Concurrent Care and Aggressive End-of-Life Lung Cancer Care

The Veteran’s Health Administration (VHA) allows concurrent care (CC): cancer treatment + hospice care while Medicare does not. Methods: This study identified 43,654 decedents with advanced non–small cell lung cancer between 2006-2012 from VHA and SEER-Medicare (SM). We assessed the prevalence of 6 end-of-life (EOL) aggressiveness indicators during the month before death in 2006-2012: no-hospice use, chemotherapy use, receipt of mechanical ventilation (MV), receipt of cardiopulmonary resuscitation (CPR), intensive care unit (ICU) admission, and >1 inpatient admissions. We then examined the prevalence of each aggressive EOL indicator among 120 VHA facilities in 2012 according to quartile of change in facility-level CC adoption between 2006-2012. The median age of the VHA sample was 67y vs. 76y in the SM sample. Among 18, 371 Veterans and 25,283 Medicare beneficiaries, 64.8% vs. 56.2% received at least 1 of the 6 aggressive EOL indicators, respectively. Among the 2012 VHA sample, the high adoption facilities (N=33, CC increasing 9-21%) appeared to have the lowest prevalence of aggressive EOL care with no-hospice (10.0%), ICU admission (0.9%), and >1 inpatient admission (2.8%) in comparison to moderate (N=27), low (N=28) or no (N=32) CC adoption. The use of concurrent care varies dramatically across VHA facilities. The high adopter CC VHA facilities appeared to have lower prevalence of aggressive EOL care. Aggressive EOL care differs between the VHA and SM.