How would you want to live your last days if you were dying of cancer? Would you want to be made comfortable with hospice care at home in the company of loved ones? Or would you choose heroic but frequently futile cancer treatments in the hospital?

It’s a question worth considering. According to the Dartmouth Institute for Health Policy and Clinical Practice, every year 1.5 million Americans will be diagnosed with cancer and 500,000 will die of the disease. How they die was the subject of a recent Dartmouth Atlas Project report on people on Medicare over the age of 65 diagnosed with terminal cancer between 2003 and 2007. The study found whether cancer patients spend their final days at home or in the hospital is largely influenced by where they live or the hospital where they receive treatment.

Nationwide, more than 30 percent of cancer patients died in hospitals — either on life support or still undergoing aggressive treatment — and the rate was as high as 50 percent in some regions. It also was reported that many patients didn’t fully understand the severity of their cancer prognoses or all available options when making treatment decisions. Sadly, for half of the patients, hospice care was only recommended during the last three days of life. As the authors of the report wrote, “this pattern of care often leaves the dying patient in pain and without the opportunity to say, ‘goodbye, I love you, please carry on.’ ”

The truth regarding a patient’s prognosis can be difficult to discuss, but the study recommended academic medical centers take the lead on training the next generation of cancer care providers to facilitate rather than fear these candid conversations.

Because choosing how to die can be as important as choosing how to live.