Silberstein PT

Background: There are a variety of treatments available for patients with stage IV colon cancer. Chemotherapy is the usual treatment, with greater amounts of surgery being associated with more aggressive hospitals. Income can play a role in the type of treatment a patient receives, or if they even receive treatment at all (Baldwin et al. 2005).

Methods: First course treatment received by stage IV colon cancer patients of Veterans Affair Hospitals (VAH) and all other hospital types were compared using the National Cancer Data Base (NCDB). Patient’ 2012 income and type of treatment provided were examined. Treatment types included chemotherapy, surgery, no treatment, etc. Data from 45 VAH with 2,667 patients and 1,543 non-VA affiliated hospitals with 144,575 patients were utilized. Chi-squared analysis was conducted to calculate statistical significance.

Results: The NCDB reveals noticeable differences between VAH and all other hospitals in percentages of stage IV colon cancer patients receiving treatment. 25.3% of VAH patients received no treatment while 16.9% of patients at all other hospitals received no treatment (P < .05). More VAH patients received solely chemotherapy compared to patients at other hospitals (21.2% vs 15.9%, P < .05). VAH patients had less surgery compared to patients at all other hospitals (47.2% vs 59.4%, P < .05). These effects were present at all income levels.

Implications: VAH patients were more likely to receive no treatment compared to patients at all other hospitals. Furthermore, VAH patients were less likely to receive aggressive surgical care compared to other hospitals. These results imply that VAH patients are more likely to receive no treatment in comparison to other hospitals, as well as less likely to receive aggressive care when treatment is given. Differences in care seen between hospital types were not influenced by income.

Background: There are a variety of treatments available for patients with stage IV colon cancer. Chemotherapy is the usual treatment, with greater amounts of surgery being associated with more aggressive hospitals. Income can play a role in the type of treatment a patient receives, or if they even receive treatment at all (Baldwin et al. 2005).

Methods: First course treatment received by stage IV colon cancer patients of Veterans Affair Hospitals (VAH) and all other hospital types were compared using the National Cancer Data Base (NCDB). Patient’ 2012 income and type of treatment provided were examined. Treatment types included chemotherapy, surgery, no treatment, etc. Data from 45 VAH with 2,667 patients and 1,543 non-VA affiliated hospitals with 144,575 patients were utilized. Chi-squared analysis was conducted to calculate statistical significance.

Results: The NCDB reveals noticeable differences between VAH and all other hospitals in percentages of stage IV colon cancer patients receiving treatment. 25.3% of VAH patients received no treatment while 16.9% of patients at all other hospitals received no treatment (P < .05). More VAH patients received solely chemotherapy compared to patients at other hospitals (21.2% vs 15.9%, P < .05). VAH patients had less surgery compared to patients at all other hospitals (47.2% vs 59.4%, P < .05). These effects were present at all income levels.

Implications: VAH patients were more likely to receive no treatment compared to patients at all other hospitals. Furthermore, VAH patients were less likely to receive aggressive surgical care compared to other hospitals. These results imply that VAH patients are more likely to receive no treatment in comparison to other hospitals, as well as less likely to receive aggressive care when treatment is given. Differences in care seen between hospital types were not influenced by income.

Background: There are a variety of treatments available for patients with stage IV colon cancer. Chemotherapy is the usual treatment, with greater amounts of surgery being associated with more aggressive hospitals. Income can play a role in the type of treatment a patient receives, or if they even receive treatment at all (Baldwin et al. 2005).

Methods: First course treatment received by stage IV colon cancer patients of Veterans Affair Hospitals (VAH) and all other hospital types were compared using the National Cancer Data Base (NCDB). Patient’ 2012 income and type of treatment provided were examined. Treatment types included chemotherapy, surgery, no treatment, etc. Data from 45 VAH with 2,667 patients and 1,543 non-VA affiliated hospitals with 144,575 patients were utilized. Chi-squared analysis was conducted to calculate statistical significance.

Results: The NCDB reveals noticeable differences between VAH and all other hospitals in percentages of stage IV colon cancer patients receiving treatment. 25.3% of VAH patients received no treatment while 16.9% of patients at all other hospitals received no treatment (P < .05). More VAH patients received solely chemotherapy compared to patients at other hospitals (21.2% vs 15.9%, P < .05). VAH patients had less surgery compared to patients at all other hospitals (47.2% vs 59.4%, P < .05). These effects were present at all income levels.

Implications: VAH patients were more likely to receive no treatment compared to patients at all other hospitals. Furthermore, VAH patients were less likely to receive aggressive surgical care compared to other hospitals. These results imply that VAH patients are more likely to receive no treatment in comparison to other hospitals, as well as less likely to receive aggressive care when treatment is given. Differences in care seen between hospital types were not influenced by income.

