VA Health Services Research & Development Service, Department of Veterans Affairs Medical Center, Portland, Oregon, USA.
J Thorac Oncol. 2011 Oct;6(10):1726-32. doi: 10.1097/JTO.0b013e31822ada77.
Lung cancer is a leading cause of death in the United States and among veterans. This study compares patterns of diagnosis, treatment, and survival for veterans diagnosed with non-small cell lung cancer (NSCLC) using a recently established cancer registry for the Veterans Affairs Pacific Northwest Network with the Puget Sound Surveillance, Epidemiology, and End Results cancer registry.
A cohort of 1715 veterans with NSCLC were diagnosed between 2000 and 2006, and 7864 men were diagnosed in Washington State during the same period. Demographics, tumor characteristics, initial surgical patterns, and survival across the two registries were evaluated.
Veterans were more likely to be diagnosed with stage I or II disease (32.8%) compared with the surrounding community (21.5%, p = 0.001). Surgical resection rates were similar for veterans (70.2%) and nonveterans (71.2%) older than 65 years with early-stage disease (p = 0.298). However, veterans younger than 65 years with early-stage disease were less likely to undergo surgical resection (83.3% versus 91.5%, p = 0.003). Because there were fewer late-stage patients among veterans, overall survival was better, although within each stage group veterans experienced worse survival compared with community patients. The largest differences were among early-stage patients with 44.6% 5-year survival for veterans compared with 57.4% for nonveterans (p = 0.004).
The use of surgical resection among younger veterans with NSCLC may be lower compared with the surrounding community and may be contributing to poorer survival. Cancer quality of care studies have primarily focused on patients older than 65 years using Medicare claims; however, efforts to examine care for younger patients within and outside the Department of Veterans Affairs are needed.
肺癌是美国和退伍军人中导致死亡的主要原因。本研究使用退伍军人事务部太平洋西北网络的最近建立的癌症登记处与普吉特湾监测、流行病学和结果癌症登记处，比较了诊断、治疗和生存模式退伍军人与非小细胞肺癌（NSCLC）诊断。
2000 年至 2006 年间诊断出 1715 名患有 NSCLC 的退伍军人，同期在华盛顿州诊断出 7864 名男性。评估了两个登记处的人口统计学，肿瘤特征，初始手术模式和生存情况。
与周围社区（21.5%，p=0.001）相比，退伍军人更有可能被诊断为 I 期或 II 期疾病（32.8%）。对于年龄大于 65 岁且患有早期疾病的退伍军人（p=0.298），手术切除率与非退伍军人相似（70.2%）。然而，年龄小于 65 岁且患有早期疾病的退伍军人进行手术切除的可能性较小（83.3%对 91.5%，p=0.003）。由于退伍军人中晚期患者较少，总体生存率较高，尽管在每个阶段组中，退伍军人的生存率都低于社区患者。最大的差异是在早期患者中，退伍军人的 5 年生存率为 44.6%，而非退伍军人为 57.4%（p=0.004）。
与周围社区相比，年轻退伍军人中 NSCLC 手术切除的使用可能较低，这可能导致生存率较差。癌症质量护理研究主要集中在使用医疗保险索赔的年龄大于 65 岁的患者上；然而，需要努力检查退伍军人事务部内外的年轻患者的护理情况。
