End-of-Life Cancer Care Differs in the U.S. and Canada

Rates of chemotherapy use are higher, but fewer hospitalizations in U.S. patients

MONDAY, May 23 (HealthDay News) -- End-of-life care for patients with non-small-cell lung cancer (NSCLC) differs in the United States and Ontario, Canada, according to a study published online May 18 in the Journal of the National Cancer Institute.

Joan L. Warren, Ph.D., from the National Cancer Institute in Bethesda, Md., and colleagues compared end-of-life care for patients aged 65 years and older with NSCLC (who were receiving government-financed health insurance) in the United States and in Ontario between 1999 and 2003. A total of 13,533 NSCLC patients were identified from U.S. Surveillance, Epidemiology, and End Results (SEER)-Medicare data and were compared with 8,100 patients identified from the Ontario Cancer Registry. Data on chemotherapy, emergency room use, hospitalizations, and supportive care were collected from health claims during the last five months of life, for short-term (died within six months after diagnosis) and longer-term survivors (died six months or more after diagnosis).

The investigators found that rates of chemotherapy use in short- and longer-term survivors were significantly higher for SEER-Medicare patients than Ontario patients in every month before death. During the last 30 days of life, significantly fewer short- and longer-term survivors were hospitalized from the SEER-Medicare cohort compared with the Ontario cohort.

"NSCLC patients in both Ontario and the United States used extensive end-of-life care. Limited availability of hospice care in Ontario and differing attitudes between the United States and Ontario regarding end-of-life care may explain the differences in practice patterns," the authors write.

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