Go to content

High end-of-life cancer hospitalization rates, care costs in Canada: study


End-of-life cancer hospitalization rates and care costs vary significantly between seven developed countries, with Canada at or near the top of the list for both measures, according to a new international study that included research conducted at Sunnybrook Health Sciences Centre and the Institute for Clinical Evaluative Sciences (ICES) in Toronto.

The study, which examined people over the age of 65 who died with cancer in 2010, found Canada had the highest number of people dying in acute care hospitals, at 52.1 per cent of deaths. Canada was also at the top of the rankings for per capita hospital expenditures in the last 180 days of life, at US $21,840.

In comparison, 29.4 per cent of deaths took place in hospital in the Netherlands, and the per capita costs in England were half that of Canada’s, at US $9,342.

“The research focused on people who had died with cancer, as that illness alone accounts for more than 20 per cent of deaths in most developed countries. It’s also among the most resource-intensive illnesses, and is easily identifiable in health records,” says Dr. Rob Fowler, study co-author, adjunct scientist at the Institute for Clinical Evaluative Sciences and critical care physician at Sunnybrook Health Sciences Centre.

One explanation for the high in-hospital death rates in developed nations like Canada is that “national healthcare systems may have under-developed end-of-life alternatives to hospitalization like hospice, home and palliative care,” says Dr. Fowler, who is also associate professor, department of medicine and interdepartmental division of critical care medicine, University of Toronto.

The study also found lower rates of acute care hospital admissions, length of stay and in-hospital deaths in the US and the Netherlands, suggesting that end-of-life care can evolve to reflect patient preferences and goals about where to die.

The study was conducted by researchers from an international consortium examining end-of-life cancer care data for seven countries, including Canada, Belgium, England, Germany, the Netherlands, Norway and the United States. Dr. Fowler obtained Canadian data for the study from health records analyzed at ICES.

The study was published today in the Journal of the American Medical Association.

Author block: Justin E. Bekelman, Scott D. Halpern, Carl Rudolf Blankart, Julie P. Bynum, Joachim Cohen, Robert Fowler, Stein Kaasa, Lukas Kwietniewski, Hans Olav Melberg, Bregje Onwuteaka-Philipsen, Mariska Oosterveld-Vlug, Andrew Pring, Jonas Schreyögg, Connie M. Ulrich, Julia Verne, Hannah Wunsch, Ezekiel J. Emanuel; for the International Consortium for End-of-Life Research (ICELR).

The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario

Sunnybrook Health Sciences Centre is inventing the future of healthcare for the 1.2 million patients the hospital cares for each year through the dedication of its more than 10,000 staff and volunteers. An internationally recognized leader in research and education and a full affiliation with the University of Toronto distinguishes Sunnybrook as one of Canada’s premier academic health sciences centres. Sunnybrook specializes in caring for high-risk pregnancies, critically-ill newborns and adults, offering specialized rehabilitation and treating and preventing cancer, cardiovascular disease, neurological and psychiatric disorders, orthopaedic and arthritic conditions and traumatic injuries. The Hospital also has a unique and national leading program for the care of Canada’s war veterans. For more information about how Sunnybrook is inventing the future of healthcare please visit us online at www.sunnybrook.ca


  • Sybil Millar
  • Communications Advisor, Sunnybrook Health Sciences Centre
  • [email protected]
  • 416-480-4040
  • Kathleen Sandusky
  • Media Advisor, ICES
  • [email protected]
  • (o) 416-480-4780 or (c) 416-434-7763


Contributing ICES Scientists

Research Programs

Associated Sites

Read the Journal Article