"We as physicians often make assumptions about what patients and families want for their lives. We tend to be really uncomfortable about sharing news that a cure is unlikely."
He's aware that "Some physicians will describe this as taking away hope. That's language that I think has caused a lot of harm in cancer care. What patients really want is for physicians to be honest with them about their chances for cancer remission, but also honest about their chances for disease progression."
The report revealed huge variation in utilization of aggressive types of care in the last month of life for patients dying of certain types of cancers known for their poor long-term survival, such as leukemia and lymphoma, and cancers of the colon and pancreas and lung.
On average, 6% of cancer patients received chemotherapy—which has limited or no benefit for frail elderly patients—during the last two weeks of life nationally, but in Olympia, WA it was 12.6% and in San Antonio, TX, 10.8, but only 3% in Worcester, MA and Baton Rouge, LA.
About 9% of patients with end stage cancer nationally received life sustaining treatments, such as endotracheal intubation, feeding tube placement and cardiopulmonary resuscitation. But rates varied by more than six across the nation, from 18.2 in Manhattan and 17.5% in Los Angeles to 3.9% in Minneapolis.
Rather than dying at home under the supervision of hospice providers, 29% cancer patients who died between 2003 and 2007 died in a hospital. But 46.7% of patients in Manhattan died in the hospital, compared with only 7% of the patients in Mason City, Iowa. The report said that in some hospitals, referral to a hospice care occurred so close to the day of death that it was unlikely to have provided much assistance and comfort to patients.