THE CARE SPAN: End-Of-Life Care For Medicare Beneficiaries With Cancer Is Highly Intensive Overall And Varies Widely

• Published in: Health affairs (Millwood, Va.) Va.), 2012-04, Vol.31 (4), p.786
• Main Authors: Morden, Nancy E, Chang, Chiang-Hua, Jacobson, Joseph O, Berke, Ethan M, Bynum, Julie PW, Murray, Kimberly M, Goodman, David C
• Format: Article
• Language: English
• Subjects: Beneficiaries; Best practice; Cancer; Chemotherapy; Codes; Death & dying; Disease; Hospice care; Hospitals; Intensive care; Medical prognosis; Medicare; Palliative care; Patients; Prostate cancer; Quality improvement; Studies
• ISSN: 0278-2715; 1544-5208
• DOI: 10.1377/hlthaff.2011.0650

Studies have shown that cancer care near the end of life is more aggressive than many patients prefer. Using a cohort of deceased Medicare beneficiaries with poor-prognosis cancer, meaning that they were likely to die within a year, we examined the association between hospital characteristics and eleven end-of-life care measures, such as hospice use and hospitalization. Our study revealed a relatively high intensity of care in the last weeks of life. At the same time, there was more than a twofold variation within hospital groups with common features, such as cancer center designation and for-profit status. We found that these hospital characteristics explained little of the observed variation in intensity of end-of-life cancer care and that none reliably predicted a specific pattern of care. These findings raise questions about what factors may be contributing to this variation. They also suggest that best practices in end-of-life cancer care can be found in many settings and that efforts to improve the quality of end-of-life care should include every hospital category. [PUBLICATION ABSTRACT]