LOS ANGELES – VA’s increasing usage of cutting-edge diagnostic and therapeutic treatments for lung cancer, as well as its equal access model to address healthcare disparities, could be a model for other medical systems, according to a new study.
The result, according to the report in Clinical Lung Cancer, is that lung cancer survival is improving across-the-board at the VHA.1
Noting that lung cancer survival is improving in the United States, a study team led by the VA Greater Los Angeles Healthcare System and the University of California Los Angeles investigated whether there was a similar trend within the VHA, the largest integrated healthcare system in the United States.
Researchers from VA healthcare systems in Palo Alto, CA; Atlanta; Nashville, TN, and Portland, OR, also participated in the study.
The investigators analyzed data from the VA Central Cancer Registry for temporal survival trends. They identified 54,922 veterans with lung cancer diagnosed from 2010 to 2017. Histologies were classified as non-small-cell lung cancer (NSCLC) (64.2%), small cell lung cancer (SCLC) (12.9%), and ‘other’ (22.9%).
They found that the proportion with stage I increased from 18.1% to 30.4%, while stage IV decreased from 38.9% to 34.6% (both P < .001). In addition, the 3-year overall survival (OS) improved for stage I (58.6% to 68.4%, P < .001), stage II (35.5% to 48.4%, P < .001), stage III (18.7% to 29.4%, P < .001), and stage IV (3.4% to 7.8%, P < .001).
For NSCLC, the median overall survival (OS) increased from 12 to 21 months (P < .001), and the 3-year OS increased from 24.1% to 38.3% (P < .001). For SCLC, the median OS remained unchanged (8 to 9 months, P = .10), while the 3-year OS increased from 9.1% to 12.3% (P = .014).
The authors pointed out that, compared to white Veterans, Black Veterans with NSCLC had similar OS (P = .81), and those with SCLC had higher OS (P = .003).
“Lung cancer survival is improving within the VHA,” the authors wrote. “Compared to white Veterans, Black Veterans had similar or higher survival rates. The observed racial equity in outcomes within a geographically and socioeconomically diverse population warrants further investigation to better understand and replicate this achievement in other healthcare systems.”
The study noted that the increased survival trends for Black and white patients within VHA are similar to findings from the NEJM 2020 report that relied on data from Surveillance, Epidemiology, and End Results (SEER).
Authors of the NEJM report attributed their observations to the recent introduction of recommendations for routine testing of molecular alterations in epidermal growth factor receptor and anaplastic lymphoma kinase and commercial use of related FDA-approved targeted therapies.
The researchers in the VA studies agreed but also suggesting that ongoing improvements in each of the following diagnostic and treatment-related factors may have also had an influence:
- increasing utilization of low-dose chest computed tomography (LDCT) scans for early detection;
- advances in biopsy techniques to increase the likelihood of obtaining a positive biopsy and correctly staging patients at the time of initial diagnosis (eg, endobronchial ultrasound and robotic bronchoscopy guided systems);
- incorporation of nurse navigators to improve the timeliness of care;
- technological advances improving the safety of lung cancer surgery and radiation therapy delivery systems (eg, minimally invasive surgery and image guided radiation therapy);
- access to newly FDA-approved targeted therapies and immunotherapies;
- better integration of palliative care for patients with metastatic lung cancer which has been shown to not only prolong survival, but also improve the quality of life for people at the end of their lung cancer journey, and
- decreased wait times for healthcare within VHA since passage of the 2014 Veterans Choice Program.
“As smaller healthcare systems in the United States are combining to form large and complex healthcare environments, and racial equities are increasingly becoming a priority, lessons learned in the VHA can serve as an example of how intentional policy implementation can mitigate social determinants of health to reduce healthcare disparities in the broader population,” the researchers advised.
- Moghanaki D, Taylor J, Bryant AK, Vitzthum LK, et. Al. Lung Cancer Survival Trends in the Veterans Health Administration. Clin Lung Cancer. 2024 Mar 2:S1525-7304(24)00035-4. doi: 10.1016/j.cllc.2024.02.009. Epub ahead of print. PMID: 38553325.