Measuring Up? End-of-Life Cancer Care in California

Dartmouth Atlas of Health Care

In California, many who die of cancer receive more aggressive care at the end of life than in the rest of the country. Cancer treatment also varies widely from region to region and from hospital to hospital within the state.

August 2013

This report on treatment of cancer patients in California as they approach death indicates there is sharp variation in the aggressiveness of care by region and by hospital. Such variation is not explained by differences among patients in terms of age, sex, or race. The report also shows trends in advanced cancer care from 2003–07 to 2010.

Over this period, there have been some improvements in care. Patients with advanced cancer were less likely to die in the hospital in 2010 compared to 2003–07, and slightly more likely to receive hospice care. However, compared to the national average, dying cancer patients in California spent more days in the hospital and were more likely to receive advanced life-support procedures such as endotracheal intubation, feeding tubes, and cardiopulmonary resuscitation in the last month of life.

The research found:

  • Compared to the country as a whole, in 2010 California's patients with advanced cancer were more likely to die in the hospital, spend time in an ICU, receive life-support procedures in the last month of life, and receive chemotherapy in the last two weeks of life.
  • Some regions saw a steep increase in the percentage of patients receiving life-sustaining procedures in the last month of life, while others saw no change or a decrease.
  • In 2010, nearly one-third of Californians with poor-prognosis cancer spent their last days in hospitals and ICUs, a decline of 7% compared with 2003–07 but still 20% higher than the national average.
  • More than 10% of Californians with poor-prognosis cancer who were in the last month of life received advanced life-support procedures in 2010.
  • About 6% of cancer patients were given chemotherapy in the last two weeks of life in 2010; in some regions of the state and in some hospitals, the rate exceeded 10%.
  • The percentage of dying cancer patients in California who received hospice care increased slightly between 2003–07 and 2010, but remained below the national average. In some California hospitals, referral to hospice care occurred so close to the day of death that it was unlikely to have provided much assistance or comfort to patients.

The complete report and related data tables are available as Document Downloads.