scholarly journals 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

2020 ◽  
Vol 23 (8) ◽  
pp. 1038-1044 ◽  
Author(s):  
Carolyn J. Presley ◽  
Ling Han ◽  
John R. O'Leary ◽  
Weiwei Zhu ◽  
Emily Corneau ◽  
...  
Keyword(s):  
Lung Cancer ◽  
End Of Life ◽  
Hospice Care ◽  
Advanced Lung Cancer ◽  
Health Administration ◽  
Veteran's Health Administration ◽  
Veteran’S Health ◽  
Aggressive Care

Aggressive care at end-of-life in the Veteran’s Health Administration versus fee-for-service Medicare among patients with advanced lung cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 12025-12025
Author(s):  
Carolyn J Presley ◽  
Kiranveer Kaur ◽  
Ling Han ◽  
Pamela R. Soulos ◽  
Weiwei Zhu ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Hospice Care ◽  
Regional Level ◽  
Advanced Lung Cancer ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Health Administration ◽  
Veteran's Health Administration ◽  
Aggressive Care ◽  
Hospice Use

12025 Background: The Veteran’s Health Administration (VHA) allows simultaneous receipt of cancer treatment and hospice care, termed concurrent care, while fee-for-service Medicare does not. Although many physicians who care for patients in the VHA also care for private sector patients, it is unclear whether there is a “spillover” relation between end of life (EOL) care in the VHA and Medicare systems at the regional level. We examined temporal trends, as well as regional-level associations between Medicare and VHA EOL practice for patients with advanced lung cancer. Methods: We conducted a retrospective study on VHA and SEER-Medicare (SM) decedents from 2006-2012 with stage IV non-small cell lung cancer (NSCLC) who received any lung cancer care. Aggressive care (AC) at EOL was defined as any of the following within 30 days of death– intensive care unit (ICU) admission, no-hospice care, cardiopulmonary resuscitation(CPR), mechanical ventilation (MV), > 1 inpatient admission and receipt of chemotherapy. Descriptive statistics were used to compare outcomes. We also analyzed the association between Medicare hospital referral region (HRR) hospice admissions, Medicare HRR EOL spending, and VHA AC use adjusted for patient’s characteristics using a random intercept mixed effect logistic regression model after matching VHA facilities with Medicare facilities in a particular HRR. Results: AC use significantly decreased during the study period, from 46% to 31% among 18,371 Veterans and from 42% to 38% among 25,283 in the SM cohort, (t-test P < .05). Hospice use significantly increased within both cohorts (p < .001). The receipt of chemotherapy at EOL was similar for both cohorts throughout the study period. Veterans who received care in regions with higher hospice admissions among Medicare beneficiaries were significantly less likely to receive AC at EOL (adjusted Odds Ratio (aOR): 0.13 95%CI: 0.08-0.23, P < .001) than veterans in regions with lower Medicare hospice use. Medicare HRR spending at the EOL was not associated with receipt of AC among Medicare beneficiaries (aOR): 1.004 95%CI: 1.00-1.009, P = 0.07). Conclusions: Perhaps due to availability of concurrent care, VHA patients received less aggressive care at EOL as compared to SM patients. At the regional level, greater hospice use among Medicare beneficiaries was significantly associated with reduced AC within the VHA.

scholarly journals Association of Expanded VA Hospice Care With Aggressive Care and Cost for Veterans With Advanced Lung Cancer

JAMA Oncology ◽  
2019 ◽  
Vol 5 (6) ◽  
pp. 810 ◽  
Author(s):  
Vincent Mor ◽  
Todd H. Wagner ◽  
Cari Levy ◽  
Mary Ersek ◽  
Susan C. Miller ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Hospice Care ◽  
Advanced Lung Cancer ◽  
Aggressive Care

scholarly journals Mortality among older adults with opioid use disorders in the Veteran's Health Administration, 2000–2011

2015 ◽  
Vol 147 ◽  
pp. 32-37 ◽  
Author(s):  
Sarah Larney ◽  
Amy S.B. Bohnert ◽  
Dara Ganoczy ◽  
Mark A. Ilgen ◽  
Matthew Hickman ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Administration ◽  
Opioid Use ◽  
Veteran's Health Administration ◽  
Opioid Use Disorders ◽  
Veteran’S Health

Safety of High-Intensity Statins in the Veteran Population: Atorvastatin 40 to 80 mg Compared With Rosuvastatin 20 to 40 mg

