Presentation
Quality of pancreatic cancer care at Veterans Administration compared with non-Veterans Administration hospitals

Presented at the 31st Annual Surgical Symposium of the Association of VA Surgeons, Little Rock, AR, May 10–12, 2007
https://doi.org/10.1016/j.amjsurg.2007.07.012Get rights and content

Abstract

Background

National efforts are underway to monitor the quality of patient care at Veterans Administration (VA) hospitals. The objective of this study was to examine treatment utilization and outcomes for localized pancreatic cancer at VA compared with non-VA hospitals.

Methods

Using the National Cancer Data Base, patients with pretreatment clinical stage I/II pancreatic adenocarcinoma were identified. Treatment utilization and outcomes were assessed at VA compared with academic and community hospitals.

Results

Of 35,009 patients, 2% were seen at VA, 38% at academic, and 54% at community hospitals. VA hospitals were more likely to use surgery (odds ratio 2.20, 95% confidence interval 1.73–2.79) and to administer adjuvant chemotherapy (odds ratio 1.77, confidence interval 1.28–2.46) compared with community hospitals. Adjusted perioperative mortality and 3-year survival rates after surgery were similar at VA and academic hospitals.

Conclusions

For localized pancreatic cancer, patients treated at VA hospitals receive stage-specific treatments and have risk-adjusted perioperative and long-term survival rates that are comparable with those for patients treated at academic centers.

Section snippets

Patients

The National Cancer Data Base (NCDB) is a program of the American College of Surgeons’ Commission on Cancer (CoC) and receives operational support from the American Cancer Society. The NCDB has been collecting data on newly diagnosed cancers since 1985 [21]. The NCDB now contains data on >20 million patients from >1,440 hospitals, including information on patients (demographics, diagnosis, treatment, recurrence, and survival) as well as health systems information (hospital type, teaching

Results

From the NCDB (1985 to 2004), we identified 31,568 clinical pretreatment stage I and II patients with pancreatic adenocarcinoma. Five hundred thirteen (2%) patients were treated at VA hospitals; 12,756 (38%) were treated at academic hospitals; and 18,299 (54%) were treated at community hospitals. A higher percentage of VA hospital patients were male, younger, and black; had lower-grade tumors, lower incomes, and less education; and presented with higher Charlson comorbidity scores (P < .0001) (

Comments

Pancreatic cancer is a formidable disease with complex surgical management and adjuvant-therapy decisions. The quality of cancer care at VA hospitals has often been questioned; however, no previous study has directly compared pancreatic cancer care at VA hospitals to that at a large national sample of non-VA hospitals. This study demonstrates that treatment utilization, perioperative mortality, and long-term outcomes were comparable at VA and academic hospitals.

Previous studies have shown that

Acknowledgments

K.Y.B. was supported by the American College of Surgeons Clinical Scholars in Residence program and a research grant from the Department of Surgery, Northwestern University.

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