U.S. Veterans with Lung Cancer Experienced Greater Survival Gains Than Other U.S. Patients

Black Patients Fared As Well or Better Than White Patients

ST. LOUIS — Advances in lung-cancer screening and treatment have improved survival for patients across the United States. But new research suggested that healthcare delivery might be just as important as medical innovation in determining outcomes.

A retrospective analysis of nearly 1.5 million patients diagnosed with non-small cell lung cancer (NSCLC) between 2007 and 2019 found substantially greater improvements in survival among veterans receiving care through the VA than among patients treated outside the VA system. The study was published in JNCI Cancer Spectrum.¹

“We expected survival to improve nationally because the study period coincided with major advances in lung cancer care,” said Nikki Rossetti, MD, a general surgery resident in the Washington University Department of Surgery and the study’s lead author. “What surprised us was the magnitude and consistency of the VHA advantage.”

Researchers analyzed data from 79,027 veterans treated within the VA and more than 1.38 million patients included in the National Cancer Database (NCDB), which represents the broader U.S. population receiving cancer care outside the VA system.

The results showed substantial gains in adjusted 3-year overall survival in both groups. In 2007, adjusted 3-year survival was 24% for both VA and non-VA patients. By 2019, however, survival had increased to 51% among veterans compared with 41% among patients treated outside the VA system.

“While both cohorts had identical adjusted 3-year survival rates of 24% in 2007, by 2019 survival had increased to 51% in the VHA compared with 41% in the non-VHA cohort, representing a 10-percentage-point advantage,” Rossetti said. “The survival benefit persisted across disease stages and remained evident even when comparing veterans to Medicare and privately insured patients.”

The study was not designed to determine why outcomes differed between the two healthcare systems. However, Rossetti believes several characteristics of the VA might contribute to the findings.

“[T]he findings likely reflect strengths of the VHA as the nation’s largest integrated healthcare system,” Rossetti said. “Lung cancer care is increasingly complex and requires coordination across multiple specialties, and the VHA’s unified infrastructure may facilitate more consistent, coordinated care.”

The authors also pointed out, “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.”

Rossetti noted that the survival advantage was observed across disease stages, suggesting that earlier diagnosis alone does not explain the difference.

Several components of the VA model might play a role, including multidisciplinary cancer care coordination, a unified electronic health record, care navigation programs and national oncology initiatives that support standardized evidence-based care.

“The VHA also provides wraparound services such as transportation assistance and psychosocial support, which can reduce barriers to timely cancer care,” Rossetti said.

Researchers also examined whether insurance coverage might explain the difference by comparing veterans with NCDB patients who had Medicare or private insurance. The survival advantage remained even in those analyses.

“Some might argue that differences in insurance coverage explain the findings,” Rossetti said. “However, the survival advantage persisted even when we limited the comparison to patients with Medicare or private insurance.”

“This suggests that insurance status alone is unlikely to explain the observed differences and points toward healthcare delivery factors as a potentially important contributor,” she added.

The findings might also challenge some common perceptions about healthcare delivered through the VA system. Historically, critics have pointed to concerns about wait times and access to services within the VA. However, the study found that veterans often entered treatment with characteristics typically associated with poorer outcomes.

“Veterans in our study were older and had a greater burden of medical comorbidities than patients in the comparison group, yet the VHA experienced larger improvements in survival over time,” Rossetti told U.S. Medicine. She said the findings “challenge some long-standing assumptions about VA care and underscore the potential value of integrated healthcare delivery.”

The results might also have implications for policy decisions affecting veterans, she said.

“As recent policies such as the MISSION Act encourage community care referrals for veterans with a broad range of medical conditions, our findings suggest that such community referrals may not confer a better outcome for veterans with lung cancer,” she said.

Although the study identified a strong association between healthcare system and survival, important questions remain.

“The most important question is why these differences occurred,” Rossetti said. Future research will examine factors such as timeliness of care, multidisciplinary treatment, molecular testing, access to immunotherapy and targeted therapies and the use of supportive services.

The findings suggested that improvements in cancer outcomes depend not only on new treatments but also on how care is delivered. As lung cancer care becomes increasingly complex, investments in care coordination, patient navigation, data infrastructure and supportive services may play an important role in helping patients live longer.

 

1. Rossetti NE, Heiden BT, Eaton DB Jr, Tohmasi S, et al. Trends in lung cancer survival: superior outcomes in US veterans compared to general population. JNCI Cancer Spectr. 2026 May 21:pkag054. doi: 10.1093/jncics/pkag054. Epub ahead of print. PMID: 42166749.Top of Form Bottom of Form