Dr. David C. Goodman, director of the Dartmouth University Center for Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice who was the lead study author, and colleagues examined the records of 235,821 Medicare patients age 65 or older with aggressive or metastatic cancer who died from 2003 to 2007. They found where a person lives predicts where they will die.
For example, more than 40 percent of cancer patients were admitted to hospital intensive care during their last month of life in Huntsville, Ala., while 6 percent were admitted in Mason City, Iowa.
At least 50 academic medical centers, fewer than half of these cancer patients received hospice services, and in some hospitals referral to hospice care occurred so close to death it was unlikely to have provided much assistance.
Almost one-third of Medicare cancer patients spend their final days in hospitals and intensive care units, with many doctors aggressively treating their patients with curative attempts they may not want instead of improving the quality of their life in their last weeks or months.
"The well-documented failure in counseling patients about their prognosis and the full range of care options, including early palliative care, leads many patients to acquiesce to more aggressive care without fully understanding its impact on the length and quality of life," Goodman said in a statement.