Early-Stage Lung Cancer in the Era of Lung Cancer Screening: Veterans Health Administration Outperforms Other Insurance Models.

Autor:	Rossetti NE; Division of Cardiothoracic Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri. Electronic address: n.e.rossetti@wustl.edu., Eaton DB Jr; John J. Cochran Veterans Hospital, St Louis, Missouri., Tohmasi S; Division of Cardiothoracic Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri., Heiden BT; Division of Cardiothoracic Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri., Schoen MW; John J. Cochran Veterans Hospital, St Louis, Missouri; Division of Hematology and Oncology, Saint Louis University, St. Louis, Missouri., Yan Y; Division of Public Health Sciences, Washington University in St. Louis School of Medicine, St. Louis, Missouri., Baumann AA; Division of Public Health Sciences, Washington University in St. Louis School of Medicine, St. Louis, Missouri., Chang SH; Division of Public Health Sciences, Washington University in St. Louis School of Medicine, St. Louis, Missouri., Thomas TS; John J. Cochran Veterans Hospital, St Louis, Missouri; Division of Oncology, Washington University in St. Louis School of Medicine, St. Louis, Missouri., Patel MR; John J. Cochran Veterans Hospital, St Louis, Missouri., Kreisel D; Division of Cardiothoracic Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri., Nava RG; Division of Cardiothoracic Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri., Brandt WS; Division of Cardiothoracic Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri., Meyers BF; Division of Cardiothoracic Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri., Kozower BD; Division of Cardiothoracic Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri., Puri V; Division of Cardiothoracic Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri; John J. Cochran Veterans Hospital, St Louis, Missouri.
Jazyk:	angličtina
Zdroj:	The Annals of thoracic surgery [Ann Thorac Surg] 2024 Nov; Vol. 118 (5), pp. 1117-1125. Date of Electronic Publication: 2024 Aug 22.
DOI:	10.1016/j.athoracsur.2024.07.041
Abstrakt:	Background: Lung cancer screening guidelines were introduced in the United States in 2013, with variable implementation. This study evaluated temporal diagnostic trends in non-small cell lung cancer (NSCLC) diagnosis since the introduction of these guidelines. Methods: This retrospective cohort analysis used data from the Veterans Administration Corporate Data Warehouse and the National Cancer Database. We evaluated temporal trends in the distribution of NSCLC stage at the time of diagnosis along with differences based on insurance coverage type, including uninsured, privately insured, Medicare, Medicaid, and Veterans Affairs (VA) coverage, with adjustment for clinically relevant variables. Results: Among 1,450,965 patients diagnosed from 2006 to 2020, the proportion of NSCLC cases diagnosed at stage I increased in all insurance groups by 12.74%, 2%, 0.25%, and 2.57% for the VA, Medicare, private insurance, and Medicaid, respectively. If all insurance systems achieved the unadjusted stage distribution seen in the Veterans Health Administration, an additional 45,684 patients would be diagnosed with stage I NSCLC and 65,933 fewer patients would be diagnosed with stage IV disease. Conclusions: For patients with any form of insurance, there has been an increase in the proportion of early-stage NSCLC (stage I and II) and a corresponding decrease in the proportion of stage III and IV since the introduction of national lung cancer screening guidelines. As the largest integrated single-payer health care system in the United States, the VA dramatically outperforms other insurance types, perhaps attributable to universal coverage and robust lung cancer screening programs. Competing Interests: Disclosures Brendan Heiden reports a relationships with Oncocyte Corporation and Eli Lilly & Company that includes: consulting or advisory and employment. Martin Schoen reports a relationship with Pfizer that includes: speaking and lecture fees. Varun Puri reports a relationship with PrecisCa that includes: speaking and lecture fees. Varun Puri (spouse) reports a relationship with Intuitive Surgical Inc that includes: equity or stocks. The other authors have no conflicts of interest to disclose. (Copyright © 2024. Published by Elsevier Inc.)
Databáze:	MEDLINE
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