A population‐based study of lung carcinoma in Pennsylvania

Abstract

BACKGROUNDLung carcinoma remains the major cause of cancer death in North America and is even more common among military veterans. The objective of this study was to determine whether there were differences in the characteristics and survival of Pennsylvania patients with lung carcinoma in the Veterans Administration (VA) hospital system compared with patients in the rest of the state.METHODSThe Pennsylvania Cancer Registry was used to identify all patients who were diagnosed with lung carcinoma in the State of Pennsylvania from 1995 to 1999. Patients who were treated within the Veterans Administration Health Care Network were identified by hospital code. Survival from the date of diagnosis of lung carcinoma was determined by using the Pennsylvania state mortality files from 1995 to 2001.RESULTSFrom 1995 to 1999, 48,994 patients were newly diagnosed with lung carcinoma in Pennsylvania (41.2% women), including 856 patients in the VA system (6 women). The current analysis was restricted to male patients (n = 28,798 men). There was no major difference in age of VA patients compared with non‐VA patients, and the proportions of patients who had localized or regional stage disease were similar (49% of VA patients vs. 48% of non‐VA patients). The proportion of black patients was much higher in the VA population (23%) compared with the non‐VA population (9%). The median survival was 6.3 months for VA patients compared with 7.9 months for patients in the rest of the state, and the 5‐year overall survival rate was 12% for VA patients compared with 15% for patients in the rest of the state. When survival was analyzed according to race, there was a significant difference in the age‐adjusted survival of white patients in the VA system compared with patients in the rest of the state (P = 0.0007), but no significant difference was observed among black patients (P = 0.92).CONCLUSIONSThe overall survival of VA patients with lung carcinoma in Pennsylvania was inferior to that of patients in the remainder of the state and this was due primarily to differences in survival among the white patients. Further investigation will be necessary to determine whether this disparity was caused by differences in socioeconomic status or comorbidities or whether there are systematic differences in the diagnosis, staging, or treatment of lung carcinoma between VA patients and civilian patients. Cancer 2005. © 2005 American Cancer Society.

Lung and colorectal cancer treatment and outcomes in the Veterans Affairs health care system

“…Campling et al identified new LC patients diagnosed in 1995–1999 from the Pennsylvania Cancer Registry (n=28,798) to compare patient characteristics and survival among VA and civilian patients. 32 VA patients had worse overall survival, based on 5-year survival rate of 12% among VA patients and 15% among non-VA patients. When examined by race, this significant survival difference among VA and non-VA patients was observed in white patients but not blacks.…”

“… 10 There were also conflicting findings in terms of survival benefit between patients treated in VA and non-VA systems. For example, one study 32 found that VA LC patients had worse overall survival than non-VA patients; however, two other studies found that VA LC patients had better all-cause 8 , 20 and cancer-specific survival. 8 Better overall survival was also found among VA CRC patients.…”

Poor survival for veterans with pathologic stage I non–small-cell lung cancer

“…1 Among US military veterans, the 5-year survival is only 12%. 2 Early detection and surgical resection provide a curative option for patients with non-small cell lung cancer (NSCLC). However, once having undergone resection for early stage disease, there is very little data on long term post-operative mortality.…”

“…2,6 Veterans treated at Veterans Affairs (VA) hospitals have a higher incidence of comorbidities, a greater frequency of multiple comorbid conditions, and an overall poorer level of health than non-veteran populations. 7,8 Together these factors suggest the importance of examining lung cancer survival among veterans.…”

Resources and Capabilities of the Department of Veterans Affairs to Provide Timely and Accessible Care to Veterans

“…Adjusted mortality was lower among Veterans who used VA care compared with male Medicare Advantage beneficiaries over 65 years of age (Selim, Berlowitz, et al, 2010;Selim, Kazis, Qian, et al, 2009;Selim et al, 2006;Selim et al, 2007). Mortality after some surgeries was higher among VA patients compared with non-Veterans receiving non-VA care (Campling et al, 2005;Chakkera et al, 2004;Glasgow et al, 2007;Henderson et al, 2007;Vaughan-Sarrazin, Wakefield, & Rosenthal, 2007) and after other surgeries, similar (Vaughan-Sarrazin, Wakefield, & Rosenthal, 2007). Mortality within one year of admission after hip fracture was 21 per cent lower among Veterans admitted to non-VA hospitals compared with Veterans admitted to VA hospitals (Richardson et al, 2013).…”