End-of-Life Cancer Care in Ontario and the United States: Quality by Accident or Quality by Design?

Extract

In this month’s issue of the Journal, Warren et al. ( 1 ) report the results of their carefully conducted analysis of patients who died with non–small cell lung cancer in the United States and Ontario. The study design selected a group of patients with well-documented advanced cancer at diagnosis. Given the cancer type and stage, the clinical teams caring for these patients would have known the generally poor survival prognosis.

The article reports two major findings: care patterns differed between the United States and Ontario and the overall use of community palliative care appears to have fallen short of the average patient preferences in both countries—most patients prefer supportive measures that avoid a hospital death ( 2 , 3 ). The US patients received more chemotherapy, whereas Ontario patients had more inpatient days, greater emergency room use, and were much more likely to die in the hospital. Despite relatively high use of community supportive care, the rates of inpatient death are too high in the United States and much too high in Ontario.