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Dartmouth Atlas: Poor Care for Terminal Cancer Patients Widespread

Cheryl Clark, for HealthLeaders Media, April 11, 2012

For example, while across all hospitals, 9.3% of cancer patients underwent a life-prolonging procedure (such as insertion of a feeding tube, use of a ventilator, or initiation of cardiopulmonary resuscitation) during the last month of life, 13.1% of patients at non-NCCN NCI cancer centers did so, 12.6% of patients at academic hospitals, 10.3% at NCCN centers, and 8.9% at community hospitals.

Chemotherapy at the end of life varied between types of hospitals as well, with 6.3% undergoing drug treatments at community hospitals, 6% at NCCN centers, 5.4% at non-NCCN NCI hospitals and 5.3% at academic hospitals.

Said another way, Morden explains, comparing the patients treated at NCCN hospitals, patients at community hospitals were 36% more likely to receive chemotherapy during the last 14 days of life.

Community vs. Academic Hospitals
"I don't know exactly what drives community hospitals to be much more likely to give patients end-of-life chemotherapy at literally, within two weeks of death. But the reimbursement structures are different at academic centers versus community hospitals, and at academic centers, the physicians tend to be salaried so these incentives may be blunted."

While overall, 24.7% of all dying cancer patients spent time in the intensive care unit during the last month of life, there was not that much difference in ICU utilization between the hospital groups. For example, 26% of academic hospitals, 26.3% of non-NCCN NCI centers, 23.3% of NCCN cancer centers and 24.6% of community hospitals put dying patients in the ICU.

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