Ahmed A

Background: There are a variety of treatments available for patients with stage IV colon cancer. Chemotherapy is the usual treatment, with greater amounts of surgery being associated with more aggressive hospitals. Income can play a role in the type of treatment a patient receives, or if they even receive treatment at all (Baldwin et al. 2005).

Methods: First course treatment received by stage IV colon cancer patients of Veterans Affair Hospitals (VAH) and all other hospital types were compared using the National Cancer Data Base (NCDB). Patient’ 2012 income and type of treatment provided were examined. Treatment types included chemotherapy, surgery, no treatment, etc. Data from 45 VAH with 2,667 patients and 1,543 non-VA affiliated hospitals with 144,575 patients were utilized. Chi-squared analysis was conducted to calculate statistical significance.

Results: The NCDB reveals noticeable differences between VAH and all other hospitals in percentages of stage IV colon cancer patients receiving treatment. 25.3% of VAH patients received no treatment while 16.9% of patients at all other hospitals received no treatment (P < .05). More VAH patients received solely chemotherapy compared to patients at other hospitals (21.2% vs 15.9%, P < .05). VAH patients had less surgery compared to patients at all other hospitals (47.2% vs 59.4%, P < .05). These effects were present at all income levels.

Implications: VAH patients were more likely to receive no treatment compared to patients at all other hospitals. Furthermore, VAH patients were less likely to receive aggressive surgical care compared to other hospitals. These results imply that VAH patients are more likely to receive no treatment in comparison to other hospitals, as well as less likely to receive aggressive care when treatment is given. Differences in care seen between hospital types were not influenced by income.

Background: There are a variety of treatments available for patients with stage IV colon cancer. Chemotherapy is the usual treatment, with greater amounts of surgery being associated with more aggressive hospitals. Income can play a role in the type of treatment a patient receives, or if they even receive treatment at all (Baldwin et al. 2005).

Methods: First course treatment received by stage IV colon cancer patients of Veterans Affair Hospitals (VAH) and all other hospital types were compared using the National Cancer Data Base (NCDB). Patient’ 2012 income and type of treatment provided were examined. Treatment types included chemotherapy, surgery, no treatment, etc. Data from 45 VAH with 2,667 patients and 1,543 non-VA affiliated hospitals with 144,575 patients were utilized. Chi-squared analysis was conducted to calculate statistical significance.

Results: The NCDB reveals noticeable differences between VAH and all other hospitals in percentages of stage IV colon cancer patients receiving treatment. 25.3% of VAH patients received no treatment while 16.9% of patients at all other hospitals received no treatment (P < .05). More VAH patients received solely chemotherapy compared to patients at other hospitals (21.2% vs 15.9%, P < .05). VAH patients had less surgery compared to patients at all other hospitals (47.2% vs 59.4%, P < .05). These effects were present at all income levels.

Implications: VAH patients were more likely to receive no treatment compared to patients at all other hospitals. Furthermore, VAH patients were less likely to receive aggressive surgical care compared to other hospitals. These results imply that VAH patients are more likely to receive no treatment in comparison to other hospitals, as well as less likely to receive aggressive care when treatment is given. Differences in care seen between hospital types were not influenced by income.

Background: There are a variety of treatments available for patients with stage IV colon cancer. Chemotherapy is the usual treatment, with greater amounts of surgery being associated with more aggressive hospitals. Income can play a role in the type of treatment a patient receives, or if they even receive treatment at all (Baldwin et al. 2005).

Methods: First course treatment received by stage IV colon cancer patients of Veterans Affair Hospitals (VAH) and all other hospital types were compared using the National Cancer Data Base (NCDB). Patient’ 2012 income and type of treatment provided were examined. Treatment types included chemotherapy, surgery, no treatment, etc. Data from 45 VAH with 2,667 patients and 1,543 non-VA affiliated hospitals with 144,575 patients were utilized. Chi-squared analysis was conducted to calculate statistical significance.

Results: The NCDB reveals noticeable differences between VAH and all other hospitals in percentages of stage IV colon cancer patients receiving treatment. 25.3% of VAH patients received no treatment while 16.9% of patients at all other hospitals received no treatment (P < .05). More VAH patients received solely chemotherapy compared to patients at other hospitals (21.2% vs 15.9%, P < .05). VAH patients had less surgery compared to patients at all other hospitals (47.2% vs 59.4%, P < .05). These effects were present at all income levels.

Implications: VAH patients were more likely to receive no treatment compared to patients at all other hospitals. Furthermore, VAH patients were less likely to receive aggressive surgical care compared to other hospitals. These results imply that VAH patients are more likely to receive no treatment in comparison to other hospitals, as well as less likely to receive aggressive care when treatment is given. Differences in care seen between hospital types were not influenced by income.

