at disneyworld!

    November 16, 2010 at 19:32 | Report abuse | Reply
  5. san

    I do wish CNN "journalists" would proofread before publishing. This article is fraught with errors in grammar and punctuation.

    November 16, 2010 at 23:15 | Report abuse | Reply
    • CnnReally?

      I agree! But then I would have to find a new comedy blog....Most of the articles are ridiculous but the comments make me laugh!
      Keep up the true journalism CNN!!!!
      Bernard Shaw was right!!!!!
      oh oh I am going to get deleted again!

      November 17, 2010 at 11:02 | Report abuse |
  6. Jim

    I know that the poor and downtrodden get treated like moldy feces in these hospitals. They are left to die alone. Its the greatest tragedy.

    November 17, 2010 at 15:06 | Report abuse | Reply
  7. Lillian "Susan" Ruano

    I was disappointed that the writer of the article never addressed the specific subject regarding which states, and/or which hospitals offer the best end of life care for Medicare patients with advanced cancer. After all, the lead stury author stated that "Geography is Destiny". So, what are the best states to be in if you have advanced cancer, and which are the best hospitals to go to? Presumably you would be advisedaggressive cancer therapy would yeild only pain and greater debilithy, and that palliative treatment in the home setting, with loved ones and the help of hiospice services would be the most logical, sensible and humane way to spend ones last days. But we're still never told, in this Dartmuth Study. in what state &/or hospital this senario would most llikely play out. I'm very frustrated because the most important information in the study has been omitted!!

    November 19, 2010 at 02:26 | Report abuse | Reply

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