In end-of-life cancer care, geography may be destiny
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When it comes to how much end-of-life care a patient with cancer receives, geography may, indeed, be destiny, according to new research led by Harvard Medical School that found striking differences in terminal care across different parts of the country.

The findings, published in the July issue of Health Affairs, reveal that in some areas, people with end-stage lung and colorectal cancers received more intensive care and racked up twice as much in spending in the last month of life.

Notably, the study found, the variations did not stem from patient beliefs and preferences. Instead, they were fueled by differences in physicians’ beliefs about end-of-life care and practice style, as well as by differences in the availability of health care services by region.

The findings, the investigators said, are particularly concerning in light of the growing body of research that shows additional care at the end of life does not contribute to better outcomes in cancer.

“Numerous studies have shown that greater spending and more care at the end of life do not contribute to better outcomes,” said study author Nancy Keating, professor of health care policy and medicine at Harvard Medical School and a physician at Brigham and

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