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    End-of-Life Cancer Care Varies by Region

    Study Shows Wide Variations Across the U.S. in Aggressive Care vs. Hospice Care

    ICU Admissions Vary by Region

    The chances of dying in a hospital vary based on where you live. For example, close to 29% of patients with advanced cancer died in a hospital between 2003 and 2007, with the highest rate of hospital deaths seen in New York City. Rate of hospital deaths were also high in some of the areas surrounding New York City.

    Admissions to ICUs varied by more than sevenfold across regions, with more than 40% of cancer patients admitted to the ICU during their last month of life in Huntsville, Ala., and 6% of cancer patients admitted to the ICU in Mason City, Iowa.

    It doesn't have to be this way, says Karen Wolk Feinstein, president and CEO of the Pittsburgh Regional Health Initiative, a supporting organization of the nonprofit Jewish Healthcare Foundation.

    "So many families given the option to opt out would do so," Feinstein says. "We get engaged in freeing people from ICUs and helping those who promised their relatives that this would not happen, and that there would be no breathing apparatus or feeding tubes."

    Some hospitals do try to make patients as comfortable as possible toward the end of life, she says. "This is the exception."

    Feinstein suggests engaging your primary care doctor in these discussions early on to help navigate the end-of-life experience.

    "Having advanced directives and choosing a health care proxy can also help make sure your wishes are honored," explains J. Donald Schumacher, PsyD, president and CEO of the National Hospice and Palliative Care Organization (NHPCO), a nonprofit group in Alexandria, Va. Schumacher is not affiliated with the Dartmouth Atlas Project.

    "Don't leave it up for someone else to decide for you. You need to have these conversations with your family," Schumacher says.

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