2019 ◽  
Vol 54 (5) ◽  
pp. 405-413 ◽  
Author(s):  
Bradley Stein ◽  
Tiffany Ward ◽  
Genevieve Hale ◽  
Elise Lyver
Keyword(s):  
Statin Therapy ◽  
High Intensity ◽  
Primary Objective ◽  
Current Evidence ◽  
Major Adverse Cardiovascular Events ◽  
Atherosclerotic Cardiovascular Disease ◽  
Health Administration ◽  
Veteran's Health Administration ◽  
Comparative Safety ◽  
Veteran’S Health

Background: High-intensity statin therapy is recommended in patients with clinical atherosclerotic cardiovascular disease (ASCVD) or at high risk of ASCVD. Current evidence demonstrates efficacy of high-intensity statin therapy in reducing major adverse cardiovascular events; yet the comparative safety profile between high-intensity statin agents remains unknown. In 2011, when atorvastatin became generic, the Veteran’s Health Administration made the formulary switch from rosuvastatin to atorvastatin. Currently, rosuvastatin is generic; however, at the time of this study, it was still under patent. Objective: The primary objective was to determine if high-intensity atorvastatin compared with rosuvastatin is associated with an increased incidence of adverse drug reactions (ADRs) in the veteran population. Methods: A retrospective cohort study at James A. Haley Veterans’ Hospital compared patients receiving rosuvastatin 20 to 40mg from January 2009 to November 2011 (n = 4,165) and atorvastatin 40 to 80mg from May 2012 to June 2016 (n = 5,852). Patients were excluded if they were nonadherent to statin therapy or had a documented ADR to atorvastatin prior to formulary switch. Results: A difference in overall ADR rates was found between atorvastatin and rosuvastatin groups (4.59% vs 2.91%; odds ratio [OR], 1.61; 95% CI, 1.29 to 2.00; P < 0.05). Statistically significant differences in abnormal liver transaminases (3.99% vs 1.39%; OR, 2.95; 95% CI, 2.21 to 3.94; P < 0.05) and statin-associated muscle symptoms (1.14% vs 0.5%; OR, 2.29; 95% CI, 1.39 to 3.74; P < 0.05) were identified between groups. Patients receiving rosuvastatin were on therapy 2.5 times longer before developing an ADR. Conclusion and Relevance: High-intensity atorvastatin compared with rosuvastatin is associated with an increased incidence of ADRs.

National trends in end of life care for veterans with advanced cancer.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 3-3 ◽  
Author(s):  
Claire Elizabeth Powers Smith ◽  
Pat Coke ◽  
Monica Kluger ◽  
Arif Kamal ◽  
Michael J. Kelley
Keyword(s):  
Lung Cancer ◽  
End Of Life ◽  
Cancer Patients ◽  
Repeated Measures ◽  
Stage Iv ◽  
Health Administration ◽  
Icu Admission ◽  
Chemotherapy Administration ◽  
Stage Iv Lung Cancer ◽  
Eol Care

3 Background: It is imperative to provide quality end of life (EOL) care for cancer patients. This entails minimizing aggressive measures at the EOL. Although rates of hospice utilization within the Veteran’s Health Administration have improved, chemotherapy administration and intensive care unit (ICU) admission at the EOL, indicators of aggressive care, are not clearly declining over recent years. Methods: We identified 32,665 veterans diagnosed with stage IV lung, colorectal, or pancreatic cancer who died between 2009-2016 using VA cancer registry and Corporate Data Warehouse data through a novel EOL Dashboard Tool, which has been validated at multiple VA sites. This EOL tool reports three indicators; incidence of chemotherapy use in the last 14 days of life, ICU admission in the last 30 days of life and hospice admission or consult. Change over time, 2009-2016, was assessed using a repeated measures one-way ANOVA with post hoc test for linear trend of time for individual cancers and two-way ANOVA for all cancers combined. Results: Chemotherapy use in the last 14 days of life declined from 6.8% in 2009 to 4.4% in 2016 (p < 0.05). ICU admission in the last 30 days did not change significantly, from 13.3% in 2009 to 14.7% in 2016. The exception was stage IV lung cancer patients in whom ICU admissions increased from 12.9% to 16.2% (p = 0.01). Patients utilizing hospice services increased from 32.4% to 52.6% (p < 0.01). When combined for all years in an unadjusted analysis by VA regional network (VISN), chemotherapy use ranged geographically from 4.2% to 8.1% and for ICU admission from 8.4% to 18.0%. Conclusions: While chemotherapy 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 utilization. Compared to prior Medicare reports, veterans have similar rates of EOL chemotherapy use and fewer EOL ICU admissions, adding to a growing body of literature showing that despite veterans having poorer health and utilizing more medical resources, the VA performs at or above non-veteran health care institutions on end of life cancer care. There is notable geographic variation in aggressive EOL care.

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