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Only one in five U.S. cancer patients over age 65 die in the hospital, compared with more than half of such patients in Belgium and Canada, about four in 10 in England, Norway, and Germany, and three in 10 in the Netherlands, according to a  published in today’s Journal of the American Medical Association. However, the U.S. patients were more than twice as likely as the patients in other countries to be admitted to the intensive care unit in the last six months of life. They also were more likely to receive outpatient chemotherapy. Per capita hospital expenditures for the cancer patients were highest on average in Canada and Norway, but the U.S. had the highest average expenditure per hospital day. “In the early 1980s, more than 70% of U.S. cancer patients died in hospital,” the authors note. “Over the last 30 years, recognition of preferences for home-based end-of-life care and patients’ rights to refuse medical interventions and economic pressures to lower end-of-life costs and expand hospice use have all played an important role in advancing end-of-life care. Yet excessive utilization of high-intensity care near the end of life, particularly in the United States relative to other developed countries, underscores the need for continued progress to improve end-of-life care practices.”