Advanced NSCLC Patients Still Receive Aggressive Treatment

PROVIDENCE, RI—Aggressive care for cancer patients appears to be increasing at the end of life, and the VA is part of that trend, according to a new study.

The report published in the Journal of Palliative Medicine found that invasive procedures are commonly performed when veterans with Stage IV non-small cell lung cancer (NSCLC) reach their last month of life.1

To evaluate the use of invasive procedures at the end of life in patients with advanced NSCLC, researchers from the Center of Innovation at the Providence, RI, VAMC and the Alpert Medical School of Brown University conducted a retrospective cohort study of veterans with newly diagnosed stage IV NSCLC who died between 2006 and 2012. Records of 19, 930 patients were pulled from the VA Central Cancer Registry.

Including all VA and Medicare fee-for-service healthcare utilization and expenditure data, the primary outcome was the number of invasive procedures performed in the last month of life. Procedures were classified into three categories: minimally invasive, life-sustaining and major-operative procedures.

Results indicated that 15.1% of subjects underwent 5,523 invasive procedures during the last month of life. The majority of procedures (69.6%) were classified as minimally invasive.

The receipt of procedures in the last month of life was associated with receipt of chemotherapy (odds ratio [OR] 3.68, 95% confidence interval [CI] 3.38-4.0) and ICU admission (OR 3.13, 95% CI 2.83-3.45) and was inversely associated with use of hospice services (OR 0.35, 95% CI 0.33-0.38), the study authors noted.

  1. Tukey MH, Faricy-Anderson K, Corneau E, Youssef R, Mor V. Procedural Aggressiveness in Veterans with Advanced Non-Small-Cell Lung Cancer at the End of Life. J Palliat Med. 2017 Dec 21. doi: 10.1089/jpm.2017.0022. [Epub ahead of print] PubMed PMID: 29265906.

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