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Cancer. 2017 Aug 15;123(16):3186-3194. doi: 10.1002/cncr.30700. Epub 2017 Apr 17.

Association between aggressive care and bereaved families' evaluation of end-of-life care for veterans with non-small cell lung cancer who died in Veterans Affairs facilities.

Author information

Veteran Experience Center (formerly the PROMISE Center), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.
University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.
Center for Gerontology and Health Care Research, Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island.
Health Economics Resource Center and Center for Innovation to Implementation, Palo Alto VA Health Care System, Menlo Park, California.
Department of Health Research and Policy, Stanford University, Stanford, California.
Center for Health Equity Research and Promotion, Department of Veterans Affairs Medical Center, Pittsburgh, Pennsylvania.
Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania.
VA Eastern Colorado Health Care System, Denver, Colorado.
Division of Health Care Policy and Research, University of Colorado, Aurora, Colorado.
Division of Primary Care and Population Health, Stanford School of Medicine, Palo Alto, California.
Center for Innovation, Providence VA Medical Center, Providence, Rhode Island.
Alpert Medical School of Brown University, Providence, Rhode Island.
VA Palo Alto Healthcare System, Palo Alto, California.



To the authors' knowledge, little is known regarding the relationship between patients' and families' satisfaction with aggressive end-of-life care. Herein, the authors examined the associations between episodes of aggressive care (ie, chemotherapy, mechanical ventilation, acute hospitalizations, and intensive care unit admissions) within the last 30 days of life and families' evaluations of end-of-life care among patients with non-small cell lung cancer (NSCLC).


A total of 847 patients with NSCLC (34% of whom were aged <65 years) who died in a nursing home or intensive care, acute care, or hospice/palliative care (HPC) unit at 1 of 128 Veterans Affairs Medical Centers between 2010 and 2012 were examined. Data sources included Veterans Affairs administrative and clinical data, Medicare claims, and the Bereaved Family Survey. The response rate for the Bereaved Family Survey was 62%.


Greater than 72% of veterans with advanced lung cancer who died in an inpatient setting had at least 1 episode of aggressive care and 31% received chemotherapy within the last 30 days of life. For all units except for HPC, when patients experienced at least 1 episode of aggressive care, bereaved families rated care lower compared with when patients did not receive any aggressive care. For patients dying in an HPC unit, the associations between overall ratings of care and ≥2 inpatient admissions or any episode of aggressive care were not found to be statistically significant. Rates of aggressive care were not associated with age, and family ratings of care were similar for younger and older patients.


Aggressive care within the last month of life is common among patients with NSCLC and is associated with lower family evaluations of end-of-life care. Specialized care provided within an HPC unit may mitigate the negative effects of aggressive care on these outcomes. Cancer 2017;123:3186-94. © 2017 American Cancer Society.


aggressive care; cancer; end-of-life care; evaluation of care; palliative care

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