Older men with several kinds of cancer–including colon cancer–do as well or better in the Veterans’ Health Administration as men covered by Medicare, according to a new study published by the Journal of Clinical Oncology in an advanced online release.
The Veterans’ Administration is the nation’s largest integrated health system, providing care for 6 million veterans a year who are eligible because of either service-related disabilities or economic disadvantage. The VHA launched a major reorganization in the mid-1990s to improve its quality of care through electronic records, better care coordination and mistake detection, and improved screening.
In this large study, researchers examined survival rates in men over age 65 diagnosed with colon, rectal, lung, bone marrow cancer or lymphoma in men treated by the VHA compared to men covered by Medicare.
The VHA patients were more likely to be African American or lower income. But after adjusting for most population differences, the study found that men treated for colon cancer at the VHA survived an average of four years and one month, compared to three years and seven months among Medicare Fee-for-Service (FFS) patients—a significant finding in the five-year follow-up period. There were no differences in survival for rectal cancer.
The researchers suggested the improved colon cancer survival was due to earlier diagnoses resulting from comprehensive screening at the VHA. But despite sophisticated, powerful statistical analysis, they could not definitively prove reasons for better outcomes, such as better adherence to treatment guidelines.
In an accompanying editorial, Dr. Stephen Edge of the Roswell Park Cancer Institute noted,
This elegant study highlights the challenges that face those conducting and interpreting comparative effectiveness research when trying to define what specific actions improve outcomes.
Nonetheless, this study documents the real progress made by the VHA in improving the care and outcomes for American veter. In fact, the VHA may now be ahead of the private sector in quality improvement.
Mary Beth Landrum, PhD and her colleagues concluded,
The survival rate for older men with cancer in the VHA was better than or equivalent to the survival rate for similar FFS-Medicare beneficiaries. The VHA provision of high-quality care, particularly preventive care, can result in improved patient outcomes.