Older men in the VHA health system less likely to have aggressive end-of-life treatment

Men aged older than 66 years diagnosed with metastatic lung or colorectal cancer treated in the Veterans Health Administration health care system received less aggressive chemotherapy and had fewer ICU stays at the end of life compared with similar men treated in fee-for-service Medicare.

Researchers analyzed end-of-life data from 2,913 men in the Veterans Health Administration group and from 2,913 similar men treated in the public sector living in SEER areas.

After adjustment, men treated in the Veterans Health Administration group were less likely than men treated in the public sector to receive chemotherapy within 14 days of death (4.6% vs. 7.5%; P<.001).

Men in the Veterans Health Administration group were also less likely to be admitted to an ICU within 30 days of death vs. those treated in fee-for-service Medicare system (12.5% vs. 19.7%; P<.001)

Finally, those in the Veterans Health Administration group were slightly less likely to have more than one emergency department visit within 30 days of death compared with those treated in the public sector (13.1 vs. 14.7; P=.09).

In adjusted analysis, among those treated in the Veterans Health Administration health care system, blacks were more likely than whites to have more than one ED visit in the last month of life (17.5% vs. 12.9%; P=.03).

“Additional studies are needed to assess whether men who undergo less aggressive care at the end of life also experience better outcomes,” the researchers wrote.

Keating NL. Cancer. 2010;doi:10.1002/cncr.25077.