Lung cancer prompts different uses of end-of-life care in the United States, Canada

In the months before death, lung cancer patients in the United States on Medicare make much more use of chemotherapy than do their counterparts in Ontario, Canada, but in the last month of life, Canadians are much more likely to be hospitalized. The different patterns in the extensive use of end-of-life care between the two countries may indicate opportunities for changing patterns or programs, according to the researchers undertaking this study.

The National Cancer Institute's (NCI) Joan L. Warren, PhD, and associates launched their investigation because few studies have compared end-of-life care for cancer patients in the United States and Canada, both of which offer government-financed health insurance for the elderly. They reviewed health claims for the last 5 months of life for 13,533 persons with non-small cell lung cancer (NSCLC) who died of the disease at 65 years or older from 1999 to 2003 using US Surveillance, Epidemiology, and End Results (SEER-Medicare) data for 13,533 persons and the Ontario Cancer Registry for 8,100. The health claims yielded data on chemotherapy, emergency room use, hospitalizations, and supportive care in both short-term (less than 6 months) and longer-term survivors.

The analysis revealed that patients in both countries used health services extensively, particularly in the last month of life. More than twice as many Canadian patients died in the hospital (48.5% of Canadian short-term survivors vs. 20.4% of US short-term survivors). In each of the last 5 months of life, chemotherapy use was statistically significantly higher among the US patients than the Canadians.

“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 researchers noted in their report, published online by the Journal of the National Cancer Institute.

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