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

Publication ,  Journal Article
Smith, CEP; Kamal, AH; Kluger, M; Coke, P; Kelley, MJ
Published in: J Oncol Pract
June 2019

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.

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Published In

J Oncol Pract

DOI

EISSN

1935-469X

Publication Date

June 2019

Volume

15

Issue

6

Start / End Page

e568 / e575

Location

United States

Related Subject Headings

  • Veterans Health Services
  • Veterans
  • United States
  • Time Factors
  • Terminal Care
  • Pancreatic Neoplasms
  • Oncology & Carcinogenesis
  • Male
  • Lung Neoplasms
  • Intensive Care Units
 

Citation

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Smith, C. E. P., Kamal, A. H., Kluger, M., Coke, P., & Kelley, M. J. (2019). National Trends in End-of-Life Care for Veterans With Advanced Cancer in the Veterans Health Administration: 2009 to 2016. J Oncol Pract, 15(6), e568–e575. https://doi.org/10.1200/JOP.18.00559
Smith, Claire E. P., Arif H. Kamal, Monica Kluger, Patty Coke, and Michael J. Kelley. “National Trends in End-of-Life Care for Veterans With Advanced Cancer in the Veterans Health Administration: 2009 to 2016.J Oncol Pract 15, no. 6 (June 2019): e568–75. https://doi.org/10.1200/JOP.18.00559.
Smith CEP, Kamal AH, Kluger M, Coke P, Kelley MJ. National Trends in End-of-Life Care for Veterans With Advanced Cancer in the Veterans Health Administration: 2009 to 2016. J Oncol Pract. 2019 Jun;15(6):e568–75.
Smith, Claire E. P., et al. “National Trends in End-of-Life Care for Veterans With Advanced Cancer in the Veterans Health Administration: 2009 to 2016.J Oncol Pract, vol. 15, no. 6, June 2019, pp. e568–75. Pubmed, doi:10.1200/JOP.18.00559.
Smith CEP, Kamal AH, Kluger M, Coke P, Kelley MJ. National Trends in End-of-Life Care for Veterans With Advanced Cancer in the Veterans Health Administration: 2009 to 2016. J Oncol Pract. 2019 Jun;15(6):e568–e575.

Published In

J Oncol Pract

DOI

EISSN

1935-469X

Publication Date

June 2019

Volume

15

Issue

6

Start / End Page

e568 / e575

Location

United States

Related Subject Headings

  • Veterans Health Services
  • Veterans
  • United States
  • Time Factors
  • Terminal Care
  • Pancreatic Neoplasms
  • Oncology & Carcinogenesis
  • Male
  • Lung Neoplasms
  • Intensive Care Units