Lung Cancer Survival Trends in the Veterans Health Administration

IntroductionLung cancer survival is improving in the United States. We investigated whether there was a similar trend within the Veterans Health Administration (VHA), the largest integrated healthcare system in the United States.MethodsData from the Veterans Affairs Central Cancer Registry (VACCR) were analyzed for temporal survival trends using Kaplan-Meier (K-M) estimates and linear regression.Results54,922 Veterans were identified with lung cancer diagnosed from 2010-2017. Histologies were classified as non-small cell lung cancer (NSCLC) (64.2%), small cell lung cancer (SCLC) (12.9%), and 'other' (22.9%). The proportion with stage I increased from 18.1% to 30.4%, while stage IV decreased from 38.9% to 34.6% (both p<0.001). The 3-year overall survival (OS) improved for stage I (58.6% to 68.4%, p<0.001), stage II (35.5% to 48.4%, p<0.001), stage III (18.7% to 29.4%, p<0.001), and stage IV (3.4% to 7.8%, p<0.001). For NSCLC, the median OS increased from 12 to 21 months (p<0.001), and 3-year OS increased from 24.1% to 38.3% (p<0.001). For SCLC, the median OS remained unchanged (8 to 9 months, p=0.10), while the 3-year OS increased from 9.1% to 12.3% (p=0.014). Compared to White Veterans, Black Veterans with NSCLC had similar OS (p=0.81), and those with SCLC had higher OS (p=0.003).ConclusionsLung cancer survival is improving within VHA. 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.Micro-AbstractA study evaluating >50,000 Veterans diagnosed with lung cancer from 2010-2017 identified improving outcomes for those who received care through the VA. The analysis identified increases in early detection and improved survival for all stages of lung cancer, regardless of non-small cell or small cell lung cancer histology. The study also identified similar survival rates for Black and White Veterans.