Conflating disease treatment with patient care against a backdrop of a fee-for-service reimbursement system is leading to more aggressive treatments for terminally ill oncology patients, research conducted for the Dartmouth Atlas Project suggests.
Cancer care for seniors at the end of life has become more aggressive—and less in line with patients' desires—than it was between 2003 and 2007, according to the latest edition of the Dartmouth Atlas Project [PDF].
There are, however, some encouraging signs, noted the project's David Goodman, MD, co-principal investigator, said during a news teleconference Wednesday.
Medicare beneficiaries with advanced cancer overall spent less time in the hospital and more received hospice care between 2010 and 200 –2007, the two periods studied. "But even as hospice care was increasing, most of the additional hospice days (in 2010) were in the final three days of life, a period when it's really too late to provide much benefit to the patient and family," he said.
Additionally, the average number of days these patients spent in the intensive care unit increased by 21% and 27% more patients received care from 10 or more physicians, between the two study periods, "generally considered a sign of fragmentation of care."
But the most important finding from the latest analysis, Goodman said, was the wide variation, or what he describes as the "striking differences in the pace and even the direction of change across hospitals."