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A recently published study has identified a trend toward more aggressive treatment of elderly, terminally ill patients at the end of life. Researchers reviewed case records of more than 28,000 people age 65 and older with lung, breast, or gastrointestinal cancer who died within a year of diagnosis from 1993 to 1996. They found a small but steady increase in the proportion of patients who were admitted to emergency departments (EDs) and intensive care units (ICUs) shortly before their deaths.
Patients in 1996 were more likely to receive chemotherapy toward the end of life, including the last 2 weeks of life, than patients in 1993. About 9% of patients visited an ED more than once during the last month of life in 1996, compared with about 7% in 1993. The same trend occurred with admissions to an ICU during the last month of life. In 1996, about 9% of patients experienced at least one ICU admission, compared with 7% in 1993. Even so, researchers found that people were more likely to receive hospice care and less likely to die in a hospital in 1996 than in 1993.
Researchers attribute the trend of treating cancer patients aggressively until their death to the availability of more and better chemotherapy drugs. They suggest broader access to hospice services so terminally ill people who are still receiving treatment can also benefit from appropriate end-of-life care.
"Trends in the Aggressiveness of Cancer Care Near the End of Life," Journal of Clinical Oncology, C. Earle, et al., January 15, 2004.
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