Advanced cancer patients less likely to die in the hospital, more likely to need end-of-life ICU care

March 18th, 2015

For two decades, the Dartmouth Atlas Project has used Medicare data to provide information and analysis about national, regional, and local markets, as well as hospitals and affiliated physicians, with the intention of helping people understand the health care system.

A newly published report from the group focuses on the increased use of intensive care units (ICUs) for Medicare patients with advanced cancer during the last month of their life. The researchers looked at the last six months of claims for 212,322 Medicare patients who died in 2010. Here’s what they found:

• Between 2003-2007 and 2010, the percentage of Medicare patients with advanced cancer dying in hospitals, and the average number of days they spent in the hospital before their deaths, declined across most regions, medical centers, and cancer centers;
• In 2003-2007, 28.8% of patients with advanced cancer died in a hospital; by 2010, the rate had dropped to 24.7%;
• The percentage of patients admitted to the ICU during the last month of life increased by nearly 22%, from 23.7% during 2003-2007 to 28.8% in 2010; and
• The average number of days spent in the ICU during the last month of life increased from 1.3 days to 1.6 days.

The report finds that although the use of hospice care for Medicare patients with advanced cancer is increasing, many of these patients do not receive/utilize hospice care until they are on their deathbed.

Some of the hospice numbers that came out of the study include:

• Medicare patients with advanced cancer were more likely to receive hospice care in 2010, with 61.3% of patients admitted into hospice care during the last month of life, compared to 54.6% in 2003-2007; and
• The percentage of patients admitted to hospice care during the last three days of life increased from 8.3% in 2003-2007 to 10.9% in 2010.

The study also finds that although fewer Medicare patients with advanced cancer died in the hospital in 2010 than in 2003-2007, many of these patients were likely to receive aggressive treatment in the final month of life, including:

• Intubation;
• Feeding tube;
• Cardiopulmonary resuscitation; and
• Chemotherapy.

“Our research continues to find that patients with advanced cancer are often receiving aggressive care until their final days, when we know that most patients would prefer care directed toward a better quality of life through hospice and palliative services. The increase in patients admitted to hospice care only days before death suggests that hospice services are often provided too late to provide much benefit.” said David C. Goodman, MD, MS, co-principal investigator for the Dartmouth Atlas Project. “Fuller discussions with patients who have advanced cancer on their prognosis and options for care can lead to a better quality of life than many receive today.”