Dartmouth Atlas Brief: Cancer Care Near the End of Life

A recent Dartmouth Atlas of Health Care Brieffound that even though most patients with advanced cancer prefer care that minimizes symptoms, many still receive intense treatment and are not admitted into hospice care until their last three days of life.

While utilization of hospice by Medicare patients with advanced cancer is increasing, a growing proportion of patients begin hospice care in the final three days of life. At the same time, these patients are spending fewer days in the last month of life hospitalized, but the number of days they spend in intensive care units (ICUs) has increased. Following are some of the study’s key findings:

• Medicare patients with advanced cancer were more likely to receive hospice care in 2010, as 61.3 percent of patients were admitted into hospice care during the last month of life, compared to 54.6 percent in 2003-2007.
• 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.
• Overall, Medicare patients with cancer were significantly more likely to spend time in the ICU, as the percentage of patients admitted to the ICU during the last month of life increased by nearly 22 percent, from 23.7 percent from 2003-2007 to 28.8 percent in 2010.

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