The Dartmouth Atlas released a new report describing how end-of-life cancer care is changing over time. Their analysis uses data from a 20 percent sample of all Medicare beneficiaries who died between the ages of 66 and 99 years during 2010, who had cancer diagnosis with a poor prognosis. The authors find that:
Deaths in hospitals
Between 2003-2007 and 2010, the percentage of Medicare patients with advanced cancer dying in hospitals and the average number of days they spent in the hospital before their deaths declined across most regions, medical centers, and cancer centers. In 2003-2007, 28.8 percent of patients with cancer died in a hospital; by 2010, the rate had dropped to 24.7 percent.
ICU at end of life
Medicare patients with cancer were significantly more likely to spend time in the ICU, as the percentage of patients admitted to the ICU during the last month of life increased…from 23.7 percent from 2003-2007 to 28.8 percent in 2010. In addition, the average number of days spent in the ICU during the last month of life increased from 1.3 days to 1.6 days.
Hospice Care at the end of life
Medicare patients with advanced cancer were more likely to receive hospice care in 2010, as 61.3 percent of patients were admitted into hospice care during the last month of life, compared to 54.6 percent in 2003-2007. The percentage of patients admitted to hospice care during the last three days of life increased from 8.3 percent in 2003-2007 to 10.9 percent in 2010.
Healthcare Economist’s Take
This analysis, while interesting, is likely of little value to policymakers. Consider the case where a new, cost-effective treatment (e.g., surgery, intravenous drug therapy) extends survival for 6 months. Is this a good idea? Of course. If hospitals decide to implement the treatment, however, some individuals will eventually die after the treatment.
The Dartmouth statistics would indicate that end-of-life care became more intensive, since among the people who died, most of them will have the new treatment. What the Dartmouth statistics do not capture is whether the treatments/hospitalizations extend patient’s life at reasonable cost and are in-line with patient preferences.
- David C. Goodman, MD, MS Nancy E. Morden, MD, MPH Chiang-Hua Chang, PhD Elliott S. Fisher, MD, MPH John E. Wennberg, MD, MPH. Trends in Cancer Care Near the End of Life. A Dartmouth Atlas Brief.