End-of-life cancer care differs between USA and Canada
MedWire News: End-of-life hospital care differs significantly between cancer patients treated in the USA and Canada, research shows.
For example, end-of-life care for lung cancer patients in the US is more likely to include chemotherapy than in Canada and is less likely to be delivered in the hospital, report investigators.
The "lack of a formal hospice program in Ontario during the study period may account for some of the differences in hospital and emergency room use between the two systems," conclude Dr Joan Warren (National Cancer Institute, Bethesda, Maryland, USA) and colleagues in the Journal of the National Cancer Institute.
The USA and Canada both have government-funded health insurance for elderly patients, but few studies have compared differences in care for cancer patients between the two systems.
In this analysis, the researchers compared end-of-life care for non-small cell lung cancer (NSCLC) patients aged 65 years and older who died of lung cancer between 1999 and 2003.
Using data from a US Medicare registry and a provincial registry in Canada, health claims during the last 5 months of life provided data on chemotherapy and emergency room use, as well as hospitalizations and use of supportive care, among 13,533 US and 8100 Canadian patients.
In the 5 months before dying, significantly more US than Canadian patients received chemotherapy (33.2 versus 9.5 patients per 100 person-months).
Additionally, significantly more short-term survivors in Canada than in the USA were hospitalized during the last month of life (78.6 versus 49.9 patients per 100 person-months).
Among longer-term cancer survivors, the rate of chemotherapy during the 5 months before death was also higher in the US population than the Canadian population, and fewer of these patients were hospitalized in the last month of life.
US patients were also significant less likely to die in the hospital: 20.4% and 19.0% of short- and long-term US survivors died in hospital compared with 48.5% and 44.3% of short- and long-term Canadian patients.
In an accompanying editorial, David Goodman (Dartmouth Medical School, Lebanon, New Hampshire, USA) wrote that US physicians are more aggressive in treating NSCLC and receive financial incentives to provide chemotherapy.
Additionally, the support for community care in Canada is lacking, which limits access to high-quality, patient-centered care that allows patients to make decisions about end-of-life treatment.
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By MedWire Reporters