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Zeliadt S.B.,VA Health Services Research and Development Service | Zeliadt S.B.,University of Washington | Sekaran N.K.,University of Washington | Hu E.Y.,VA Health Services Research and Development Service | And 6 more authors.
Journal of Thoracic Oncology | Year: 2011

Introduction: 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. Methods: 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. Results: 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). Conclusions: 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. © 2011 by the International Association for the Study of Lung Cancer.

Zeliadt S.B.,VA Health Services Research and Development Service | Zeliadt S.B.,University of Washington | Zeliadt S.B.,Fred Hutchinson Cancer Research Center | Hoffman R.M.,Medicine Service | And 5 more authors.
Journal of General Internal Medicine | Year: 2010

BACKGROUND: The occurrence and timing of prostate biopsy following an elevated prostate-specific antigen (PSA) test varied considerably in randomized screening trials. OBJECTIVE: Examine practice patterns in routine clinical care in response to an elevated PSA test (=4 ng/μl) and determine whether time to biopsy was associated with cancer stage at diagnosis. DESIGN: Retrospective cohort study. PARTICIPANTS: All veterans (n=13,591) in the Pacific Northwest VA Network with a PSA=4 ng/μl between 1998 and 2006 and no previous elevated PSA tests or prostate biopsy. MAIN MEASURES: We assessed follow-up care including additional PSA testing, urology consults, and biopsies. We compared stage at diagnosis for men who were biopsied within 24 months vs. those men biopsied and diagnosed >24 months after the elevated PSA test. KEY RESULTS: Two-thirds of patients received follow- up evaluation within 24 months of the elevated PSA test: 32.8% of men underwent a biopsy, 15.5% attended a urology visit but were not biopsied, and 18.8% had a subsequent normal PSA test. Younger age, higher PSA levels, more prior PSA tests, no copayment requirements, existing urologic conditions, low body mass index, and low comorbidity scores were associated with more complete follow-up. Among men who underwent radical prostatectomy, a delayed diagnosis was not significantly associated with having a pathologically advanced-stage cancer (T3/T4), although we found an increased likelihood of presenting with stage T2C relative to stage T2A or T2B cancer. CONCLUSIONS: Follow-up after an elevated PSA test is highly variable with more than a third of men receiving care that could be considered incomplete. A delayed diagnosis was not associated with poorer prognosis. © Society of General Internal Medicine 2010.

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