Background: Recent evidence from the Government Performance Review Act Report on Oncology has shown an earlier detection of colorectal, lung, and prostate cancer in Veterans Administration Hospitals (VAHs) versus other SEER hospitals despite similar incidence rates.

Purpose: Assess melanoma screening by looking at incidence of stages at diagnosis. Earlier detection of melanoma compared to other hospitals may suggest better screening in VAHs.

Methods: Community Programs (CCP) receive 100-500 newly diagnosed cancer cases per year. Hospitals receiving 500+ patients are either Academic Comprehensive Programs (ACP) or Comprehensive Community Cancer Programs (CCCP). Using NCDB (2003-2013), which includes > 70% of newly diagnosed cancer patients, we utilized chi-square analysis and compared stage at diagnosis for patients with melanoma.

Results: VA hospitals consistently detect higher rates of early stage melanoma with 41% stage 0 and 73% stage 0/I versus the average of 27.75% stage 0 and 67.25% stage 0/I between all hospitals (P < .01). VA hospitals also consistently detect lower rates of late stage melanoma stage IV between all hospitals (P < .01).

Implications: This is the first study showing higher rates of early diagnosis of melanoma in VAH versus other hospital types in NCDB by looking at staging. Early stage melanoma was detected at greater frequencies and late stage melanoma at lower frequencies in VA hospitals. This may suggest better screening, resulting in better prognosis, for patients treated in VAH. 27.5% less patients were stage IV in VAH than the calculated average. If we apply the percentage of VAH stage IV melanoma to all other hospitals, good screening in VAH may have prevented 5,138 patients from becoming stage IV.

Background: Recent evidence from the Government Performance Review Act Report on Oncology has shown an earlier detection of colorectal, lung, and prostate cancer in Veterans Administration Hospitals (VAHs) versus other SEER hospitals despite similar incidence rates.

Purpose: Assess melanoma screening by looking at incidence of stages at diagnosis. Earlier detection of melanoma compared to other hospitals may suggest better screening in VAHs.

Methods: Community Programs (CCP) receive 100-500 newly diagnosed cancer cases per year. Hospitals receiving 500+ patients are either Academic Comprehensive Programs (ACP) or Comprehensive Community Cancer Programs (CCCP). Using NCDB (2003-2013), which includes > 70% of newly diagnosed cancer patients, we utilized chi-square analysis and compared stage at diagnosis for patients with melanoma.

Results: VA hospitals consistently detect higher rates of early stage melanoma with 41% stage 0 and 73% stage 0/I versus the average of 27.75% stage 0 and 67.25% stage 0/I between all hospitals (P < .01). VA hospitals also consistently detect lower rates of late stage melanoma stage IV between all hospitals (P < .01).

Implications: This is the first study showing higher rates of early diagnosis of melanoma in VAH versus other hospital types in NCDB by looking at staging. Early stage melanoma was detected at greater frequencies and late stage melanoma at lower frequencies in VA hospitals. This may suggest better screening, resulting in better prognosis, for patients treated in VAH. 27.5% less patients were stage IV in VAH than the calculated average. If we apply the percentage of VAH stage IV melanoma to all other hospitals, good screening in VAH may have prevented 5,138 patients from becoming stage IV.

Background: Recent evidence from the Government Performance Review Act Report on Oncology has shown an earlier detection of colorectal, lung, and prostate cancer in Veterans Administration Hospitals (VAHs) versus other SEER hospitals despite similar incidence rates.

Purpose: Assess melanoma screening by looking at incidence of stages at diagnosis. Earlier detection of melanoma compared to other hospitals may suggest better screening in VAHs.

Methods: Community Programs (CCP) receive 100-500 newly diagnosed cancer cases per year. Hospitals receiving 500+ patients are either Academic Comprehensive Programs (ACP) or Comprehensive Community Cancer Programs (CCCP). Using NCDB (2003-2013), which includes > 70% of newly diagnosed cancer patients, we utilized chi-square analysis and compared stage at diagnosis for patients with melanoma.

Results: VA hospitals consistently detect higher rates of early stage melanoma with 41% stage 0 and 73% stage 0/I versus the average of 27.75% stage 0 and 67.25% stage 0/I between all hospitals (P < .01). VA hospitals also consistently detect lower rates of late stage melanoma stage IV between all hospitals (P < .01).

Implications: This is the first study showing higher rates of early diagnosis of melanoma in VAH versus other hospital types in NCDB by looking at staging. Early stage melanoma was detected at greater frequencies and late stage melanoma at lower frequencies in VA hospitals. This may suggest better screening, resulting in better prognosis, for patients treated in VAH. 27.5% less patients were stage IV in VAH than the calculated average. If we apply the percentage of VAH stage IV melanoma to all other hospitals, good screening in VAH may have prevented 5,138 patients from becoming stage IV.

