National Trends in End-of-Life Care for Veterans With Advanced Cancer in the Veterans Health Administration: 2009 to 2016

Abstract

PURPOSE: It is imperative to provide quality end-of-life (EOL) care for patients with cancer. Although rates of hospice use within the Veterans Health Administration have improved, antineoplastic administration and intensive care unit (ICU) admission at the EOL, indicators of aggressive care, have not clearly declined over recent years. METHODS: We identified 32,665 veterans diagnosed with stage IV lung, colorectal, or pancreatic cancer who died between 2009 and 2016 using a novel EOL Dashboard Tool created from Veterans Administration Cancer Registry data. This EOL tool reports the incidence of antineoplastic drug use in the last 14 days of life, ICU admission in the last 30 days of life, and hospice admission or consult. Change from 2009 to 2016 was assessed using a repeated measures one-way analysis of variance with post hoc test for linear trend of time for individual cancers and two-way analysis of variance for all cancers combined. RESULTS: Antineoplastic use in the last 14 days of life declined from 6.8% in 2009 to 4.4% in 2016 ( P = .03). ICU admission in the last 30 days did not change significantly, from 13.3% in 2009 to 14.7% in 2016. The exception was patients with stage IV lung cancer, in whom ICU admissions increased from 12.9% to 16.2% ( P = .01). Patients using hospice services increased from 32.4% to 52.6% ( P < .01). CONCLUSION: Although antineoplastic administration at the EOL is declining for veterans with stage IV cancer, ICU admissions are unchanged and becoming more common in stage IV lung cancer despite increasing hospice use.

Association between strong patient–oncologist agreement regarding goals of care and aggressive care at end-of-life for patients with advanced cancer

“…Of particular note is that we had high rates of hospital admission, ED use, ICU use and low hospice use-a pattern that persisted regardless of the oncologists understanding of their patient's goals of care. This pattern reflects current national patterns [40][41][42][43] that show increased use of aggressive care (especially ICU, hospitalizations, ED visits) over the past 5-10 years for patients with metastatic cancer. Efforts to reduce aggressive care have not yielded meaningful results to date.…”

The Role of Palliative Care in the Management of Patients with Lung Cancer

“…Aggressive end-of-life care Multiple recent studies have noted a trend in increasing use of aggressive inpatient end-of-life care, including intensive care unit stays and use of anticancer therapies near the end-of-life in lung cancer patients [33][34][35][36]. Aggressive cancer therapy in the last month of life is associated with increased likelihood of dying in the hospital.…”