Comparison between Veteran and Non-Veteran Populations with Clinical Stage I Non-Small Cell Lung Cancer Undergoing Surgery

Objective The aim of this study was to compare quality of care and outcomes between Veteran and non-Veteran patients undergoing surgery for clinical stage I non-small cell lung cancer (NSCLC). Background Prior studies and the lay media have questioned the quality of care that Veterans with lung cancer receive through the Veterans Health Administration (VHA). We hypothesized Veterans undergoing surgery for early-stage NSCLC receive high quality care and have similar outcomes compared to the general population. Methods We performed a retrospective cohort study of patients with clinical stage I NSCLC undergoing resection from 2006 to 2016 using a VHA dataset. Propensity score matching for baseline patient- and tumor-related variables was used to compare operative characteristics and outcomes between the VHA and the National Cancer Database (NCDB). Results The unmatched cohorts included 9,981 VHA and 176,304 NCDB patients. The VHA had more male, non-white patients with lower education levels, higher incomes, and higher Charlson/Deyo scores. VHA patients had inferior unadjusted 30-day mortality (VHA 2.1% vs NCDB 1.7%, p = 0.011) and median overall survival (69.0 vs 88.7 months, p < 0.001). In the propensity matched cohort of 6,792 pairs, VHA patients were more likely to have minimally invasive operations (60.0% vs 39.6%, p < 0.001) and only slightly less likely to receive lobectomies (70.1% vs 70.7%, p = 0.023). VHA patients had longer lengths of stay (8.1 vs 7.1 days, p < 0.001) but similar readmission rates (7.7% vs 7.0%, p = 0.132). VHA patients had significantly better 30-day mortality (1.9% vs 2.8%, p < 0.001) and median overall survival (71.4 vs 65.2 months, p < 0.001). Conclusions Despite having more comorbidities, Veterans receive exceptional care through the VHA with favorable outcomes, including significantly longer overall survival, compared to the general population.