Background: Winchester et al (1999) showed that 61% of stage 4 pancreatic cancer patients in the National Cancer Data Base (NCDB) from 1985-95 received no treatment.

Methods: NCDB was queried to evaluate treatment of stage 4 pancreatic cancer from years 2003-2013. The study included 1,525 hospitals and 61,063 patients, of which 47 hospitals and 1,528 patients were from VA hospitals. Chi-square tests were run to compare patients at all hospitals not receiving treatment to VA patients.

Results: More stage 4 pancreatic patients at the VA received no treatment compared to the average in 2003-2013 (58.5% vs 46.8%). However, the VA was still lower than the 61% Winchester found in the 1990s. The percentage of patients within each age group that did not
receive treatment was at least 10% greater at the VA compared to other hospitals. VA patients had lower incomes, greater distances traveled to hospitals, and lived in areas that had more people without a high school degree compared to patients at all hospitals. 19.5% of VA patients,
versus 6.5% of all hospital patients, traveled over 100 miles for care. 22.3% of VA patients, compared to 15.7% of all hospital patients, had an income of less than $36,000. 21.1% of VA patients, compared to 14.5% of all hospital patients had lower education as shown by living in areas where more than 23% of the population did not graduate high school. (all P < .05)

Implications: The majority of stage IV pancreatic patients at the VA are not treated. VA patients with stage 4 pancreatic cancer who did not receive treatment traveled greater distances for care, had less education, and had lower incomes compared to those at other hospitals. Further investigation must be done to determine ways to provide better care to veterans facing pancreatic cancer.

Background: Winchester et al (1999) showed that 61% of stage 4 pancreatic cancer patients in the National Cancer Data Base (NCDB) from 1985-95 received no treatment.

Methods: NCDB was queried to evaluate treatment of stage 4 pancreatic cancer from years 2003-2013. The study included 1,525 hospitals and 61,063 patients, of which 47 hospitals and 1,528 patients were from VA hospitals. Chi-square tests were run to compare patients at all hospitals not receiving treatment to VA patients.

Results: More stage 4 pancreatic patients at the VA received no treatment compared to the average in 2003-2013 (58.5% vs 46.8%). However, the VA was still lower than the 61% Winchester found in the 1990s. The percentage of patients within each age group that did not
receive treatment was at least 10% greater at the VA compared to other hospitals. VA patients had lower incomes, greater distances traveled to hospitals, and lived in areas that had more people without a high school degree compared to patients at all hospitals. 19.5% of VA patients,
versus 6.5% of all hospital patients, traveled over 100 miles for care. 22.3% of VA patients, compared to 15.7% of all hospital patients, had an income of less than $36,000. 21.1% of VA patients, compared to 14.5% of all hospital patients had lower education as shown by living in areas where more than 23% of the population did not graduate high school. (all P < .05)

Implications: The majority of stage IV pancreatic patients at the VA are not treated. VA patients with stage 4 pancreatic cancer who did not receive treatment traveled greater distances for care, had less education, and had lower incomes compared to those at other hospitals. Further investigation must be done to determine ways to provide better care to veterans facing pancreatic cancer.

Background: Winchester et al (1999) showed that 61% of stage 4 pancreatic cancer patients in the National Cancer Data Base (NCDB) from 1985-95 received no treatment.

Methods: NCDB was queried to evaluate treatment of stage 4 pancreatic cancer from years 2003-2013. The study included 1,525 hospitals and 61,063 patients, of which 47 hospitals and 1,528 patients were from VA hospitals. Chi-square tests were run to compare patients at all hospitals not receiving treatment to VA patients.

Results: More stage 4 pancreatic patients at the VA received no treatment compared to the average in 2003-2013 (58.5% vs 46.8%). However, the VA was still lower than the 61% Winchester found in the 1990s. The percentage of patients within each age group that did not
receive treatment was at least 10% greater at the VA compared to other hospitals. VA patients had lower incomes, greater distances traveled to hospitals, and lived in areas that had more people without a high school degree compared to patients at all hospitals. 19.5% of VA patients,
versus 6.5% of all hospital patients, traveled over 100 miles for care. 22.3% of VA patients, compared to 15.7% of all hospital patients, had an income of less than $36,000. 21.1% of VA patients, compared to 14.5% of all hospital patients had lower education as shown by living in areas where more than 23% of the population did not graduate high school. (all P < .05)

Implications: The majority of stage IV pancreatic patients at the VA are not treated. VA patients with stage 4 pancreatic cancer who did not receive treatment traveled greater distances for care, had less education, and had lower incomes compared to those at other hospitals. Further investigation must be done to determine ways to provide better care to veterans facing pancreatic cancer.