Comparing US and Canadian End-of-Life Care for Cancer Patients

In a study presented by Khaki and colleagues at the 2019 ASCO Quality Care Symposium, researchers compared more aggressive end-of-life care approaches, including chemotherapy and intensive care unit (ICU) admission, between Washington State, USA, and Alberta, Canada.

What Is End-of-Life Care?

Care for people nearing the end of life who have stopped standard treatment to cure or control their disease. It includes physical, emotional, social and spiritual support for patients and families. The goal is to control pain and other symptoms so patients remain as comfortable as possible. It may include palliative care, supportive care and hospice care.

Study Methods

Despite similar populations and treatment access, researchers hypothesized that Canada’s single social health system versus the USA’s multipayer system would alter end-of-life care, potentially making it more intensive in Canada.

They examined chemotherapy and ICU admissions in patients dying between 2014-2016 with stage 2 - 4 solid cancers.

Approximately 11.200 Alberta patients and 7.900 Washington patients met criteria. Common cancers were lung (31% of Canadian versus 35% of US patients), colorectal (17% versus 9%), breast (10% versus 6%) and prostate (11% versus 4%).

Study Findings

• In the last 30 days, multiple emergency visits were similar: Washington 12.4%, Alberta 12.1%.
• In the final 14 days, chemotherapy was more common in the USA: 6,3% versus 2,7%.
• In the final 30 days, chemotherapy was more common in the USA: 13.4% versus 6,6%.
• In the final 30 days, ICU admissions were more common in the USA: 19,9% versus 3,9%.

The researchers commented: "Chemotherapy and ICU admissions during the last 30 days were more common in Washington than Alberta. Alberta’s lower ICU rate may reflect efforts to prioritize goals-of-care discussions. Future studies identifying and comparing drivers of inappropriately aggressive end-of-life care may improve cancer care for US and Alberta patients." They made this observation.

Well-designed end-of-life care delivered by trained professionals benefits patients substantially while saving billions of dollars in health expenditure.