How Does NSCLC Treatment Differ Between Veterans and the General Population?

Recent research published online in Annals of Surgery showed improved care rates for veterans with non-small cell lung cancer (NSCLC) treated through the Veterans Health Administration (VHA) compared to the general population. 

“Prior studies and the lay media have questioned the quality of care that Veterans with lung cancer receive through the VHA,” explained the study authors. “We hypothesized Veterans undergoing surgery for early-stage NSCLC receive high quality care and have similar outcomes compared to the general population.”

The research team conducted a retrospective cohort study. The cohort included patients with clinical stage I NSCLC undergoing resection from 2006 to 2016 using a VHA dataset. Of important note, propensity score matching for baseline patient- and tumor-related variables was used. The research team used these scores to compare operative characteristics as well as outcomes between the VHA and the National Cancer Database (NCDB). 

For the study, researchers identified 9981 VHA patients and 176,304 NCDB patients. Additionally, there were more male, nonwhite patients with lower education levels, higher incomes, and higher Charlson/Deyo scores among the VHA cohort. 

According to the findings, “VHA patients had inferior unadjusted 30-day mortality (VHA 2.1% vs NCDB 1.7%, P=0.011) and median overall survival (69.0 vs 88.7 months, P< 0.001).”

Among the propensity matched cohort of 6792 pairs, the study authors found the VHA population experienced more minimally invasive operations (60.0% vs 39.6%, P< 0.001) and only slightly less likely to receive lobectomies (70.1% vs 70.7%, P=0.023). 

Further findings also suggested “VHA patients had longer lengths of stay (8.1 vs 7.1 days, P< 0.001) but similar readmission rates (7.7% vs 7.0%, P=0.132).”

Patients from the VHA cohort showed significantly better 30-day mortality (1.9% vs 2.8%, P< 0.001) and median overall survival (71.4 vs 65.2 months, P< 0.001).

“Despite having more comorbidities, veterans receive exceptional care through the VHA with favorable outcomes, including significantly longer overall survival, compared to the general population,” the authors concluded. 

Reference:
Heiden BT, Eaton DB Jr, Chang SH, et al. Comparison between veteran and non-veteran populations with clinical stage I non-small cell lung cancer undergoing surgery. Ann Surg. 2023;277(3):e664-e669. doi:10.1097/SLA.0000000000004928