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Lung cancer survival is improving in the United States. We investigated whether there was a similar trend within the Veterans Health Administration (VHA), the largest integrated healthcare system in the United States. Data from the Veterans Affairs Central Cancer Registry (VACCR) were analyzed for temporal survival trends using Kaplan-Meier (K-M) estimates and linear regression. 54,922 Veterans were identified with lung cancer diagnosed from 2010-2017. Histologies were classified as non-small cell lung cancer (NSCLC) (64.2%), small cell lung cancer (SCLC) (12.9%), and 'other' (22.9%). The proportion with stage I increased from 18.1% to 30.4%, while stage IV decreased from 38.9% to 34.6% (both p<0.001). The three-year overall survival (OS) improved for stage I (58.6% to 68.4%, p<0.001), stage II (35.5% to 48.4%, p<0.001), stage III (18.7% to 29.4%, p<0.001), and stage IV (3.4% to 7.8%, p<0.001). For NSCLC, the median OS increased from 12 to 21 months (p<0.001), and 3-year OS increased from 24.1% to 38.3% (p<0.001). For SCLC, the median OS remained unchanged (eight to nine months, p=0.10), while the three-year OS increased from 9.1% to 12.3% (p=0.014). Compared to White Veterans, Black Veterans with NSCLC had similar OS (p=0.81), and those with SCLC had higher OS (p=0.003). Lung cancer survival is improving within VHA. Compared to White Veterans, Black Veterans had similar or higher survival rates. The observed racial equity in outcomes within a geographically and socioeconomically diverse population warrants further investigation to better understand and replicate this achievement in other health care systems. [ABSTRACT FROM AUTHOR]

Background: Increasing evidence indicates an association between statins and reduced prostate cancer-specific mortality (PCSM). However, significant bias may exist in these studies. One particularly challenging bias to assess is the healthy user effect, which may be quantified by screening patterns. We aimed to evaluate the association between statin use, screening, and PCSM in a dataset with detailed longitudinal information., Methods: We used the Veterans Affairs Informatics and Computing Infrastructure to assemble a cohort of patients diagnosed with prostate cancer (PC) between 2000 and 2015. We collected patient-level demographic, comorbidity, and tumor data. We also assessed markers of preventive care utilization including cholesterol and prostate specific antigen (PSA) screening rates. Patients were considered prediagnosis statin users if they had at least one prescription one or more years prior to PC diagnosis. We evaluated PCSM using hierarchical Fine-Gray regression models and all-cause mortality (ACM) using a cox regression model., Results: The final cohort contained 68,432 men including 40,772 (59.6%) prediagnosis statin users and 27,660 (40.4%) nonusers. Prediagnosis statin users had higher screening rates than nonusers for cholesterol (90 vs. 69%, p < 0.001) and PSA (76 vs. 67%, p < 0.001). In the model which excluded screening, prediagnosis statin users had improved PCSM (SHR 0.90, 95% CI 0.84-0.97; p = 0.004) and ACM (HR 0.96, 95% CI 0.93-0.99; p = 0.02). However, after including cholesterol and PSA screening rates, prediagnosis statin users and nonusers showed no differences in PCSM (SHR 0.98, 95% CI 0.91-1.06; p = 0.59) or ACM (HR 1.02, 95% CI 0.98-1.05; p = 0.25)., Conclusion: We found that statin users tend to have more screening than nonusers. When we considered screening utilization, we observed no relationship between statin use before a prostate cancer diagnosis and prostate cancer mortality.