Trends in lung cancer survival: superior outcomes in US Veterans compared with the general population

BACKGROUND: Non-small cell lung cancer (NSCLC) remains the leading cause of cancer-related mortality in the United States, but survival outcomes are shifting with evolving therapies and screening. Recent findings suggest that survival improvements vary across health-care systems, with favorable trends observed in the Veterans Health Administration (VHA). We sought to compare NSCLC survival trends across US health systems. METHODS: We conducted a retrospective cohort study of patients with NSCLC (2007-2019) using data from the VHA and the National Cancer Database (NCDB), representing the non-VHA US general population. The primary exposure was health system (VHA vs non-VHA), and the primary outcome was 3-year all-cause mortality. Multivariable Cox models estimated annual adjusted overall survival (OS), with interaction terms for health system and stage. RESULTS: Among 1 463 996 patients (VHA n = 79 027; NCDB n = 1 38 4 969), adjusted 3-year OS increased from 24% to 51% (VHA) and from 24% to 41% (non-VHA) between 2007 and 2019. The VHA survival advantage persisted in analyses stratified by stage (all P-values <.0001) and when analyses were limited to NCDB patients with Medicare or private insurance (51% vs 42% in 2019; P < .0001). CONCLUSIONS: In this nationally representative study, 3-year OS among patients with NSCLC improved between 2007 and 2019, with larger and more rapid gains observed within the VHA compared with non-VHA settings. These findings suggest that lung cancer care delivered within an integrated, publicly funded system is associated with greater and more rapidly improving survival than care delivered across a heterogeneous mix of US health-care delivery settings represented in the NCDB.