Dartmouth Atlas Report on Cancer Care

The Dartmouth Atlas of Healthcare website 

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From from the report: 

"This Dartmouth Atlas report examines how elderly patients with poor prognosis cancer are cared for across regions and hospitals and finds remarkable variation depending on where the patients live and receive care. Even among the nation's leading medical centers, there is no consistent pattern of care or evidence that treatment patterns follow patient preferences. Rather, the report demonstrates that many hospitals and physicians aggressively treat patients with curative attempts they may not want, at the expense of improving the quality of their last weeks and months." 

Patients with cancer ... want honest conversations with their providers. This includes balanced information about the chances of disease remission or progression, and the possible benefits and discomforts of different treatment options. Most importantly, they want to be active partners with clinicians in making the decisions about the type and place of care. Too often, care for patients near the end of life falls short of the desires of patients and families." 


Fundamental to patient-centered cancer care are health care providers educating patients about their prognoses, eliciting their preferred treatment approaches, and formulating care plans that respect their choices regarding the goals of care. The majority of cancer patients want to be involved in their medical care, but a collusion of silence and health care fragmentation results in far too many patients uninformed of their prognoses and the option of hospice. Many are informed far too late, resulting in hospice referral in the last three days of life.This pattern of care often leaves the dying patient in pain and without the opportunity to say "goodbye, I love you, please carry on."

Joan M. Teno, MD, MS 


As a doctor caring for people who have serious, life-threatening conditions, I commonly ask patients to consider a few basic questions: What is most important to you as you think about the end of your life? Where would you like to be during your final days? Who would you want to care for you? What types of treatment would you want, or not want?

It is important for each of us to discuss our personal answers to these questions with our families and our doctors. It is also important for each of us to complete an advance directive that formally names those we trust to speak for us in making health care decisions if we become unable to speak for ourselves.

For people who want to be at home through the end of life, and for families who want to care for them, hospice is essential. Hospice programs provide medications needed to control pain and other discomfort, visits by highly skilled nurses, a team of professionals, and quick access to someone to answer questions or manage problems 24 hours a day.
Ira Byock, MD 

  • NPR story
  • Washington Post
  • Bloomberg

  • Quoting the NHPCO press release:

    "The Dartmouth Atlas Project is to be commended for undertaking this thorough examination of end-of-life care for Medicare beneficiaries with advance cancer," said J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization. "While the findings of variation in care are not necessarily a surprise, one of the key messages that I take away from this report is the critical need for hospitals and all healthcare professionals to ensure that all patients are informed earlier about the course of an illness and the range of options available - options that include hospice and palliative care." 
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