Breaking News
February 18, 2019 - How Inactivity and Junk Food Can Harm Your Brain
February 18, 2019 - Diabetes tops common conditions for frequent geriatric emergency patients
February 18, 2019 - Longer-lived sperm produces offspring with healthier lifespans
February 18, 2019 - New dental adhesive prevents tooth decay around orthodontic brackets
February 18, 2019 - New eHealth tool shows potential to improve quality of asthma care
February 18, 2019 - New Australian initiative helps emergency clinicians to improve patient care
February 17, 2019 - Apellis Pharmaceuticals’ APL-2 Receives Fast Track Designation from the FDA for the Treatment of Patients with Paroxysmal Nocturnal Hemoglobinuria
February 17, 2019 - Researchers identify faulty ‘brake’ that interferes with heart muscle’s ability to contract and relax
February 17, 2019 - Support from trusted adults can reduce risk of dying in suicidal teens, finds study
February 17, 2019 - Heart attack awareness improved since 2008
February 17, 2019 - Exercise gives a better brain boost to older men than women
February 17, 2019 - New research disproves previous assumptions of how looks influence personality
February 17, 2019 - Cannabis use as a teenager linked to depression later in life
February 17, 2019 - Sinks by Toilets in ICU Patient Rooms Harbor Harmful Bacteria
February 17, 2019 - Cancer cells’ plasticity makes them harder to stop
February 17, 2019 - Young cannabis users have increased risk of depression and suicidal behavior
February 17, 2019 - Tasmanian Devils Likely to Survive Cancer Scourge
February 17, 2019 - Neoadjuvant PD-1 blockade seems effective in glioblastoma
February 17, 2019 - Personal, social factors play role in enabling sustainable return to work after ill health
February 17, 2019 - Mouse studies show ‘inhibition’ theory of autism wrong
February 17, 2019 - Study shows how neuroactive steroids inhibit activity of pro-inflammatory proteins
February 17, 2019 - Use of liver grafts from older donors decreased despite better outcomes in recipients
February 17, 2019 - MUSC researchers discover new mechanism for a class of anti-cancer drugs
February 17, 2019 - HPV misconceptions are causing women to miss smear tests
February 17, 2019 - Sanofi and Regeneron Offer Praluent (alirocumab) at a New Reduced U.S. List Price
February 17, 2019 - Researchers say auditory testing can identify children for autism screening
February 17, 2019 - New method analyzes how single biological cells react to stressful situations
February 17, 2019 - WVU gynecologic oncologist investigates novel treatment for cervical and vaginal cancers
February 17, 2019 - ADHD diagnoses poorly documented
February 17, 2019 - Majority of gender minority youth do not identify with traditional sexual identity labels
February 17, 2019 - AbbVie, Teneobio enter into strategic transaction to develop potential treatment for multiple myeloma
February 17, 2019 - Lower Birth Weight May Up Risk for Psychiatric Disorders
February 17, 2019 - Scientists identify reversible molecular defect underlying rheumatoid arthritis
February 17, 2019 - Moffitt researchers shed light on how CAR T cells function mechanistically
February 16, 2019 - Female Anatomy May Play Big Role in Sperm’s Success
February 16, 2019 - BMI may mediate inverse link between fiber intake, knee OA
February 16, 2019 - Movement impairments in autism can be reversed through behavioral training
February 16, 2019 - Studies address racial disparities in postpartum period and cardiovascular health
February 16, 2019 - Scientists implicate hidden genes in the severity of autism symptoms
February 16, 2019 - Decreased deep sleep linked to early signs of Alzheimer’s disease
February 16, 2019 - Neuroscientists show how the brain responds to texture
February 16, 2019 - Gilead Announces Topline Data From Phase 3 STELLAR-4 Study of Selonsertib in Compensated Cirrhosis (F4) Due to Nonalcoholic Steatohepatitis (NASH)
February 16, 2019 - What Can I Do About Sweating? (for Teens)
February 16, 2019 - Companies navigate dementia conversations with older workers
February 16, 2019 - Newly developed stem cell technologies show promise for treating PD patients
February 16, 2019 - Collaborative material research could advance self-assembling nanomaterials
February 16, 2019 - Researchers take major step in creating technology that mimics the human brain
February 16, 2019 - Erasing memories associated with cocaine use reduces drug seeking behavior
February 16, 2019 - Artificial intelligence can accurately predict prognosis of ovarian cancer patients
February 16, 2019 - Racial disparities in cancer deaths on the decline for America
February 16, 2019 - FDA authorizes new interoperable insulin pump for children, adults with diabetes
February 16, 2019 - Coexisting Medical Conditions, Smoking Explain PTSD-CVD Link
February 16, 2019 - Skin Cancer Screening: MedlinePlus Lab Test Information
February 16, 2019 - ‘Happiness’ exercises can boost mood in those recovering from substance use disorder
February 16, 2019 - Cell manipulation could soon halt or reverse aging
February 16, 2019 - Pumped Breast Milk Falls Short of Breastfed Version
February 16, 2019 - Men’s porn habits could fuel partners’ eating disorders, study suggests
February 16, 2019 - Rapid progression of age-related diseases may result from formation of vicious cycles
February 16, 2019 - Immune checkpoint molecule protects against future development of cancer
February 16, 2019 - New method produces hydrogels that have properties similar to cells’ environment
February 16, 2019 - $4.1 million funding for heart research on Valentine’s Day
February 16, 2019 - General anesthesia in early infancy unlikely to have lasting effects on developing brains
February 16, 2019 - New breakthroughs for muscular dystrophy research
February 16, 2019 - First Opinion: Embryo editing for higher IQ is a fantasy. Embryo profiling for it is almost here
February 16, 2019 - Vapers develop cancer-related gene deregulation as cigarette smokers
February 16, 2019 - Bringing Antimicrobial Susceptibility Testing (AST) to the Community
February 16, 2019 - Decolonization protocol after hospital discharge can prevent dangerous infections
February 16, 2019 - Children with ASD more likely to face maltreatment, study finds
February 16, 2019 - Study finds genetic vulnerability to use of menthol cigarettes
February 16, 2019 - Promising drug developed to rejuvenate muscle cells
February 16, 2019 - H-RT should be the standard of care for men with low risk prostate cancer, study shows
February 16, 2019 - New technique using patients’ own modified cells could help treat Crohn’s disease
February 16, 2019 - Therapeutic endoscopy has an expanding role in the treatment of IBD
February 16, 2019 - Blood clot discovery could lead to development of better treatments for blood diseases
February 16, 2019 - Intervention can increase exclusive breastfeeding rates
February 16, 2019 - New project explores how gaming technologies can help cancer patients communicate better
February 16, 2019 - Catalyst Biosciences Presents Updated Data from Its Phase 2/3 Trial of Subcutaneous Marzeptacog Alfa (Activated) in Individuals with Hemophilia A or B with Inhibitors at the 12th Annual EAHAD Congress
February 16, 2019 - Rerouting nerves during amputation reduces phantom limb pain before it starts
February 16, 2019 - A Hormone Produced When We Exercise Might Help Fight Alzheimer’s
February 16, 2019 - Millions of British people breathe toxic air travelling to GPs
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