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How patients with advanced cancer spend their last days probably has more to do with the medical infrastructure in their region and less to do with their wishes, finds a new study of end of life care by the Dartmouth Atlas Project.

"The use of hospice care varied markedly across regions and hospitals," the study notes. "In at least 50 academic medical centers, less than half of patients with poor prognosis cancer received hospice services."

And when they did receive hospice referrals, it was often too late. "In some hospitals, referral to hospice care occurred so close to the day of death that it was unlikely to have provided much assistance and comfort to patients," the study concluded. "Published research strongly indicates that care patterns near the end of life are partly driven by the local availability of health resources, such as hospital beds and new treatment technologies," the study adds. "In addition, communication with cancer patients and families often fails to include accurate information about prognosis and treatment options."

Bottom line: "High hospital day rates and low hospice use are often signs of overly aggressive treatment," the study concludes. "Further work needs to be done to improve end-of-life care." The study, including statistics for Medicare beneficiaries, is at .