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. 2020 Aug;23(8):1038-1044.
doi: 10.1089/jpm.2019.0485. Epub 2020 Mar 2.

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

Carolyn J Presley  1 , Ling Han  2 , John R O'Leary  2 , Weiwei Zhu  2 , Emily Corneau  3 , Herta Chao  2   4 , Tracy Shamas  4 , Michal Rose  2   4 , Karl Lorenz  5 , Cari R Levy  6 , Vincent Mor  3   7 , Cary P Gross  8
Affiliations

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

Carolyn J Presley et al. J Palliat Med. 2020 Aug.

Erratum in

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.

Keywords: concurrent care; end-of-life; hospice; lung cancer; quality of life.

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Conflict of interest statement

Dr. C.J.P. reports grants from Ohio State University, grants from Yale Lung Spore Career Development Award, grants from Robert Wood Johnson Veterans Affairs Clinical Scholar Program, during the conduct of the study; other from Potentia Metrics, outside the submitted work; Dr. V.M. reports other from NaviHealth, Inc., other from PointRight, Inc., during the conduct of the study; Dr. C.P.G. reports grants from American Cancer Society, during the conduct of the study; grants from NCCN/Pfizer, grants from Johnson & Johnson, personal fees from Flatiron Health, outside the submitted work. All other authors have nothing to disclose.

Figures

FIG. 1.
FIG. 1.
Prevalence of aggressive end-of-life care measures by death year. *Denotes p < 0.001 from Z-test prevalence between 2006 and 2012. Authors' analysis of data from the VACCR and the VHA Information Resource Center, 2006–2012. VACCR, Veterans Affairs Central Cancer Registry; VHA, Veteran's Health Administration.
FIG. 2.
FIG. 2.
Multilevel Random Intercept Model* of aggressive care at the end of life by levels of concurrent care (N = 18,371 decedents). Authors' analysis of data from the VACCR and the VHA Information Resource Center, 2006–2012. *Model adjusted for patient and facility-level covariates. CC, concurrent care.
See this image and copyright information in PMC

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