High end-of-life cancer hospitalization rates, care costs in Canada: study
End-of-life cancer hospitalization rates and care costs vary significantly between seven developed countries, with Canada at or near the top of the list for both measures, according to a new study involving a Sunnybrook researcher.
The study, which examined people over the age of 65 who died with cancer in 2010, found Canada had the highest number of people dying in acute care hospitals, at 52.1% of deaths. Canada was also at the top of the rankings for per capita hospital expenditures in the last 180 days of life, at US$21,840.
In comparison, 29.4% of deaths took place in hospital in the Netherlands, and the per capita costs in England were half that of Canada’s, at US$9,342.
“The research focused on people who had died with cancer, as that illness alone accounts for more than 20% of deaths in most developed countries. It’s also among the most resource-intensive illnesses, and is easily identifiable in health records,” says Dr. Rob Fowler, study co-author, adjunct scientist at the Institute for Clinical Evaluative Sciences (ICES) and critical care physician at Sunnybrook Health Sciences Centre.
One explanation for the high in-hospital death rates in developed nations like Canada is that “national health care systems may have under-developed end-of-life alternatives to hospitalization like hospice, home and palliative care,” says Dr. Fowler, who is also associate professor, department of medicine and interdepartmental division of critical care medicine, University of Toronto.
The study also found lower rates of acute care hospital admissions, length of stay and in-hospital deaths in the US and the Netherlands, suggesting that end-of-life care can evolve to reflect patient preferences and goals about where to die.
The study was conducted by researchers from an international consortium examining end-of-life cancer care data for seven countries, including Canada, Belgium, England, Germany, the Netherlands, Norway and the United States. Dr. Fowler obtained Canadian data for the study from health records analyzed at ICES.
The study was published today in the Journal of the American Medical Association (JAMA).