How might VA-Medicare differences inform the delivery of end-of-life cancer care?

摘要

I n this issue of Cancer, Keating et al evaluated differences in the use of aggressive medical interventions during the last 30 days of life between elderly patients with metastatic lung or colorectal cancer treated in the Veterans Health Administration (VHA) medical system or under fee-for-service Medicare. By using propensity score matching to control for differences in the patient populations, they compared receipt of chemotherapy within 14 days of death, intensive-care unit admissions within 30 days of death, and >1 emergency room visit within 30 days of death for 2913 male veterans who were diagnosed or received their initial course of treatment in the Department of Veterans Affairs (VA) and 2913 nonve-terans by using linked VA-Medicare data (for veterans) and SEER-Medicare data (for nonveterans). Adjusted comparison found nonveterans more likely than veterans to receive chemotherapy within 14 days of death (7.5% vs 4.6%), more likely to be admitted to an intensive care unit (19.7% vs 12.5%), or to make more than 1 emergency room visit (14.7% vs 13.1 %) in their last month of life.