Reduced Overall and Event-Free Survival Among Colon Cancer Patients Using Dual System Care
En comparant les données de deux systèmes d’assurance maladie dédiée aux anciens combattants américains, cette étude analyse, à 3 ans, la survie globale des patients atteints d'un cancer colorectal non métastatique
Background:Many veterans have dual Veterans Administration (VA) and Medicare healthcare coverage. We compared 3-year overall and cancer event-free survival (OS; EFS) among patients with non-metastatic colon cancer who obtained substantial portions of their care in both systems and those whose care was obtained predominantly in the VA or in the Medicare fee-for-service system. Methods:Many veterans have dual Veterans Administration (VA) and Medicare healthcare coverage. We compared 3-year overall and cancer event-free survival (OS; EFS) among patients with non-metastatic colon cancer who obtained substantial portions of their care in both systems and those whose care was obtained predominantly in the VA or in the Medicare fee-for-service system. Results:VA and non-VA users (all stages) had reduced hazard of dying compared to dual users (for example, for stage I, VA HR 0.40, CI95 0.28-0.56; non-VA HR 0.54, CI95 0.38-0.78). For EFS, stage I findings were similar (VA HR 0.47, CI95 0.35-0.62; non-VA HR 0.64, CI95 0.47-0.86). Stage II and III VA users, but not non-VA users, had improved EFS (Stage II: VA HR 0.74, CI95 0.56-0.97; non-VA HR 0.92 CI95 0.69-1.22. Stage III: VA HR 0.73, CI95 0.56-0.94; non-VA HR 0.81 CI95 0.62-1.06). Conclusions:Improved survival among VA and non-VA compared to dual users raises questions about coordination of care and unmet needs. Impact:Additional study is needed to understand why these differences exist, why patients use both systems and how systems may be improved to yield better outcomes in this population.