Procedural Aggressiveness in Veterans with Advanced Non-Small-Cell Lung Cancer at the End of Life

J Palliat Med. 2018 Apr;21(4):445-451. doi: 10.1089/jpm.2017.0022. Epub 2017 Dec 21.


Background: Evidence suggests that the aggressiveness of care in cancer patients at the end of life is increasing. We sought to evaluate the use of invasive procedures at the end of life in patients with advanced non-small-cell lung cancer (NSCLC).

Objective: To evaluate the utilization of invasive procedures at the end of life in Veterans with advanced NSCLC.

Design: Retrospective cohort study of Veterans with newly diagnosed stage IV NSCLC who died between 2006 and 2012.

Setting/subjects: Subjects were identified from the Veterans Affairs Central Cancer Registry.

Measurements: All Veterans Administration (VA) and Medicare fee-for-service healthcare utilization and expenditure data were assembled for all subjects. The primary outcome was the number of invasive procedures performed in the last month of life. We classified procedures into three categories: minimally invasive, life-sustaining, and major-operative procedures. Logistic regression analysis was used to evaluate factors associated with the receipt of invasive procedures.

Results: Nineteen thousand nine hundred thirty subjects were included. Three thousand (15.1%) subjects underwent 5523 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).

Conclusions: Invasive procedures are commonly performed among Veterans with stage IV NSCLC during their last month of life and are associated with other measures of aggressive end-of-life care.

Keywords: end-of-life care; invasive procedures; lung cancer.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Carcinoma, Non-Small-Cell Lung / mortality
  • Carcinoma, Non-Small-Cell Lung / pathology
  • Carcinoma, Non-Small-Cell Lung / therapy*
  • Female
  • Humans
  • Lung Neoplasms / mortality
  • Lung Neoplasms / pathology
  • Lung Neoplasms / therapy*
  • Male
  • Medicare
  • Middle Aged
  • Neoplasm Staging
  • Registries
  • Retrospective Studies
  • Terminal Care*
  • United States
  • Veterans*