title: Effect of palliative care services on the aggressiveness of end-of-life care in the Veteran's Affairs cancer population.
abstract: BACKGROUND
  Cancer care near the end of life (EOL) has become more aggressive over the years. Palliative care services (PCS) may decrease this aggressive cancer care in terminally ill cancer patients. Our objective was to observe the aggressiveness of cancer care near the EOL among Veterans Affairs cancer patients before and after the institution of a PCS team. We also assessed the time taken prior to death to initiate a PCS consultation and its effect on the aggressiveness of cancer care near the EOL.
  
  
  METHODS
  This is a retrospective chart review analysis performed at the local Veterans Affairs hospital looking at the last 100 patients in each of the years, 2002 and 2008, who died with active cancer. Only patients in 2008 had access to a PCS team.
  
  
  RESULTS
  In the last 30 days of life, compared to 2002, patients in 2008 had a higher incidence of: chemotherapy administration, more than one hospital admission, more than 14 days of hospital stay, intensive care unit admissions, and in-hospital deaths. Patients with timely PCS consults in 2008 appeared to have a lower incidence of: chemotherapy administration, more than one emergency department visit, more than one hospital admission, more than 14-day hospital stays, intensive care unit admissions, and deaths in the hospital. Timely PCS consults were associated with earlier and more frequent hospice referral.
  
  
  CONCLUSIONS
  Cancer care near the EOL has become more aggressive with time at one of the hospitals in the Veterans Affairs healthcare system (VAHS). Institution of a PCS service was unable to completely decrease this trend of increasing aggressiveness of cancer care near the EOL. However, timely PCS consults may help attenuate this aggressiveness.
authors: Creighton University School of Medicine, Division of Hematology/Oncology, University of Nebraska Medical Center, Division of Hematology/Oncology and Geriatric Medicine, Omaha, Nebraska, USA.
authors: Wilson I
authors: WI
authors: Gonsalves
authors: Tsewang
authors: T
authors: Tashi
authors: Jairam
authors: J
authors: Krishnamurthy
authors: Tracy
authors: T
authors: Davies
authors: Stephanie
authors: S
authors: Ortman
authors: Ramya
authors: R
authors: Thota
authors: Ibrahim
authors: I
authors: Aldoss
authors: Ashwin
authors: A
authors: Ganta
authors: Mudappa
authors: M
authors: Kalaiah
authors: Neha
authors: N
authors: Didwaniya
authors: Catherine
authors: C
authors: Eberle
authors: Apar K
authors: AK
authors: Ganti
authors: Peter T
authors: PT
authors: Silberstein
authors: Shanmuga
authors: S
authors: Subbiah
mesh_terms: D032722:Advance Care Planning / Q000458:organization & administration / Q000639:trends*; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D004363:Drug Utilization; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006787:Hospitals, Veterans / Q000592:standards / Q000639:trends*; D006801:Humans; D008297:Male; D009329:Nebraska; D009362:Neoplasm Metastasis; D009369:Neoplasms / Q000473:pathology / Q000628:therapy*; D010166:Palliative Care / Q000592:standards / Q000639:trends*; D013727:Terminal Care / Q000592:standards / Q000639:trends*; D019452:Terminally Ill; D014481:United States
chemical_list: D000970:Antineoplastic Agents