A major revamping of Veterans Health Administration care for more than six million Americans in the 1990s corrected many problems in the then "dysfunctional" system. And since then, research has documented that the VA's major improvements in preventive and long-term care, and for care for several acute and chronic conditions, has made the system at least as good as the private sector, and in some cases better.
But data have been lacking for cancer care. A study in Monday's Annals of Internal Medicine has found that process improvements in care for colorectal, lung or prostate cancer, or lymphoma or multiple myeloma are now "similar to or better than care for fee-for-service Medicare beneficiaries."
However adoption of some expensive technologies to treat prostate cancer, such as three-dimensional conformal radiotherapy or intensity modulated radiation therapy, have tended to lag.
The report was prepared by Nancy L. Keating, MD and colleagues at Harvard Medical School and was funded by the Department of Veterans Affairs. It covered male patients over age 65 who were treated between 2001 and 2004 in both the VA system in all parts of the country and compared them with data collected for fee-for-service Medicare beneficiaries and followed them through 2005.
The VA, which treats 6.1 million patients, is the largest integrated healthcare system in the country. So outcomes from its care procedures and policies can inform other providers, the researchers say.
Among the report's findings:
- Patients in the VHA system with colon and rectal cancer received the diagnosis at earlier stages than those in the private sector, although rates of unstaged colorectal cancer were also higher in the VHA population.
- Patients received curative surgery for stage I or II non-small cell lung cancer and mediastinal evaluation, and chemotherapy and radiation for stage IIIA resected non-small cell lung cancer at the same rates as the private sector population.
- For prostate cancer, patients received androgen ablation within four months of diagnosis at similar rates. However patients with local or regional prostate cancer who under went external –beam radiation therapy were less likely than those in the private sector to receive 3-dimensional conformal radiation therapy or intensity modulated radiation therapy. Implementation of those expensive technologies was delayed in the VA system.
- Care was said to be better in the VHA system than in the private sector for patients with hematologic cancers, lymphoma and myeloma because patients had higher rates of chemotherapy regimen called CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone.)
"Our results provide encouraging support for the effectiveness of healthcare delivery, including specialized cancer care, for men in the VHA ...(and) suggest that the VHA system might serve as a model for care delivery as healthcare reform is implemented," wrote Keating, associate professor of medicine and of health care policy at Harvard Medical School and an associate physician at Brigham and Women's Hospital.
In an accompanying editorial, Joan J. Ryoo, MD of the UCLA Jonsson Comprehensive Cancer Center and Jennifer Malin, MD, of the Veterans Affairs Greater Los Angeles Healthcare System, suggested that the success of the VHA in cancer care should lead providers to more seriously consider the benefits of a single payer healthcare system.
"Despite the clamor of special interests, corporate lobbying and the particular American distaste for government run institutions, the public option may yet find its voice in the latest round of accomplishments demonstrated by the VHA," they wrote.
"The results of Keating and colleagues' analysis provide a poignant reminder that a vision for a national, integrated, government-run healthcare system not only exists but is, in fact, successful."