Va copay rates 201412/30/2023 VHA patients initially diagnosed with stage III NSCLC between Januand Decemwere identified using the VA Corporate Data Warehouse (CDW), which contains an extract of the VA Cancer Registry System (CRS). The secondary objective was to report reasons why patients did not receive CCRT. The primary objective of this study was to report on more recent nationwide CCRT treatment patterns in VHA patients and identify patient- and facility-level factors associated with receipt of CCRT. Among those patients who received chemotherapy (CT) and RT, almost 60% received CCRT (as opposed to SCRT). īetween 20, only one-quarter of VHA patients with stage III NSCLC received chemotherapy and radiation within 4 months of diagnosis and had unresectable disease. Many VHA patients are current (16%) or past (61%) smokers, which can impact histology and treatment of NSCLC. In 2010, 18% of incident veteran cancer cases diagnosed in the VHA were lung cancer. Compared to the general US population, VHA patients tend to be older, have lower levels of income and education, and have a higher comorbidity burden. The majority of VHA patients are male, married, white, and non-Hispanic. It has approximately 171 medical centers and 1112 outpatient sites of care and serves approximately 9 million patients each year. The VHA is the largest integrated health care system in the US. In the United States (US), military veterans (i.e., those who served in the armed forces), are eligible for medical care from the Veterans Health Administration (VHA). As a result, frail patients may not be able to tolerate CCRT. For example, CCRT has a higher rate of grade 3 or 4 esophagitis than SCRT. However, guidelines also note that as part of the treatment selection process, one should consider a patient’s ability to tolerate CCRT. In patients with unresectable stage III non-small cell lung cancer (NSCLC), high-level evidence from randomized controlled trials published starting in the 1990s have demonstrated that concurrent chemoradiation therapy (CCRT) results in improved overall survival compared to radiation therapy (RT) alone or sequential chemoradiation therapy (SCRT) with tolerable additional toxicity. Older patients and those with multiple comorbidities were less likely to receive CCRT and even when controlling for these factors, non-white patients were less likely to receive CCRT. ConclusionsĬCRT rates among VHA patients with unresectable, stage III NSCLC slightly increased from 2013 to 2017 however in 2017, only half were receiving CCRT. Among these, 29% declined treatment, and 71% did not receive CCRT due to “not being a candidate” for reasons related to frailty or lung nodules being too far apart for radiation therapy. In a chart review sample of 200 patients, less than half ( n = 85) had a documented reason for not receiving CCRT. White race was associated with increased odds of CCRT receipt (aOR = 1.24 95% CI: 1.004–1.53). Factors associated with decreased odds of CCRT receipt compared to any other treatment included increasing age (adjusted odds ratio per 10 years = 0.67 95% CI: 0.60–0.76) and Charlson-Deyo comorbidity score (aOR = 0.94 95% CI: 0.91–0.97). ResultsĪmong 4054 VHA patients who met study criteria, CCRT rates slightly increased from 44 to 50% between 20. Using Department of Veteran Affairs (VA) Cancer Registry System data linked to VA electronic medical records, we determined rates of CCRT, sequential CRT (SCRT), radiation therapy (RT) only, chemotherapy (CT) only, and neither treatment. The objective was to report recent CCRT treatment patterns in VHA patients and identify characteristics associated with receipt of CCRT. Among VHA patients, the rate of use of concurrent chemoradiation therapy (CCRT) among those with unresectable, stage III non-small cell lung cancer (NSCLC) is unknown. The Veterans Health Administration (VHA) is the largest integrated health care system in the United States (US).
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