Breaking News
July 21, 2018 - Bundled-payment system did not lower costs for serious medical conditions, shows study
July 21, 2018 - Therapy dogs found to be effective in reducing ADHD symptoms in children
July 21, 2018 - Could rotating multiple therapists better treat PTSD patients?
July 21, 2018 - Binge drinking impairs working memory in adolescent brain
July 21, 2018 - Dying at home could be beneficial for terminally ill cancer patients and their relatives
July 21, 2018 - Researchers identify subtypes of retinal ganglion cells using single-cell RNA sequencing
July 21, 2018 - Study uncovers opportunities to reduce death by suicide among cancer patients
July 21, 2018 - Genetic sequencing reveals new clues to aggressiveness of prostate cancer
July 21, 2018 - BioSight Launches a Phase 2b Clinical Trial of BST-236 as a First-Line Treatment of Acute Myeloid Leukemia
July 21, 2018 - First major study comparing robotic to open surgery published in The Lancet
July 21, 2018 - ADHD medications may fail to improve cognition in healthy college students, study shows
July 21, 2018 - Intervention program that includes a personalized app could benefit teens with suicidal thoughts
July 21, 2018 - Researchers identify new compound that protects against neurodegeneration
July 21, 2018 - Gene therapy may hold potential to treat people with spinal cord injuries
July 21, 2018 - FDA Approves Nivestym (filgrastim-aafi), a Biosimilar to Neupogen
July 21, 2018 - Surgeons have substantial impact on genetic testing in breast cancer patients who need it
July 21, 2018 - Species diversity can have positive and negative impacts on disease transmission
July 21, 2018 - Genome research suggests presence of enteric fever in medieval Europe
July 21, 2018 - Risk of Sensory Deficits Drops With Rising Gestational Age
July 21, 2018 - Mum’s sleep matters—the effect of sleep on an unborn baby
July 21, 2018 - UC San Diego researchers awarded two grants for investigating stem cell-based therapies
July 21, 2018 - Cellular ‘garbage disposal’ may actually work on some of the proteins to neuronal development
July 21, 2018 - More Pregnant Women Having Heart Attacks
July 21, 2018 - Acne Breakouts | NIH News in Health
July 21, 2018 - Change health messaging to focus on potential impact to help stop the next pandemic
July 21, 2018 - Frailty associated with poor survival rates in young heart patients
July 21, 2018 - New discovery could save millions of lives from fatal fungal infections
July 21, 2018 - OBD presents latest data on the use of EpiSwitch™ in predicting patient response to immunotherapy and identifying lymphoma subtypes
July 21, 2018 - Childhood adversity increases susceptibility to addiction via immune response
July 21, 2018 - Scientists identify potential target for the treatment of binge eating
July 21, 2018 - Whole-brain LIPUS therapy improves cognitive dysfunction in mice simulating dementia, Alzheimer’s
July 21, 2018 - Digital media use raising risk of ADHD symptoms among the young
July 21, 2018 - Phase 3 study of tanezumab in patients with osteoarthritis pain meets all three co-primary endpoints
July 21, 2018 - Restoring mitochondrial function to reverse aging-related skin wrinkles, hair loss in mice
July 21, 2018 - SP PennTech introduces RW-500 rotary vial washer for biotech, pharmaceutical applications
July 21, 2018 - Researchers to study molecular mechanisms behind susceptibility of males to autism
July 21, 2018 - Using tendon transfer surgery to restore key functions in spinal cord injury patient
July 21, 2018 - Scientists create wearable device that measures cortisol in sweat
July 21, 2018 - Researchers study efficacy and safety of new treatment for OUD
July 21, 2018 - Fourth Published Clinical Trial Confirms Long-Term Safety of Niagen Supplementation at High Doses and Shows Potential for Improvement in Liver Health
July 21, 2018 - Study examines effects of a two-day intermittent calorie restriction diet for patients with type 2 diabetes
July 21, 2018 - Greening vacant urban land reduces feelings of depression for surrounding residents
July 21, 2018 - Parents say intense gun violence in PG-13 movies appropriate for teens 15 and older
July 21, 2018 - Collaborative study to assess effects of exercise training for cognitive deficits in MS
July 21, 2018 - FAU researchers find possible cause of Parkinson’s disease in the patients’ immune system
July 21, 2018 - Protective qualities of ‘good cholesterol’ reduce after menopause
July 21, 2018 - Researchers develop new way to uncover hidden breast cancer tumors
July 21, 2018 - FDA approves first drug for treatment of adult AML patients with specific genetic mutation
July 21, 2018 - Top AI companies join hands to discover novel drugs for DMD
July 21, 2018 - Ferring announces FDA approval of ZOMACTON for injection in four new pediatric indications
July 20, 2018 - Researchers design proteins that can self-assemble into complex structures
July 20, 2018 - AVITA Medical expands management team to support launch of RECELL device to treat burns
July 20, 2018 - FDA Approves Tibsovo (ivosidenib) for Relapsed or Refractory Acute Myeloid Leukemia with an IDH1 Mutation
July 20, 2018 - Developmental screening and surveillance rates remain low, new study suggests
July 20, 2018 - TGen opens tissue donation portal to advance DIPG research
July 20, 2018 - Health impact of highly processed summertime staples
July 20, 2018 - Exergaming can improve health in overweight and obese children, study shows
July 20, 2018 - Postmenopausal factors may impact heart-protective qualities of ‘good cholesterol’
July 20, 2018 - MRI and blood test combination results in improved prostate cancer diagnosis
July 20, 2018 - Update Health Professional and Consumer on Recent Recalled Products
July 20, 2018 - Researchers trace Parkinson’s damage in the heart
July 20, 2018 - Wearable device designed to measure cortisol in sweat
July 20, 2018 - Scientists demonstrate a new regulation mechanism for skeletal muscles
July 20, 2018 - Exposure to mobile phone radiation may negatively impact memory performance in adolescents
July 20, 2018 - SUSU scientists find alternative method to treat post-traumatic stress disorder syndrome
July 20, 2018 - Gestational diabetes may increase offspring’s heart disease risk
July 20, 2018 - New vaccine could protect unborn babies from Zika virus
July 20, 2018 - Researchers find high mercury and methylmercury concentrations in traditional Tibetan medicine
July 20, 2018 - Brief Safety Plan Intervention in ER Can Cut Suicidal Behavior
July 20, 2018 - The Mount Sinai Hospital receives accreditation as geriatric emergency department
July 20, 2018 - Toward a better understanding of Parkinson’s disease
July 20, 2018 - Med school communications office wins four national awards | News Center
July 20, 2018 - Professional baseball players with faster hand-eye coordination may have better batting performance
July 20, 2018 - Study looks into mechanisms that control sleep and wakefulness
July 20, 2018 - Scientists identify melanoma biomarkers that could help tailor immunotherapy treatments
July 20, 2018 - Research reveals long-term efficacy of drug used to treat common cause of kidney failure
July 20, 2018 - Timing of dinner associated with breast and prostate cancer risks
July 20, 2018 - Health Tip: Performing the Heimlich Maneuver
July 20, 2018 - Nearly all adolescents have eating, activity or weight-related issues
July 20, 2018 - Sage launches new web-based tool that helps explore curated genomic analyses of Alzheimer’s
Geography may be destiny in end-of-life care for cancer patients

