VHA cancer management quality study does NOT include prostate cancer


A new study in the Journal of Clinical Oncology has provided data regarding the survival of men of 65 years and older diagnosed with and treated for selected cancers within the Veterans Health Administration (VHA) system as compared to similar men treated under the fee-for-service Medicare system. This study has received a lot of media coverage.

Men initially diagnosed with prostate cancer should be aware that this study by Landrum et al. did not include patients diagnosed with and treated for prostate cancer. In fact it was limited to men of ≥ 65 years who were diagnosed or received their first course of treatment for colorectal cancer, lung cancer, lymphoma, or multiple myeloma in VHA hospitals from 2001 to 2004 and to similar Medicare enrollees managed under fee for service.in the same time frame.

It should be noted that the authors found the following for the four types of cancer studied:

  • Survival rates were higher in the VHA system for patients with colon cancer (adjusted hazard ratio [aHR] = 0.87; 95% CI, 0.82 to 0.93) and non-small-cell lung cancer (aHR = 0.91).
  • Survival rates were comparable for patients with rectal cancer (aHR = 1.05), small-cell lung cancer (aHR = 0.99), diffuse large–B-cell lymphoma a(HR = 1.02), and multiple myeloma (aHR = 0.92).
  • The diagnosis of VHA patients at earlier stages of colon cancer and non-small-cell lung cancer explained much of the survival benefit for these two disorders.

Exactly why prostate cancer was no included in this study (given that it is the most prevalent form of cancer diagnosed within the VHA system) is not completely clear. One probable reason, however, is that meaningful data would have required a 10-, 15-, or 20-year follow-up study.

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