endoflife care for lung cancer patients in the united states and ontario background both the united states and canada offer governmentfinanced health insurance for the elderly but few studies have compared care at the end of life for cancer patients between the two systemsmethods we identified care for nonsmall cell lung cancer nsclc patients who died of cancer at age 65 years and older during 19992003 patients were identified from us surveillance epidemiology and end results seermedicare data n 13533 and the ontario cancer registry n 8100 health claims during the last 5 months of life identified chemotherapy and emergency room use hospitalizations and supportive care we estimated rates per personmonths pm for shortterm survivors died 6 months after diagnosis and longerterm survivors died 6 months after diagnosis adjusting for demographic differences to test whether monthly rates in ontario were statistically significantly different from the united states standardized differences were computed and a 99 confidence interval ci was constructed to account for the multiple tests performed all statistical tests were twosidedresults rates of chemotherapy use were statistically significantly higher for seermedicare patients than ontario patients in every month before death shortterm survivors at 5 months before death seermedicare 332 patients per 100 pm vs ontario 95 per 100 pm rate difference 237 per 100 pm 99 ci 183 to 291 per 100 pm p 001 longerterm survivors at 5 months before death seermedicare 244 patients per 100 pm vs ontario 145 per 100 pm rate difference 99 per 100 pm 99 ci 77 to 121 per 100 pm p 001 during the last 30 days of life fewer seermedicare than ontario patients were hospitalized shortterm survivors 499 vs 786 patients per 100 pm rate difference 286 per 100 pm 95 ci 229 to 344 per 100 pm p 001 longerterm survivors 441 vs 671 patients per 100 pm rate difference 230 per 100 pm 95 ci 185 to 275 per 100 pm p 001conclusions nsclc patients in both ontario and the united states used extensive endoflife care limited availability of hospice care in ontario and differing attitudes between the united states and ontario regarding endoflife care may explain the differences in practice patterns