The rise of concurrent care for veterans with advanced cancer at the end of life

BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSIONS 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. Concurrent receipt of hospice and chemotherapy or radiation therapy has increased among veterans who die with cancer without reductions in the receipt of cancer therapy. This approach reflects the expansion of hospice services in the Veterans Health Administration with its policy of allowing the concurrent receipt of hospice care and antineoplastic therapies.