Center of Innovation, Providence Veterans Health Administration (VA) Medical Center, Providence, Rhode Island.
Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island.
Cancer. 2016 Mar 1;122(5):782-90. doi: 10.1002/cncr.29827. Epub 2015 Dec 15.
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.
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.
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).
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 2016;122:782-790. © 2015 American Cancer Society.
与医疗保险不同，退伍军人健康管理局（VA）的医疗保健系统不要求癌症患者在接受临终关怀服务或改变疾病的化疗/放疗之间做出“可怕的选择”。在本报告中，作者描述了 VA 提供的同时护理，定义为在生命的最后 6 个月中，患者同时接受临终关怀服务和化疗或放疗的天数。
这项回顾性队列研究包括 2006 年至 2012 年间患有癌症的退伍军人，他们是从癌症诊断的索赔中确定的。临终关怀和癌症治疗是使用 VA 和医疗保险管理数据来确定的。使用描述性统计来描述同时护理、临终关怀、姑息治疗和化疗或放疗的变化。
接受化疗或放疗的退伍军人比例保持稳定在 45%左右，而接受临终关怀的退伍军人比例从 55%增加到 68%。在此期间，同时护理的比例也从 16.2%增加到 24.5%。从开始临终关怀到死亡的中位数时间保持稳定，约为 21 天。在生命的最后 6 个月接受化疗或放疗的退伍军人中，从治疗结束到死亡的中位数时间范围从 35 天到 40 天。VA 医疗中心之间同时护理的使用存在很大差异（2012 年的四分位间距为 16%-34%）。
在癌症死亡的退伍军人中，同时接受临终关怀和化疗或放疗的比例增加，而癌症治疗的比例没有下降。这种方法反映了 VA 中临终关怀服务的扩展，VA 政策允许同时接受临终关怀和抗肿瘤治疗。癌症 2016；122:782-790。©2015 美国癌症协会。
