Improved Equity in Cancer Outcomes within the Veterans Administration

Oftentimes studies emphasize differences and outcome disparities, but can we find circumstances where previously-observed disparities are absent? A diverse, multi-specialized research group led by Dr. Ryan Orosco set out to explore this question as it pertains to patients with larynx cancer in the journal Cancer. The group dug into a novel database from the Veterans Health Administration (VHA) that has not been looked at previously. For decades, a great deal of work has exposed healthcare disparities across numerous realms, and larynx cancer is no exception. This group looked to see if similar disparities exist within the VHA. Most large database research looking at patients with laryngeal cancer comes from hospitals that her outside of the Veterans health administration. Their study found that black patient's in the VHA presented with the same severity of larynx cancers as white patients. Furthermore, these black patients had similar survival and cancer outcomes, which is counter to the expectation based on previous studies from non-VHA data.

The research raises important issues in clinical medicine and also serves as a showcase of the collaborative research environment at UC San Diego Health. Ryan Orosco, MD, Brent Rose, MD and Mateo Banegas, PhD are part of the Center for Health Equity, Education & Research (CHEER) based in the UC San Diego Health Department of Radiation Medicine and Applied Sciences. Through the support of CHEER, the UC San Diego School of Medicine, and the Altman Clinical and Translational Research Institute (ACTRI), they spent the last year mentoring an outstanding group of medical students that contributed to this publication, and a handful of other studies.

Improved equity in cancer outcomes within the VHA is an exciting, encouraging observation but the factors that contribute to this apparent reversal of outcome disparity remain to be elucidated. In each and every disease and healthcare situation, a myriad of factors influence the ultimate outcome—comorbid conditions, genetics, socioeconomic factors, individual behaviors, just to name a few. Factors can contribute directly or indirectly, and the web of potential associations is an enormously complex puzzle. This study, as is so often the case with research, perhaps leads to more questions than before. Would there have been different results if these VHA patients were treated through the non-VHA healthcare system? What are the key patient, disease, and socioeconomic factors that influenced the results? What factors does the VHA manage well? What factors could all hospitals manage better? The hope is that this work helps move the scientific community toward studies and future interventions that can optimize outcomes for each unique individual case. Read More