<--GAT-->
Clinical Topics

Veterans Study Calls for Better Guidance on Lung Cancer Treatment

by U.S. Medicine

November 19, 2018

SAN FRANCISCO—With increased imaging now detecting lung cancer nodules in sicker patients, a new report suggested that guidelines should be more directive in how to maximize benefit and minimize harm, while taking into account comorbidities and life expectancy.

The study in PLoS One pointed out that current pulmonary nodule guidelines don’t provide enough information on how to individualize follow-up for complex patients.

University of California San Francisco-led researchers sought to characterize comorbidity and life expectancy in older veterans with incidental, symptom-detected or screen-detected nodules in 2008-09 vs. 2013-14. The retrospective cohort study compared the effect of those patient factors on four-year nodule follow-up among the 2008-09 subgroup.

The study, conducted at an urban VAMC, focused on 243 veterans 65 and older with newly diagnosed pulmonary nodules in 2008-09—followed for four years through 2012 or 2013—and 446 older veterans diagnosed in 2013-14.

Defined as the primary outcome was receipt of any follow-up nodule imaging and/or biopsy within four years after nodule diagnosis. Primary predictor variables included age, Charlson-Deyo Comorbidity Index (CCI) and life expectancy, with favorable life expectancy defined as age 65–74 with CCI 0, while limited life expectancy was defined as age 85 or older with CCI ≥1 or age 65 or older with CCI ≥4. Researchers also examined Interaction by nodule size.

The study noted that, from 2008-09 to 2013-14, the number of older veterans diagnosed with new pulmonary nodules almost doubled, including among those with severe comorbidity and limited life expectancy.

Results indicated that, overall among the 2008-09 subgroup, receipt of nodule follow-up decreased with increasing comorbidity (CCI ≥4 vs. 0: adjusted RR 0.61, 95% CI 0.39-0.95) with a trend toward decreased follow-up among those with limited life expectancy (adjusted RR 0.69, 95% CI 0.48-1.01).

“However, we detected an interaction effect with nodule size such that comorbidity and life expectancy were associated with decreased follow-up only among those with nodules ≤6 mm,” the researchers wrote.

They added, “We found some individualization of pulmonary nodule follow-up according to comorbidity and life expectancy in older veterans with smaller nodules only.”



Related Articles

VA Overall Appointment Wait Times Shorter than the Private-Sector

Despite intense scrutiny of wait times for veterans seeking VA care over the last three years, a new study pointed out that delays in the private sector weren’t statistically less in 2014 and that, possibly because of the focus, wait times now are significantly shorter for the VA compared to private-sector healthcare facilities.

Senate Blocks Agent Orange Exposure Extension to Blue Water Veterans

Blue Water Navy veterans who claim to be impacted by toxic exposure while serving off the coast of Vietnam were forced to grapple with disappointment once again as the 115th Congress ended without passing legislation addressing their VA benefits.


U.S. Medicine Recommends


More From oncology

Oncology

Hypertension, MGUS Associated with Herbicide Exposure in Vietnam Veterans

Based on a new review, two conditions–one extremely common and the other rare–appear to be related to herbicide exposure during the Vietnam War era.

Oncology

Detailed Medical History Crucial for Lung Disease Diagnosis

Both general medicine physicians and specialists can find interstitial lung disease (ILD) and pulmonary fibrosis confusing, according to a recent study.

Oncology

Melanomas Associated With Internal Malignancy Risk

Genetic and environmental risk factors have been associated with the development of multiple primary melanomas (MPM) but a new study questioned whether those patients might have increased predisposition to developing internal malignancies.

Oncology

Some RCC Risk Factors Can Be Modified

Obesity, hypertension and smoking are the three modifiable risk factors that could aggressively be targeted to reduce renal cell carcinoma, according to a new study.

Oncology

Better Survival for NSCLC Patients Treated by Military Medicine

Does universal healthcare access provided by the MHS translate into improved patient outcomes for non-small cell lung cancer?

Subscribe to U.S. Medicine Print Magazine

U.S. Medicine is mailed free each month to physicians, pharmacists, nurse practitioners, physician assistants and administrators working for Veterans Affairs, Department of Defense and U.S. Public Health Service.

Subscribe Now

Receive Our Email Newsletter

Stay informed about federal medical news, clinical updates and reports on government topics for the federal healthcare professional.

Sign Up