Surprise Results of 7-Country End-of-Life Study

Surprise Results of 7-Country End-of-Life Study

Penn-Led Analysis Finds Elderly U.S. Cancer Patients Least Likely To Die In Hospital

A seven-country study of end-of-life treatments and costs headed by Ezekiel Emanuel and Justin Bekelman has surprisingly found that elderly U.S. cancer patients spend the least time in the hospital during the last six months of their life. However, a relatively high price is paid for that care -- but not the world's highest price.


Penn's Justin Bekelman and Ezekiel Emanuel were respectively Lead Author and Senior Author of the seven-country study. Both are LDI Senior Fellows.

Widely held assumptions
Some of study's results are striking because they run counter to  widely held assumptions that the U.S. has both the worst and most expensive end-of-life care among the world's industrialized countries. 

Emanuel, MD, PhD, LDI Senior Fellow and senior author of the study, is the Chair of Medical Ethics and Health Policy at Penn's Perelman School of Medicine; Bekelman, MD and LDI Senior Fellow, is an Associate Professor of Radiation Oncology at Perelman.

Originally published in the Journal of the American Medical Association, the new study, which focused on cancer patients over 65, has generated headlines in a variety of major media outlets including the Washington Post, Vox and Newsworks.

'Surprised and shocked'
"When I tell people the results -- we have the lowest deaths in the hospital and we're not the most expensive -- there isn't a single person who isn't surprised and shocked," Emanuel told the Washington Post.

The analysis of data from the U.S., Canada, Norway, Germany, Belgium, the Netherlands and England found that the lowest health care spending for this demographic during the last six months of life occurred in England -- at $9,342. U.S. costs were $18,500; Canada has the highest costs at $21,840.

The study found that elderly U.S. cancer patients were the most likely to receive aggressive high-tech, high-cost care. They are also twice as likely as any other country except Germany to be admitted to intensive care units during the last six months of life.

'Concerted effort'
In an interview with Penn News, Bekelman, the study's lead author noted, "The U.S. continues to have high rates of ICU admissions and other markers of care intensity near the end of life. We can do better. We need a concerted effort toward making end-of-life care more consistent with our patients' wishes."

Scott Halpern, MD, PhD, an Assistant Professor of both Medicine and Epidemiology at Perelman, LDI Senior Fellow, and founding Director of the FIELDS center for end-of-life decision science was also a researcher on the project.