Comparing End-of-Life Care for Cancer Patients in 7 Developed Countries

Among 7 developed countries, the United States has the lowest proportion of deaths that occur in the hospital and the lowest number of days spent in the hospital during the last 6 months of life.

The United States actually has the lowest proportion of deaths in the hospital and the lowest number of days in the hospital in the last 6 months of life among 7 developed countries, according to a new study published in JAMA.

Some 20 years ago, most deaths due to terminal illness were reported to occur in the hospital. More than one-fourth of the Medicare budget was devoted to the care of beneficiaries. Developed countries spend large amounts in healthcare usage for patients during their end-of-life treatments.

The new study, led by Ezekiel J. Emanuel, MD, PhD, compared the utilization of healthcare services and end-of-life costs among developed countries. The study focused on Belgium, Canada, England, Germany, the Netherlands, Norway, and the United States.

Using administrative and registry data from 2010, the researchers included patients older than 65 years of age who died with cancer. The bases of comparison were the patterns of care they received, the utilization of healthcare services and the costs during the final days before their death.

The researchers found that 29.4% of cancer patients in Netherlands died in the hospital. In England, Norway, and Germany, over 38% of the cancer patients died in hospital. Belgium and Canada had large figures—more than 50%. As compared to the 6 nations, US had the least number of patients dying in the hospital—just about 22.2%.

However, US showcased poor performance in dispensing end-of-life care related to high technology interventions. Mora than 40% of patients who died with cancer were admitted to the intensive care unit in the last 6 months of life. This is more than twice of any other country in the study. Also, 38.7% of American patients dying with cancer received at least 1 chemotherapy episode in the last 6 months of life, again more than the other countries in the study.

In Belgium, Canada, England, Germany, and Norway, end-of-life care is more hospital-centric than it is in the Netherlands or the US. However, hospital expenditures near the end of life were higher in the US, Norway, and Canada as compared with the other countries.

End-of-life care in America is considered expensive, resource consuming and insufficiently attentive to patients’ needs and wishes. Comparatively, other developed nations spend less than the US on healthcare. Many argue that it is because of the lower-intensity care offered toward the end-of-life. However, irrespective of nation of origin, there appears to be a disconnect between patients’ stated preferences for dying at home and actually dying in the hospital.

“Excessive utilization of high-intensity care near the end of life, particularly in the United States relative to other developed countries, underscores the need for continued progress to improve end-of-life care practices,” the study authors commented.