* 29 pct of terminal cancer patients die in hospital
* Get aggressive treatment they or families may not want
* Cancer map: where patients live decides how they die
By Maggie Fox, Health and Science Editor
WASHINGTON (Reuters) - One third of U.S. patients
dying of cancer end up getting costly but futile treatment in
hospitals, when hospice care to ease their suffering would be
more appropriate, researchers reported Tuesday.
The Dartmouth Atlas, a project that studies and documents
variations in medical care across the United States, also found
that where cancer patients live may decide the way they die: in
an emergency room or at home.
The latest study finds that 29 percent of patients with
advanced cancer died in a hospital between 2003 and 2007.
Last-ditch treatment of dying patients is expensive,
upsetting to families and adds to suffering in many cases,
cancer experts agree. They get feeding and breathing tubes and
are often resuscitated repeatedly.
"Patients often unnecessarily receive care in the ICU and
invasive procedures," said Dr. John Goodman who coauthored the
Dartmouth Atlas study of 235,821 patients with federal Medicare
health insurance who died of cancer between 2003 and 2007.
"On average, patients ... would much prefer to receive care
that allows them the highest quality of life in their last
weeks and months and care that allows them whenever possible to
be at home and with their families," Goodman told reporters in
a telephone briefing.
The report, available at http://www.dartmouthatlas.org,
shows a lack of planning about how to treat fatal cancer, which
is the second leading cause of death in developed countries and
will kill more than 500,000 Americans this year.
The study found that cancer care at the end of life varies
markedly from region to region and from hospital to hospital.
"I think that the care patients receive has less to do with
what they want and more to do with the hospital they happen to
seek care from," Goodman said.
"In some healthcare systems, patients with advanced cancer
have a greater chance of spending their last weeks and months
in hospitals," he added. "Geography is destiny."
New York's borough of Manhattan had the most cancer deaths
in-hospital -- 46.7 percent, compared with Mason City, Iowa,
where 7 percent of cancer patients died in the hospital.
The issue affects the bottom line. The United States spent
$2.3 trillion on healthcare in 2008 -- $7,681 per resident,
accounting for 16 percent of gross domestic product or GDP.
Studies have shown about 31 percent of this -- by far the
biggest single share -- is spent in hospitals.
INFORMING HEALTHCARE REFORM
President Barack Obama's signature program, healthcare
reform, is under fire from Republicans about to take control of
the House of Representatives who say it does not do enough to
control costs, as well as by left-wing Democrats who say it did
not go far enough but who also want to control costs.
The American Society of Clinical Oncology, which groups and
guides cancer specialists, supports palliative or hospice care
for dying cancer patients, which eases pain and often allows
patients to spend their last days or weeks at home.
In September, researchers reported that cancer patients who
die at home do so more peacefully and at least one study has
shown that dying cancer patients actually live a little longer
on average if chemotherapy and other lifesaving measures are
replaced with pain relief.
Doctors are often poor at telling patients outright that
they are dying, and patients often resist hearing that message,
said Dr. Douglas Blayney, immediate past president of ASCO.
"I never use the words 'there is nothing more that can be
done.' We say 'there is very little that will help us treat the
cancer -- we need to focus on you and your symptoms,"' Blayney
said in a telephone interview.
"Often, in the hustle and bustle of the hospital, that
conversation can be lost."
Goodman agreed. "It really feels like a fight," he said.
"We tend to be really uncomfortable about sharing the news that
cure is unlikely."
(Reporting by Maggie Fox, Editing by Anthony Boadle)
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