Terminally ill cancer patients continue to receive aggressive treatment at end of life

The increasing use of chemotherapy and intensive hospital treatment for cancer patients in their last two weeks of life continued at least into the late 1990s despite the growth of the hospice movement that emphasizes comforting personal bonds and controlling pain and discomfort, say researchers at the Dana-Farber Cancer Institute in Boston.

A new report, presented at the annual meeting of the American Society of Clinical Oncology in Atlanta, confirms and expands on similar findings involving cancer care in the early 1990s, and the new data confirm the validity of the methods used to reach these conclusions.

"We have essentially found the same trends up to 1999 now," said Craig Earle, M.D., a Dana-Farber specialist in outcomes research. The study covered some 215,488 Medicare-eligible patients aged 65 and older in 77 Health Care Service Areas across the country, and, while there were significant variations in use of aggressive treatment, the overall trend has continued, said Earle.

"The use of hospice definitely increased steadily over this time period," he said. "But an increasing number of patients were admitted to hospice in just the last three days of life, so the hospices were not being used for symptom relief and building relationships," he said.

Earle said that the National Institutes of Health-sponsored study would continue to collect data for two more years, and that he and his colleagues are looking at whether the same pattern is occurring in younger patients who aren't eligible for Medicare.

The study's validity is strengthened, he said, by the most recent data showing that the differing levels of intensive treatment in different regions held up over several years.

More and more people are receiving appropriate hospice care, but too often it appears that doctors "are treating patients up to the end and then saying, go to the hospice," Earle said. This interpretation was based on data showing that an increasing number of patients who were seen in emergency rooms or admitted to intensive care units during the last month of life. At the same time, however, there was a drop in the number of cancer patients dying in acute-care hospitals, and that more terminal patients were using hospice facilities.

"As oncologists," said Earle, "we need to make sure that we view hospice care for what it is, an important part of the care continuum that focuses on keeping patients comfortable and free of pain."

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