Effect of palliative care services on the aggressiveness of end-of-life care in the veteran's affairs cancer population

Wilson I. Gonsalves, Tsewang Tashi, Jairam Krishnamurthy, Tracy Davies, Stephanie Ortman, Ramya Thota, Ibrahim Aldoss, Ashwin Ganta, Mudappa Kalaiah, Neha Didwaniya, Catherine Eberle, Apar K. Ganti, Peter T. Silberstein, Shanmuga Subbiah

Research output: Contribution to journalReview article

55 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)1231-1235
Number of pages5
JournalJournal of Palliative Medicine
Volume14
Issue number11
DOIs
StatePublished - Nov 1 2011

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Terminal Care
Veterans
Palliative Care
Population
Neoplasms
Veterans Hospitals
Intensive Care Units
Length of Stay
Referral and Consultation
Drug Therapy
Terminally Ill
Hospices
Incidence
Hospital Emergency Service
Delivery of Health Care

All Science Journal Classification (ASJC) codes

  • Medicine(all)
  • Anesthesiology and Pain Medicine
  • Nursing(all)

Cite this

Gonsalves, W. I., Tashi, T., Krishnamurthy, J., Davies, T., Ortman, S., Thota, R., ... Subbiah, S. (2011). Effect of palliative care services on the aggressiveness of end-of-life care in the veteran's affairs cancer population. Journal of Palliative Medicine, 14(11), 1231-1235. https://doi.org/10.1089/jpm.2011.0131

Effect of palliative care services on the aggressiveness of end-of-life care in the veteran's affairs cancer population. / Gonsalves, Wilson I.; Tashi, Tsewang; Krishnamurthy, Jairam; Davies, Tracy; Ortman, Stephanie; Thota, Ramya; Aldoss, Ibrahim; Ganta, Ashwin; Kalaiah, Mudappa; Didwaniya, Neha; Eberle, Catherine; Ganti, Apar K.; Silberstein, Peter T.; Subbiah, Shanmuga.

In: Journal of Palliative Medicine, Vol. 14, No. 11, 01.11.2011, p. 1231-1235.

Research output: Contribution to journalReview article

Gonsalves, WI, Tashi, T, Krishnamurthy, J, Davies, T, Ortman, S, Thota, R, Aldoss, I, Ganta, A, Kalaiah, M, Didwaniya, N, Eberle, C, Ganti, AK, Silberstein, PT & Subbiah, S 2011, 'Effect of palliative care services on the aggressiveness of end-of-life care in the veteran's affairs cancer population', Journal of Palliative Medicine, vol. 14, no. 11, pp. 1231-1235. https://doi.org/10.1089/jpm.2011.0131
Gonsalves, Wilson I. ; Tashi, Tsewang ; Krishnamurthy, Jairam ; Davies, Tracy ; Ortman, Stephanie ; Thota, Ramya ; Aldoss, Ibrahim ; Ganta, Ashwin ; Kalaiah, Mudappa ; Didwaniya, Neha ; Eberle, Catherine ; Ganti, Apar K. ; Silberstein, Peter T. ; Subbiah, Shanmuga. / Effect of palliative care services on the aggressiveness of end-of-life care in the veteran's affairs cancer population. In: Journal of Palliative Medicine. 2011 ; Vol. 14, No. 11. pp. 1231-1235.
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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.",
author = "Gonsalves, {Wilson I.} and Tsewang Tashi and Jairam Krishnamurthy and Tracy Davies and Stephanie Ortman and Ramya Thota and Ibrahim Aldoss and Ashwin Ganta and Mudappa Kalaiah and Neha Didwaniya and Catherine Eberle and Ganti, {Apar K.} and Silberstein, {Peter T.} and Shanmuga Subbiah",
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T1 - Effect of palliative care services on the aggressiveness of end-of-life care in the veteran's affairs cancer population

AU - Gonsalves, Wilson I.

AU - Tashi, Tsewang

AU - Krishnamurthy, Jairam

AU - Davies, Tracy

AU - Ortman, Stephanie

AU - Thota, Ramya

AU - Aldoss, Ibrahim

AU - Ganta, Ashwin

AU - Kalaiah, Mudappa

AU - Didwaniya, Neha

AU - Eberle, Catherine

AU - Ganti, Apar K.

AU - Silberstein, Peter T.

AU - Subbiah, Shanmuga

PY - 2011/11/1

Y1 - 2011/11/1

N2 - 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.

AB - 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.

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U2 - 10.1089/jpm.2011.0131

DO - 10.1089/jpm.2011.0131

M3 - Review article

VL - 14

SP - 1231

EP - 1235

JO - Journal of Palliative Medicine

JF - Journal of Palliative Medicine

SN - 1096-6218

IS - 11

ER -