Cancer. 2015 Dec 15. doi: 10.1002/cncr.29827. [Epub ahead of print]

The rise of concurrent care for veterans with advanced cancer at the end of life.

Mor V1,2, Joyce NR1,3, Coté DL1, Gidwani RA4,5,6, Ersek M7,8, Levy CR9, Faricy-Anderson KE1,10, Miller SC1,2, Wagner TH4,5,6, Kinosian BP7,11, Lorenz KA5,6,Shreve ST12,13.

Author information

• 1Center of Innovation, Providence Veterans Health Administration (VA) Medical Center, Providence, Rhode Island.
• 2Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island.
• 3Department of Health Policy, Harvard Medical School, Boston, Massachusetts.
• 4VA Health Economics Resource Center, VA Palo Alto Healthcare System, Palo Alto, California.
• 5Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, California.
• 6School of Medicine, Stanford University, Stanford, California.
• 7Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.
• 8National Performance Reporting and Outcomes Measurement to Improve the Standard of Care at End-of-Life (PROMISE) Center, US Department of Veterans Affairs, Washington, DC.
• 9Eastern Colorado VA Healthcare System, Denver, Colorado.
• 10Warren Alpert Medical School of Brown University, Providence, Rhode Island.
• 11Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
• 12Hospice and Palliative Care Program, US Department of Veterans Affairs, Washington, DC.
• 13Penn State College of Medicine, Hershey, Pennsylvania.

Abstract

BACKGROUND:

Unlike Medicare, the Veterans Health Administration (VA) health care system does not require veterans with cancer to make the "terrible choice" between receipt of hospice services or disease-modifying chemotherapy/radiation therapy. For this report, the authors characterized the VA's provision of concurrent care, defined as days in the last 6 months of life during which veterans simultaneously received hospice services and chemotherapy or radiation therapy.

METHODS:

This retrospective cohort study included veteran decedents with cancer during 2006 through 2012 who were identified from claims with cancer diagnoses. Hospice and cancer treatment were identified using VA and Medicare administrative data. Descriptive statistics were used to characterize the changes in concurrent care, hospice, palliative care, and chemotherapy or radiation treatment.

RESULTS:

The proportion of veterans receiving chemotherapy or radiation therapy remained stable at approximately 45%, whereas the proportion of veterans who received hospice increased from 55% to 68%. The receipt of concurrent care also increased during this time from 16.2% to 24.5%. The median time between hospice initiation and death remained stable at around 21 days. Among veterans who received chemotherapy or radiation therapy in their last 6 months of life, the median time between treatment termination and death ranged from 35 to 40 days. There was considerable variation between VA medical centers in the use of concurrent care (interquartile range, 16%-34% in 2012).

CONCLUSIONS:

Concurrent receipt of hospice and chemotherapy or radiation therapy increased among veterans dying from cancer without reductions in the receipt of cancer therapy. This approach reflects the expansion of hospice services in the VA with VA policy allowing the concurrent receipt of hospice and antineoplastic therapies. Cancer 2015. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.