While cancer patients spent on average 5.1 days in the hospital during their last month of life across the country, in several regions of New York and New Jersey, the rate was between 7.1 and 7.3 days, while patients in Salt Lake City, Madison, WI and Portland OR were hospitalized between 3.5 and 4 days.
Nationally, about 24% of Medicare patients with cancer were admitted to intensive care at least once during their last month of life. But variation across the country was seven-fold. In Huntsville, AL, it was 42.4%, in McAllen TX it was 41%, in Los Angeles it was 40.3% and in Miami, 40.3%. But in Mason City, Iowa, it was only 6%.
The number of days spent in intensive care during this 30 days averaged 1.3, but in Huntsville, AL it was 3.1, and Miami 3.0, but in Appleton, WI, it was only .1.
Nationally, about 55% of cancer patients used hospice services in the last month of life. But again, variation was threefold across the country depending on hospital referral region. In Mason City, Iowa, 82.5% of patients were enrolled in hospice, but only 21% in the Bronx and 24% in Anchorage.
In many cases, Goodman says, studies have shown that so-called curative care in this population is often "not curative at all" nor does it prolong life.
"There were some instances where patients actually live longer wit hospice care." That, he said illustrates the importance of funding and organizing high quality comparative effectiveness research, because such studies just may find results "that really turn the world upside down in terms of our assumptions.