Demographic Factors Influence VA Use by Terminally Ill Patients

Race and marital status can influence how often terminally ill cancer patients use VA health system services, according to a study presented recently at the American Society for clinical oncology. ¹

The “findings have implications for cost of care and should be confirmed in larger studies in our veterans, including caregivers,” the authors said in the abstract of the study.

The study, which was partly funded by Project Death in America, noted that little information exists about how socio-demographic factors influence health services utilization for terminal cancer patients receiving palliative care.

For the 2002-2004 study, researchers followed 103 advanced cancer patients receiving palliative care in the Section of Hematology Oncology at a VA Medical Center, but not hospice, every four to six weeks from the start of palliative care until death. The study sample included a subset of 39 patients who received palliative care for at least 24 weeks.

In the subset were 17 Caucasians, 21 African-Americans and one of “other” race. Of those, 21 were married, seven were divorced, six were widowed, four never married and one had unknown marital status. The majority of patients had either prostate cancer (39.47%) or lung cancer (28.95%).

Charts were reviewed retrospectively for measures of health system utilization, including total length of hospital days, number of admissions, number of clinic visits and emergency department visits.

For the group, the mean total number of inpatient days was 23.6, mean number of admissions was 2.9, mean number of clinic visits was 27 and ED visits was 1.3 per patient. How often those services were used varied by socio-demographic factors, however.

Mean total hospital days were longer for African-Americans (25) than Caucasians (17.7); the patient of “other” race had a total of 94 hospital days. The average number of ED visits was 0.48 for Caucasians, 2.0 for African-Americans and 0 for other.

Total number of inpatient days was longest for those who were never married (33.8 days) and less for those who were married (26.0), divorced (12.7) or widowed (9.3). A similar trend was found for clinic visits.
1. J Clin Oncol 30, 2012 (suppl; abstr e19639)

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