Terminally ill patients continue to receive aggressive treatment at end of life

ATLANTA--The increasing use of chemotherapy and intensive hospital treatment for cancer patients in their last two weeks of life continued at least into the late 1990s despite the growth of the hospice movement that emphasizes comforting personal bonds and controlling pain and discomfort, say researchers at the Dana-Farber Cancer Institute in Boston.

A new report, which will be presented at the annual meeting of the American Society of Clinical Oncology in Atlanta (Monday, June 5, 3:00 p.m., Building B, Level 2 Room B216), confirms and expands on similar findings involving cancer care in the early 1990s, and the new data confirm the validity of the methods used to reach these conclusions.

"We have essentially found the same trends up to 1999 now," said Craig Earle, M.D., a Dana-Farber specialist in outcomes research. The study covered some 215,488 Medicare-eligible patients aged 65 and older in 77 Health Care Service Areas across the country, and, while there were significant variations in use of aggressive treatment, the overall trend has continued, said Earle.

"The use of hospice definitely increased steadily over this time period," he said. "But an increasing number of patients were admitted to hospice in just the last three days of life, so the hospices were not being used for symptom relief and building relationships," he said.

Earle said that the National Institutes of Health-sponsored study would continue to collect data for two more years, and that he and his colleagues are looking at whether the same pattern is occurring in younger patients who aren't eligible for Medicare.

The study's validity is strengthened, he said, by the most recent data showing that the differing levels of intensive treatment in different regions held up over several years.

More and more people are receiving appropriate hospice care, but too often it appears that doctors "are treating patients up to the end and then saying, go to the

Contact: Bill Schaller
Dana-Farber Cancer Institute

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