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Presley CJ, Han L, O'Leary JR, Zhu W, Corneau E, Chao H, Shamas T, Rose M, Lorenz K, Levy CR, Mor V, Gross CP. Concurrent Hospice Care and Cancer-Directed Treatment for Advanced Lung Cancer and Receipt of Aggressive Care at the End of Life in the Veteran's Health Administration. J Palliat Med 2020; 23:1038-1044. [PMID: 32119800 DOI: 10.1089/jpm.2019.0485] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: Aggressive care at the end of life (EOL) is a persistent issue for patients with stage IV nonsmall cell lung cancer (NSCLC). We evaluated the use of concurrent care (CC) with hospice care and cancer-directed treatment simultaneously within the Veteran's Health Administration (VHA) and aggressive care at the EOL. Objective: To determine whether VHA facility-level CC is associated with changes in aggressive care at the EOL. Design/Setting: Veterans with stage IV NSCLC who died between 2006 and 2012 and received lung cancer care within the VHA. Measurements: The primary outcome was aggressive care at EOL (i.e., hospital admissions, chemotherapy, and intensive care unit) within the last month of life. To compare aggressive care across VHA facilities, we used a random intercept multilevel logistic regression model to examine the association between facility-level CC within each study year (<10%, 10% to 19%, and ≥20%) and aggressive care at the EOL among the decedents as a binary outcome. Results: In total, 18,371 veterans with NSCLC at 154 VHA facilities were identified. Facilities delivering CC for ≥20% of veterans (high CC) increased from 20.0% in 2006 to 43.2% in 2012 (p < 0.001). Overall, hospice care significantly increased and aggressive care at EOL decreased over the study period. However, facility-level CC adoption was not associated with any difference in aggressive care at EOL (adjusted odds ratio high CC vs. low CC: 0.91 [95% CI, 0.79 to 1.05], p = 0.21). Conclusions: Although the VHA adoption of CC increased hospice use among patients with NSCLC, additional measures may be needed to decrease aggressive care at the EOL.
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Affiliation(s)
- Carolyn J Presley
- Department of Internal Medicine, Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ling Han
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - John R O'Leary
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Weiwei Zhu
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Emily Corneau
- Providence Veterans Health Administration Medical Center, Center of Innovation, Providence, Rhode Island, USA
| | - Herta Chao
- Yale University School of Medicine, New Haven, Connecticut, USA.,Connecticut Veterans Health Administration Medical Center, West Haven, Connecticut, USA
| | - Tracy Shamas
- Connecticut Veterans Health Administration Medical Center, West Haven, Connecticut, USA
| | - Michal Rose
- Yale University School of Medicine, New Haven, Connecticut, USA.,Connecticut Veterans Health Administration Medical Center, West Haven, Connecticut, USA
| | - Karl Lorenz
- Department of Medicine, Primary Care and Population Health, Stanford University, Palo Alto, California, USA
| | - Cari R Levy
- Eastern Colorado VA Healthcare System, Aurora, Colorado, USA
| | - Vincent Mor
- Providence Veterans Health Administration Medical Center, Center of Innovation, Providence, Rhode Island, USA.,Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Cary P Gross
- National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut, USA
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Merchant SJ, Brogly SB, Goldie C, Booth CM, Nanji S, Patel SV, Lajkosz K, Baxter NN. Palliative Care is Associated with Reduced Aggressive End-of-Life Care in Patients with Gastrointestinal Cancer. Ann Surg Oncol 2018; 25:1478-1487. [DOI: 10.1245/s10434-018-6430-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Indexed: 12/25/2022]
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