Background: Prostate cancer is the second leading cause of cancer death in American men, diagnosed mainly in older men. Treatment options for stage 3 prostate cancer include external beam radiation plus hormone therapy (HT) vs external beam radiation plus brachytherapy vs radical prostatectomy in selected cases.

Methodology: A total of 52,384 patients with stage 3 prostate cancer have been studied from national cancer database comparing Veterans Affairs Hospital (VAH) vs Academic Centers from years 2003-2013. Fisher exact test was used to make direct comparisons between centers and treatment type. We used a Bonferroni-adjusted P.

Results: Within both the 50-59 and 60-69-year-old age groups, when compared to Academic hospitals, VAH performed surgery alone at a lower rate (87.6% vs 77.4% and 86.1% vs 77.7%, respectively) and performed Surgery + Radiation and Radiation + Hormone therapy at a significantly higher rate (8.2% vs 15.0% and 6.8% vs 10.0%, respectively). In 70-79 year age group, when compared to Academic hospitals, VAH performed surgery alone at a lower rate (73.5% vs 43.1%) and Hormone therapy only and Radiation + Hormone therapy at significantly higher rate (3.7% vs 17.3% and 20.8% vs 33.9%, respectively) (all P < .001).

Conclusion: In VAH, people within age groups of 50-59, 60-69 years had more surgery plus radiation, radiation plus HT and less surgery alone than Academic centers. In 70-79 age group, VAH performed much more HT only, radiation plus HT and less surgery alone than Academic Centers.

Background: Prostate cancer is the second leading cause of cancer death in American men, diagnosed mainly in older men. Treatment options for stage 3 prostate cancer include external beam radiation plus hormone therapy (HT) vs external beam radiation plus brachytherapy vs radical prostatectomy in selected cases.

Methodology: A total of 52,384 patients with stage 3 prostate cancer have been studied from national cancer database comparing Veterans Affairs Hospital (VAH) vs Academic Centers from years 2003-2013. Fisher exact test was used to make direct comparisons between centers and treatment type. We used a Bonferroni-adjusted P.

Results: Within both the 50-59 and 60-69-year-old age groups, when compared to Academic hospitals, VAH performed surgery alone at a lower rate (87.6% vs 77.4% and 86.1% vs 77.7%, respectively) and performed Surgery + Radiation and Radiation + Hormone therapy at a significantly higher rate (8.2% vs 15.0% and 6.8% vs 10.0%, respectively). In 70-79 year age group, when compared to Academic hospitals, VAH performed surgery alone at a lower rate (73.5% vs 43.1%) and Hormone therapy only and Radiation + Hormone therapy at significantly higher rate (3.7% vs 17.3% and 20.8% vs 33.9%, respectively) (all P < .001).

Conclusion: In VAH, people within age groups of 50-59, 60-69 years had more surgery plus radiation, radiation plus HT and less surgery alone than Academic centers. In 70-79 age group, VAH performed much more HT only, radiation plus HT and less surgery alone than Academic Centers.

Background: Prostate cancer is the second leading cause of cancer death in American men, diagnosed mainly in older men. Treatment options for stage 3 prostate cancer include external beam radiation plus hormone therapy (HT) vs external beam radiation plus brachytherapy vs radical prostatectomy in selected cases.

Methodology: A total of 52,384 patients with stage 3 prostate cancer have been studied from national cancer database comparing Veterans Affairs Hospital (VAH) vs Academic Centers from years 2003-2013. Fisher exact test was used to make direct comparisons between centers and treatment type. We used a Bonferroni-adjusted P.

Results: Within both the 50-59 and 60-69-year-old age groups, when compared to Academic hospitals, VAH performed surgery alone at a lower rate (87.6% vs 77.4% and 86.1% vs 77.7%, respectively) and performed Surgery + Radiation and Radiation + Hormone therapy at a significantly higher rate (8.2% vs 15.0% and 6.8% vs 10.0%, respectively). In 70-79 year age group, when compared to Academic hospitals, VAH performed surgery alone at a lower rate (73.5% vs 43.1%) and Hormone therapy only and Radiation + Hormone therapy at significantly higher rate (3.7% vs 17.3% and 20.8% vs 33.9%, respectively) (all P < .001).

Conclusion: In VAH, people within age groups of 50-59, 60-69 years had more surgery plus radiation, radiation plus HT and less surgery alone than Academic centers. In 70-79 age group, VAH performed much more HT only, radiation plus HT and less surgery alone than Academic Centers.

Ocular melanoma is the most common primary intraocular malignancy and can often be fatal. It is relatively uncommon and presents in about 5.1 cases per million population per year. Oftentimes, the patient is asymptomatic at diagnosis and the presentation is highly variable. We present a case of ocular melanoma.

