Variation in End-of-Life Cancer Treatments

According to a recent Dartmouth Atlas study:

The nation’s most elite cancer care centers performed only modestly better than community hospitals at meeting recognized quality standards for treating dying cancer patients, displaying similar patterns of relatively aggressive, high-intensity treatments in the final weeks of these patients’ lives…

The Dartmouth researchers also found that even among hospitals with a specific clinical focus on cancer care, such as those in the National Comprehensive Cancer Network and at designated National Cancer Institute centers, there were significant variations in how they treated patients at the end of life. The analysis found two-fold differences among these institutions in the rates of intensive care unit use in the last month of life, chemotherapy in the last 14 days of life, deaths occurring in the hospital, and the use of hospice care for fewer than three days.”

This begs the question of whether most variation is due to random noise due to unobservable factors not accounted for by the paper’s risk adjustment model and how much represents true, hospital-specific findings.

1 Comment

  1. You pull out an interesting, yet small, excerpt from this report, which is very compelling in its entirely. I thought the report on a whole begged the question of why there is so much variation in patterns and procedures during the last six months of life? Even more, why is there so much variation in patient and provider preferences during this fragile and delicate time of like across regions and clinical settings? I think this report is pretty timely as ACOs continue to become part and parcel of healthcare reform so I am curious to hear more about your perspective and concern.

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