End-of-life care for Medicare beneficiaries with cancer is highly intensive overall and varies widely

Abstract

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.

Exhibit 5. Percentage Of Patients Dying In The Hospital, By Hospital Type

SOURCE Authors’ analysis of Medicare data. NOTES Each circle represents one hospital and its rate of in-hospital death among Medicare beneficiaries dying with poor-prognosis cancer. NCCN is National Comprehensive Cancer Network. Non-NCCN NCI is National Cancer Institute centers, excluding those in the NCCN. Academic hospital is defined according to Note 22 in text. Community hospitals are those not in any of the other hospital categories. Adjusted for patients’ age, sex, race, estimated 2006 median household income of ZIP code, chronic comorbidity count category (0, 1, and more than 1), and cancer category (lung, unspecified, hematologic, and other). Plots of other care measures are presented in Appendix Exhibit 5S (see Note 31 in text).