How We Compare to Other Countries in End-of-Life Cancer Care

We recently wrote on the importance of discussing end-of-life wishes for cancer patients and their families. A new study on this topic examines the reality of end-of-life care in the United States and how it compares to other countries. Our team of lung cancer and mesothelioma attorneys details this new study below.

The study compared cancer patients in their finals months of life in seven developed countries based on three factors: site of death, health care utilization, and hospital spending. Aside from the U.S., the remaining six countries were Norway, the Netherlands, Germany, England, Canada and Belgium.

This is the first systemic international comparison of healthcare for cancer patients at the end of their life. Researchers focused on cancer because it is the most expensive type of illness per patient, and is the second-leading cause of death in these seven countries.

Site of Death

Among their findings, researchers concluded that 22% of American cancer patients died in the hospital in 2010, which was the lowest rate among all studied countries. Americans also spent the fewest number of days in the hospital in their last six months of life, at an average of a week and a half.

Canadian cancer patients, to compare, spent an average of three weeks in the hospital in their last six months, and just over half died in the hospital. The study did not take into account patients who died in nursing homes or hospice programs, which are very commonly used in the U.S.

Unnecessary Care

Unfortunately, Americans did spend an inordinately longer period of time in the intensive care unit; twice as many days, in fact, than patients from other countries. Americans received much more chemotherapy, even though it likely would not improve the quality or length of life. About 40% of Americans received at least one chemotherapy session in their last six months.

Hospital Spending

Hospital-related care for patients in the U.S. averaged $18,500. In Canada, the average was just over $21,800, and in Norwegians spent about $19,700 per patient. Conversion methods researchers used in this study are not entirely clear, however.

It is important to note that the United States is the only country where hospitals and physicians bill separately. The study only included in-hospital costs, and did not included costs from nursing homes and hospice programs, which, as stated, are very common in the U.S. Costs per-patient are much higher when physician’s bills, hospice care, and nursing home spending are taking into account.

What Can Be Learned

Researchers agreed that all countries have areas to work on. For American patients, the focus should lie precisely where we described in our previously-mentioned blog post: having candid discussions about end-of-life wishes and goals. These discussions should include the patient, their doctors, and their family and loved ones. There may be legal documents to be drafted and signed, or financial arrangements to be made. We as a country need to become more comfortable and accepting of patient’s hopes for how they want to live in their final days, and where they wish to ultimately pass.

Patients must be aware that chemotherapy sessions in the last six months of life shows no benefit, and only contributes to a worsened quality of life. The same is true for intensive care unit admissions. Researchers point to making high-quality palliative care the default treatment for patients with advanced or incurable cancer, rather than an option.

Although 25% of all Medicare spending goes to caring for dying seniors, researchers argue that end-of-life care is not the driving factor in our country’s insane health care costs. Thus, our focus should not be on reducing end-of-life care (such as palliative programs), but on reducing our fee-for-service system. This type of spending encourages more, unnecessary care, over better-quality care.

Perhaps most importantly, researchers write that our end-of-life care is improving. In the mid-1980s, more than 70% of cancer patients died in the hospital. In the past, most patients received chemotherapy in their last months of life, and though the number is still high, it is dropping. We do need to improve the rate of which we admit dying cancer patients to the intensive care unit, however.

The cancer lawyers at Pintas & Mullins Law Firm offer a free book, 100 Questions & Answers About Mesothelioma, to help patients and families tackle these major issues. Our book contains information on the nation’s top hospitals and doctors, standard and alternative treatments, and how to talk to family members about your illness. You are not alone. We are here to help at any time of day or night. We offer free consultations to concerned patients and families nationwide.

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