A 68-year-old man with a history of hypertension, osteoarthritis, and coronary artery disease came in after having worsening pain in multiple joints. Review of systems revealed worsening blurry vision and eye floaters. He denied eye pain or other associated complaints. He had no past history of any ocular pigmented lesions or history of skin cancer. Ophthalmology evaluation a few years earlier did not identify any abnormalities. Approximately 10 years prior to presentation, he did have LASIK surgery on both eyes. Subsequent ophthalmological evaluation showed an iris mass, elevated pressure, intra-retinal hemorrhages, and evidence of involvement in the choroid and conjunctivae. This was highly suspicious for iris melanoma of the right eye. He was started on intraocular pressure lowering medications and further workup was initiated. Biopsy confirmed the diagnoses of choroidal melanoma with an iris mass measuring 1 mm radially by 4 mm circumferentially. The mass extended posteriorly and involved well over half his iridocorneal angle resulting in very high intraocular pressure. A metastatic workup was done and was negative at the time. He underwent successful enucleation surgery with prostheses placement. Patient did well until about 1.5 years later when he was found to have multiple liver lesions suggestive of metastasis. This is currently being further evaluated.

No current guidelines exist for the screening of primary ocular melanoma as well as for screening for metastasis in those already diagnosed. Unfortunately, up to 50% of patients with ocular melanoma develop metastases. This case opens the discussion of needing current guidelines for screening and better surveillance in ocular melanomas. It highlights the importance of looking into screening using genomics and also developing targeted therapies, as well as focusing on immunotherapies for these cases.

Ocular melanoma is the most common primary intraocular malignancy and can often be fatal. It is relatively uncommon and presents in about 5.1 cases per million population per year. Oftentimes, the patient is asymptomatic at diagnosis and the presentation is highly variable. We present a case of ocular melanoma.

A 68-year-old man with a history of hypertension, osteoarthritis, and coronary artery disease came in after having worsening pain in multiple joints. Review of systems revealed worsening blurry vision and eye floaters. He denied eye pain or other associated complaints. He had no past history of any ocular pigmented lesions or history of skin cancer. Ophthalmology evaluation a few years earlier did not identify any abnormalities. Approximately 10 years prior to presentation, he did have LASIK surgery on both eyes. Subsequent ophthalmological evaluation showed an iris mass, elevated pressure, intra-retinal hemorrhages, and evidence of involvement in the choroid and conjunctivae. This was highly suspicious for iris melanoma of the right eye. He was started on intraocular pressure lowering medications and further workup was initiated. Biopsy confirmed the diagnoses of choroidal melanoma with an iris mass measuring 1 mm radially by 4 mm circumferentially. The mass extended posteriorly and involved well over half his iridocorneal angle resulting in very high intraocular pressure. A metastatic workup was done and was negative at the time. He underwent successful enucleation surgery with prostheses placement. Patient did well until about 1.5 years later when he was found to have multiple liver lesions suggestive of metastasis. This is currently being further evaluated.

No current guidelines exist for the screening of primary ocular melanoma as well as for screening for metastasis in those already diagnosed. Unfortunately, up to 50% of patients with ocular melanoma develop metastases. This case opens the discussion of needing current guidelines for screening and better surveillance in ocular melanomas. It highlights the importance of looking into screening using genomics and also developing targeted therapies, as well as focusing on immunotherapies for these cases.

Ocular melanoma is the most common primary intraocular malignancy and can often be fatal. It is relatively uncommon and presents in about 5.1 cases per million population per year. Oftentimes, the patient is asymptomatic at diagnosis and the presentation is highly variable. We present a case of ocular melanoma.

A 68-year-old man with a history of hypertension, osteoarthritis, and coronary artery disease came in after having worsening pain in multiple joints. Review of systems revealed worsening blurry vision and eye floaters. He denied eye pain or other associated complaints. He had no past history of any ocular pigmented lesions or history of skin cancer. Ophthalmology evaluation a few years earlier did not identify any abnormalities. Approximately 10 years prior to presentation, he did have LASIK surgery on both eyes. Subsequent ophthalmological evaluation showed an iris mass, elevated pressure, intra-retinal hemorrhages, and evidence of involvement in the choroid and conjunctivae. This was highly suspicious for iris melanoma of the right eye. He was started on intraocular pressure lowering medications and further workup was initiated. Biopsy confirmed the diagnoses of choroidal melanoma with an iris mass measuring 1 mm radially by 4 mm circumferentially. The mass extended posteriorly and involved well over half his iridocorneal angle resulting in very high intraocular pressure. A metastatic workup was done and was negative at the time. He underwent successful enucleation surgery with prostheses placement. Patient did well until about 1.5 years later when he was found to have multiple liver lesions suggestive of metastasis. This is currently being further evaluated.

