Dartmouth Atlas: Poor Care for Terminal Cancer Patients Widespread

Cheryl Clark, April 11, 2012

In a study that surprised its researchers, National Cancer Institute-designated hospitals as well as academic centers provided their dying oncology patients the same low level of palliative, comfort care or hospice services as community hospitals.

And overall, the amount of aggressive and futile care, such as chemotherapy in the last two weeks of life, was disturbingly higher than expected across all hospital types, and not according to established quality measures, with wide variation among hospitals within each type.


Those are some conclusions from the Dartmouth Atlas Project's, latest research in which investigators looked at cancer care provided to 215,000 Medicare beneficiaries with advanced metastatic disease at 4,400 facilities. The period examined was between 2003 to 2007.

Overall 30.2% of these terminal patients died in the hospital instead of at home or in a hospice facility, 65% were hospitalized at some point during their last month of life, and 24.7% were treated in the intensive care unit during the last month of life.

It would have been nice if the data had revealed some distinctions in care practice—for example, that a patient with a terminal diagnosis who wanted more aggressive care could seek a particular type of hospital, said Nancy Morden, MD, lead author of the paper published Monday in the journal, Health Affairs. But that was not what the study found.


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