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Tarlov, Elizabeth; Lee, Todd A; Weichle, Thomas; Durazo-Arvizu, Ramon; Zhang, Qiuying; Perrin, Ruth; Bentrem, David J; Hynes, Denise M
Reduced Overall and Event-Free Survival Among Colon Cancer Patients Using Dual System Care.
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology (2012) 21:2231-2241.
Abstract
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.
Note
Automated medline import. Electronic deposit: 2012-10-11.Electronic publication: 2012-10-16. Publication Date: 2012-12-01. Publication status: ppublish. Status: MEDLINE.
PubMed ID
23064003
PubMed Central ID
N/A
Digital Object Identifier (DOI)
10.1158/1055-9965.EPI-12-0548
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Last updated from PubMed on Friday, May 22, 2015