Wonder where you'll spend your last days? It might depend on where you live.
In the United States, older patients suffering advanced lung cancer make much less use of hospital and emergency room services at the end of their life than those living in Ontario, a new study found. Rather, U.S. patients receive far more chemotherapy treatment, according to analysis of data from the U.S. government and the Ontario Cancer Registry.
Ontario patients spend more days in the hospital, utilize emergency rooms more and are much more likely to die in a hospital.
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In general, though, patients in both countries used health care services extensively during the last month of their life. More than twice as many Ontario patients died in a hospital (48.5 percent of short-term survivors compared to 20.4 percent in the U.S.) even though the majority of Ontario patients reported that they would prefer to die at home. For long-term survivors, the corresponding numbers were 19 percent in the U.S. and 44.3 percent in Ontario.
In each of the last five months, chemotherapy rates were significantly higher among SEER-Medicare patients than among the Ontario patients. Researchers noted that chemotherapy might be more common in the U.S. because of recommendations by professional societies that some patients with advanced non-small cell lung cancer might benefit from medical therapy.
They also noted that the higher rates of end-of-life hospitalization in Ontario might result from the lack of a hospice program in Canada, as most of the final-month hospitalizations in Ontario were for supportive care.
Although government-financed health care covers elderly patients in both Canada and the U.S., coverage at the end of life differs. In the U.S., Medicare covers hospice care for qualified patients, while Ontario—Canada's most populous province—has no hospice program comparable to what exists in the U.S. They do, however, provide palliative care through inpatient acute care units, outpatient services and home health care.
"The findings from this study will inform health planners and policymakers in each country regarding current patterns of end-of-life care, and where there may be opportunities for changing practice patterns or programs," researchers concluded.
The study was conducted by the National Cancer Institute and compared people 65 and older who died from non-small-cell lung cancer between 1999 and 2003.
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