Expensive but futile
Terminal cancer patients flock to hospitals for costly, futile treatments
before dying: study
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http://www.nydailynews.com/ny_local/2010/11/16/2010-11-16_terminal_cancer_patients_flock_to_hospitals_for_costly_futile_treatments_before_.html#ixzz15aIfIe00
Too many cancer patients are dying in hospitals instead of at home or hospice - especially in Manhattan, researchers reported Tuesday.
Nearly one-third of U.S. patients with advanced cancer spend their final moments in a hospital, where they may get expensive but futile treatment, the study says.
The numbers were even more dramatic in Manhattan, which had the most in-hospital cancer deaths - 46.7% percent, according to Dartmouth College researchers.
Mason City, Iowa, had the lowest rate - just 7% percent of cancer patients there died in the hospital.
"In some healthcare systems, patients with advanced cancer have a greater chance of spending their last weeks and months in hospitals," said Dr. John Goodman, who co-authored the study. "Geography is destiny."
The city's best-known cancer hospital - Memorial Sloan-Kettering - had a lower rate than other Manhattan facilities. Thirty-four percent died there, while 42% were admitted to a hospice.
Goodman said that showed Sloan-Kettering doctors were having end-of-life conversations with patients "early enough in the process to give them the opportunity to die at home or in a hospice."
He said that patients with no hope of a cure would prefer care that allows them to be home with their families.
Recent studies have found that terminal cancer patients who die at home do so peacefully and that they may live longer than patients who get last-ditch chemotherapy instead of pain relief.
Yet insurance reimburses efforts to cure at a far higher rate than palliative care, researchers said.
And patients and doctors are often reluctant to give up the fight against cancer or to even discuss that scenario.
"Physicians tend to go overboard so as not to miss a chance to save a patient's life," said George Sledge, president of the American Society of Clinical Oncology.
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