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Study: N.J. cancer patients likelier to die in hospital:

Cancer patients in New Jersey are more likely than patients elsewhere to spend their dying days in a hospital receiving aggressive care such as chemotherapy, tube-feeding and breathing assistance, an analysis of Medicare records found.

Its findings highlight the types of discussion that need to take place – both individually and as a society – about care at the end of life. It also raises questions about possible overtreatment and the waste of resources used to provide futile care.

“The care patients receive has less to do with what they want and more to do with the hospital they seek care from,” said Dr. David C. Goodman, the lead author of the study.

With previous research showing that the vast majority of patients, if given a choice, would strongly prefer to die in a homelike setting surrounded by family, this report shows the gulf between patient preferences and the type of care they receive, he said.

“Patients want to live long, but they also want to live well,” Goodman said. “Physicians need to open up the conversation in terms of living well as well as living long.” [E]ven within two weeks of their deaths, many patients here received chemotherapy to treat their disease.

Physicians need to examine how they communicate with patients. The culture of oncology, said Goodman, is “to press on with treatments” even when cure is not possible. Patients need an honest explanation of their prognosis and the options for care, he said.

[I]n most regions of New Jersey, fewer than half of the advanced cancer patients whose records were examined were enrolled [in hospice care] during the last month of their life. Many entered the program for just three days or less, not enough time for it to really help, said Goodman.

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