Geography may be destiny in end-of-life care for cancer patients

image_pdfDownload PDFimage_print

When it comes to how much end-of-life care a patient with cancer receives, geography may, indeed, be destiny, according to new research led by Harvard Medical School that found striking differences in terminal care across different parts of the country.

The findings, published in the July issue of Health Affairs, reveal that in some areas, people with end-stage lung and colorectal cancers received more intensive care and racked up twice as much in spending in the last month of life.

Notably, the study found, the variations did not stem from patient beliefs and preferences. Instead, they were fueled by differences in physicians’ beliefs about end-of-life care and practice style, as well as by differences in the availability of health care services by region.

The findings, the investigators said, are particularly concerning in light of the growing body of research that shows additional care at the end of life does not contribute to better outcomes in cancer.

“Numerous studies have shown that greater spending and more care at the end of life do not contribute to better outcomes,” said study author Nancy Keating, professor of health care policy and medicine at Harvard Medical School and a physician at Brigham and Women’s Hospital. “Given that more care and greater spending also do not stem from patient preferences, much of these additional services can be considered wasteful or even harmful.”

Physicians in areas with higher spending reported feeling less prepared and less knowledgeable in their care of patients with terminal cancer. They also reported being less likely to seek hospice care for themselves if they were to become terminally ill with cancer, the research showed. Patient beliefs did not contribute to spending differences, the researchers found.

These findings, the researchers said, underscore the need for better physician education and training that boost doctors’ comfort level in both addressing end-of-life issues and delivering appropriate levels of care.

“What we really need are interventions that help physicians feel more comfortable taking care of patients at the end of life, along with better training about the lack of efficacy and potential harms of some intensive treatments for patients with advanced cancer,” Keating said.

Allocating resources strategically to ensure that enough services are available to meet patient needs without driving wasteful spending is also important, the researchers said.

To conduct their analysis, the researchers used data from the Cancer Care Outcomes Research and Surveillance Consortium (CanCORS), combining information about social and demographic factors, patient clinical characteristics, and survey responses about patient and physician beliefs. The study sample included more than 1,100 patients, 65 years of age and older diagnosed with end-stage lung and colon cancer between 2003 and 2005 who died before 2013.

The average amount spent on end-of-life care during a patient’s last month was slight more than $13,600. However, in some regions, it was more than $19,300, while it was just over $10,000 in other areas.

Compared with physicians in areas with lower spending, physicians in higher spending regions reported being:

  • Less prepared to treat symptoms at the end of life.
  • Less knowledgeable discussing end-of-life treatment options.
  • Less comfortable discussing do-not-resuscitate status.
  • Less comfortable discussing hospice care.
  • Less likely to enroll in hospice themselves should they be terminally ill with cancer.
  • More likely to suggest chemotherapy for patients who were unlikely to benefit from the treatment due to poor health status.

The analysis also revealed that geographic areas with higher spending tended to have a greater concentration of physicians per capita, fewer primary care doctors and fewer hospices.

While the study did not specifically explore the origins of various physician practices and beliefs, the researchers say that region-specific treatment patterns in end-of-life care likely emerged from shared informal observations during training or over the course of careers, with colleagues mirroring the practices of doctors around them.

“Doctors learn from each other,” Keating said. “If I train in a place where I see all of my colleagues doing lots of things when someone is sick, I may be more likely to try to do lots of things when I have patients who are sick, whereas if my colleagues tell their patients, ‘The end is getting near, let’s call in hospice,’ I may be more likely to suggest hospice for my patients.

Keating noted that there are already efforts underway to help physicians avoid wasteful and potentially harmful treatments, such as the American Board of Internal Medicine Foundation’s Choosing Wisely campaign to encourage physicians not to use chemotherapy to treat metastatic patients with poor performance status. The new study’s findings suggest that it is important to reinforce these efforts, Keating said.

Source:

https://hms.harvard.edu/news/end-life-cancer-care-geography-may-be-destiny

Tagged with:

About author

Related Articles