Geography Can Be a Destiny in End-of-Life Care for Cancer Patients

July 10, 2018

When it comes to end-of-life care for a cancer patient, geography may well be fate, according to a new study by Harvard Medical School that found differences striking

The findings, published in the July 1945 issue of Health Affairs reveal that in some areas, people with lung cancer and colorectal cancer in the terminal phase receive more care intensive and accumulated twice as much spending in the last month of life.

Notably, the study found, the variations did not come from the patient's beliefs and preferences. Instead, they were fueled by differences in physicians' beliefs about end-of-life care and style of practice, as well as differences in the availability of health care services by region

. in light of the growing body of research showing that additional end-of-life care does not contribute to better outcomes in cancer.

"Numerous studies have shown that an increase in spending and end-of-life care do not contribute to results," said study author Nancy Keating, a professor of policy of health care and medicine at Harvard Medical School and a doctor at Brigham and Women's Hospital. "Since more care and expenses do not stem from patient preferences, most of these additional services may to be considered useless or even harmful. "

Doctors in the areas with the highest expenditures felt less prepared and less knowledgeable, patients with terminal cancer, and they also reported being less likely to seek palliative care for themselves if they were to become terminally ill with cancer, research has shown.According to the researchers, these findings underscore the need for a Better training and better education of physicians that enhance the comfort level of physicians, both to solve end-of-life problems and to provide the appropriate care.

"What we really need are interventions that help doctors feel more comfortable taking care of patients at the end of their lives, as well as better training on the lack of of effectiveness and the potential disadvantages of some intensive treatments.

To conduct their badysis, researchers used data from Cancer. Consortium for Research and Monitoring Care Outcomes (CanCORS), combining information on social and demographic factors, clinical data on patient characteristics and responses to the survey on the beliefs of patients and physicians. The study sample included more than 1,100 patients aged 65 years and older diagnosed with end-stage lung and colon cancer between 2003 and 2005 who died before 2013.

The amount average spent for end-of-life care last month was light over $ 13,600. However, in some areas it was over $ 19,300, while it was slightly above $ 10,000 in other areas.

Compared to physicians in regions with lower expenditures, physicians at the end of life

The badysis also revealed that geographic areas a greater concentration of physicians per capita, fewer primary care physicians and fewer hospices.

Although the study did not specifically explore the origin of the various practices and beliefs of physicians, the researchers say that region-specific treatment regimens in end-of-life care probably have emerged from informal observations shared during training or during the career, with colleagues reflecting the practices of the physicians who surround them,

"Keating said." If I coach in a place where I see all My colleagues do a lot of things when someone is sick, I am more likely to try to do a lot of things when I have sick patients, whereas if my colleagues tell their patients " I may be more likely to suggest a hospice for my patients. "

Keating noted that efforts are already underway to help physicians avoid unnecessary and potentially harmful treatments, such as: The Carefully Selecting Campaign of the American Board of Internal Medicine Foundation encourages doctors not to use chemotherapy to treat metastatic patients with poor performance. The findings of the new study suggest that it is important to strengthen these efforts,