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The amount you spend on end-of-life cancer treatment varies depending on where you live.
But more spending is not necessarily associated with better results.
A new study finds that end-of-life differences. Cancer care for life does not come from the beliefs and preferences of patients.
They have more to do with the beliefs and style of practice of physicians as well as the health care services available in a particular area
. The researchers specifically studied people with terminal lung and colorectal cancers.
In some areas, patients received more intensive care and spent twice as much in the last month of life than patients in other regions. The care and the increase in expenses do not stem either from patients' preferences, most of these additional services may be considered unnecessary or even harmful, "said Dr. Nancy Keating, author of the study. and professor of medicine and health at Harvard Medical School. A Brigham and Women researcher said in a press release
Researchers say there is a need for education and training of doctors to address end-of-life issues.
The full study is published in Health Affairs. About the study data
The study data came from the Cancer Care Outcomes Research and Surveillance Consortium (CanCORS).
It included social and demographic information as well as clinical characteristics of patients.
surveys were also used.
The 1,132 patients in the study were all at least 65 years old. All were diagnosed with advanced lung or colon cancer between 2003 and 2005. All died before 2013.
On average, over $ 13,600 was spent at the end of life in the last month of life
. from just over $ 10,000 to over $ 19,300, depending on the geographic location of the patient.
Overall, nearly 43% of physicians reported that they would advise a patient with end stage lung cancer to have chemotherapy.
In areas where spending is higher, physicians were more likely to recommend chemotherapy to patients who would probably not benefit.
More than 65% of physicians said that they would enroll themselves in a hospice
However, doctors from the more sparing regions said that they would be less inclined to to treat themselves if they had terminal cancer.
Regions with higher expenditures tend to have more doctors per capita. But they have fewer doctors and primary care hospitals.
Of the patients, 37% said that they wanted the treatment to last longer even if it caused more pain. Nearly 43% said they would like this treatment even if it depletes their finances.
The Affordable Care Act Connection
In the Spendiest Fields, Physicians Say They Feel Less Prepared and Informed About Patient Care
Kurt Mosley, Vice President of Strategic Alliances for Consultants Merritt Hawkins' health told Healthline that it's important to note the dates and status of patients who are not resuscitated. The researchers used data from patients diagnosed from 2003 to 2005. They were followed until 2012.
Mosley noted that in 2016, as part of the Affordable Care Act ( ACA), Medicare has created a distinct billable
This is a change that would not be reflected in this particular study.
"We need to simplify things to help families make informed decisions. That's what Medicare is trying to do, "Mosley said.
Marlon Saria, Ph.D., RN, Nurse Scientist at the John Wayne Cancer Institute of Providence Saint John's Health Center, California, qualifies the issue as complicated
. against making generalizations about doctors.
Saria also draws attention to the dates of the study.
"They were looking at pre-ACA data.When you talk about disparities in health care by region, we do not know what the impact of ACA was." It's unfortunate for a country like America to have these disparities depending on where you live, "he told Healthline
on the issue of regional differences in the availability of health services. health care such as the hospice. ] "We still have a lot of work to do if the quality of death depends on where you are and what resources you have." Decisions at the bedside are influenced by what is happening in the home. DC, "said Saria.
A Multidimensional Problem
The study did not specifically examine where the practices and beliefs of physicians come from. But the researchers say that this probably comes from the common observations of the doctors around them.
In some areas of the country, higher spending on health care is not limited to end-of-life care but to all care, according to Mosley. 19659002] Poverty and access to lifelong health care also play a role, he added.
says Mosley.
He pointed out that many cancers, such as colon and lungs, are largely preventable. And routine screening can catch these cancers before they have a chance to spread.
"We need to intensify and improve these issues earlier in life rather than prolong death." Keating said that there are efforts, such as the Choosing Carefully from the Foundation's campaign. American Board of Internal Medicine (ABIM), which encourage physicians not to use chemotherapy for patients with metastatic cancer with poor performance status.
Room for improvement
Mr. Mosley has said that the United States can learn something from other countries doing good work in health care and end-of-life
were dying in hospitals.A study showed that people did not want dying in hospitals, so they changed the way they get out of it, now 95% of people are dying in their homes, "he said.
Mosley said that some doctors using chemotherapy, even when they do not think it will change the outcome, could practice defensive medicine.
The 2015 Quality of Death Index of the Economist Intelligence Unit ranked the availability, affordability, and quality of end-of-life care in 80 countries.
The United Kingdom has been credited with having the best quality of death due to national policies and the extensive integration of palliative care into the National Health Service, with a strong hospice movement.
The United States ranked ninth. At the top of the list, there are several things in common.
Among them is a strong national palliative care policy framework, extensive palliative care training resources, and grants to help patients with the financial burden of palliative care.
"Palliative care is a way of caring for end-of-life patients. This includes pain control and helps them to be comfortable. We must also pay more attention to the mental state of patients. And families should be involved, "said Mosley.
Treatment vs Care
Saria said that when it comes to cancer, there is a strong stigma against abandonment
"There is an assumption that patients will want to continue fighting even if the result is clear," he added.
"Patients can rely on their oncologist. But with all the variations in knowledge, practice, acceptance, and end-of-life care in the healthcare community, you can imagine how much this is even more frustrating to patients, "said Saria [19659005]. about medicine on both sides of the exam table. Medical providers are there to treat the disease – it's a failure of medicine. "
The authors of the study wrote that additional end-of-life care does not contribute to better outcomes in cancer.
" I do not mean that the additional treatment of the disease requires additional treatment
"I want to emphasize that even when we refuse treatment, it does not mean that we are being treated We are still caring for patients," Saria said.
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