Effect of Increased VA Hospice Care on Use of Aggressive Care and Costs for Veterans With Advanced Lung Cancer
In a study reported in JAMA Oncology, Mor et al found that veterans with advanced lung cancer treated in Veterans Affairs (VA) Medical Centers with high hospice use were more likely to receive concurrent cancer care but less likely to receive aggressive care. Moreover, veterans treated at facilities with high levels of hospice use also incurred lower costs of care.
The study included data from 13,085 veterans newly diagnosed with stage IV non–small cell lung cancer (NSCLC) from 113 VA Medical Centers with a minimum of 5 veterans diagnosed with stage IV NSCLC per year between 2006 and 2012. Aggressive treatment was defined as 2 or more hospital admissions within 30 days, tube feeding, mechanical ventilation, and intensive care unit (ICU) admission. Total costs in the first 6 months after diagnosis were calculated.
Hospice Use and Effect on Care and Cost
Veterans with NSCLC treated in a VA Medical Center in the top hospice quintile (79% hospice users) vs the bottom quintile (55% hospice users) were significantly more likely to receive concurrent cancer treatment after initiating hospice care (adjusted odds ratio [OR] = 2.28, 95% confidence interval [CI] = 1.67–3.31). However, veterans seen in VA Medical Centers in the top vs bottom hospice quintile were less likely to receive aggressive treatment in the 6 months after diagnosis (adjusted OR = 0.66, 95% CI = 0.53–0.81) and less likely to have ICU admission (adjusted OR = 0.78, 95% CI = 0.62–0.99). For the highest vs lowest quintile groups, 6-month costs were lower by an estimated $266 per day. No survival difference was observed between the highest and lowest quintile groups.
The investigators concluded, “Increasing the availability of hospice care without restricting treatment access for veterans with advanced lung cancer was associated with less aggressive medical treatment and significantly lower costs, while still providing cancer treatment.”
Vincent Mor, PhD, of the Department of Health Services, Policy & Practice, Brown University School of Public Health, is the corresponding author for the JAMA Oncology article.
Disclosures: The study was supported by an award from the U.S. Department of Veterans Affairs, Health Services Research & Development Service. The study authors’ full disclosures can be found at jamanetwork.com.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