No current guidelines exist for the screening of primary ocular melanoma as well as for screening for metastasis in those already diagnosed. Unfortunately, up to 50% of patients with ocular melanoma develop metastases. This case opens the discussion of needing current guidelines for screening and better surveillance in ocular melanomas. It highlights the importance of looking into screening using genomics and also developing targeted therapies, as well as focusing on immunotherapies for these cases.

Purpose/Objectives: Surgery and radiotherapy are the mainstays of treatment for stage I non-small cell lung cancer (NSCLC). While surgical resection is the treatment of choice, radiotherapy remains an option for high risk surgical candidates. We aim to analyze the use of selected primary treatment modalities at VA, community, and academic hospitals. To our knowledge, we are the largest study to compare the utilization of surgery and radiotherapy among hospital types for treatment of stage I NSCLC from 2003-2013.

Materials/Methods: This retrospective study employed the NCDB, a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society. 148,797 patients treated for stage I NSCLC at VA, community, or academic hospitals between 2003-2013 were identified. The Pearson’s chi-square test was used to determine significance.

Results: Of patients treated at the VA, community, and academic hospitals, 56.0%, 47.8%, and 42.2%, respectively, had one or more comorbid condition(s). Median distance traveled ranges (miles) were 25-49, 5-9, and 10-24, respectively. Median age ranges (years) were 60-69, 70-79, and 70-79, respectively. 96.9% were male at the VA, compared to 49.6% at community and 46.7% at academic hospitals. Slightly more patients were treated with surgery alone at the VA (60.2%) compared to community hospitals (51.5%; P < .0001); a smaller proportion of patients were treated with surgery at the VA compared to academic hospitals (64.4%; P < .0001). More patients were treated with radiation alone at the VA (16.8%) compared to academic (15.1%) and community (12.2%) hospitals (P < .0001). Patients received less combination therapy at VA hospitals (0.9%) compared to academic (1.8%) and community (1.8%) hospitals (P < .0001). The remaining patients (approximately 30%) received one of several permutations that combined 2 or more of the following treatment modalities: hormone therapy, chemotherapy, biological response modifier therapy, radiotherapy, and surgery.

Conclusion: Although there are minor differences in the proportion of patients receiving each treatment modality, use of radiotherapy and surgery to treat stage I NSCLC is relatively consistent among VA, community, and academic hospitals. Future studies should explore the treatment modalities excluded from this study, compare radiotherapy to stereotactic radiosurgery, and examine how treatment modality affects recurrence and survival.

Purpose/Objectives: Surgery and radiotherapy are the mainstays of treatment for stage I non-small cell lung cancer (NSCLC). While surgical resection is the treatment of choice, radiotherapy remains an option for high risk surgical candidates. We aim to analyze the use of selected primary treatment modalities at VA, community, and academic hospitals. To our knowledge, we are the largest study to compare the utilization of surgery and radiotherapy among hospital types for treatment of stage I NSCLC from 2003-2013.

Materials/Methods: This retrospective study employed the NCDB, a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society. 148,797 patients treated for stage I NSCLC at VA, community, or academic hospitals between 2003-2013 were identified. The Pearson’s chi-square test was used to determine significance.

Results: Of patients treated at the VA, community, and academic hospitals, 56.0%, 47.8%, and 42.2%, respectively, had one or more comorbid condition(s). Median distance traveled ranges (miles) were 25-49, 5-9, and 10-24, respectively. Median age ranges (years) were 60-69, 70-79, and 70-79, respectively. 96.9% were male at the VA, compared to 49.6% at community and 46.7% at academic hospitals. Slightly more patients were treated with surgery alone at the VA (60.2%) compared to community hospitals (51.5%; P < .0001); a smaller proportion of patients were treated with surgery at the VA compared to academic hospitals (64.4%; P < .0001). More patients were treated with radiation alone at the VA (16.8%) compared to academic (15.1%) and community (12.2%) hospitals (P < .0001). Patients received less combination therapy at VA hospitals (0.9%) compared to academic (1.8%) and community (1.8%) hospitals (P < .0001). The remaining patients (approximately 30%) received one of several permutations that combined 2 or more of the following treatment modalities: hormone therapy, chemotherapy, biological response modifier therapy, radiotherapy, and surgery.

Conclusion: Although there are minor differences in the proportion of patients receiving each treatment modality, use of radiotherapy and surgery to treat stage I NSCLC is relatively consistent among VA, community, and academic hospitals. Future studies should explore the treatment modalities excluded from this study, compare radiotherapy to stereotactic radiosurgery, and examine how treatment modality affects recurrence and survival.

Purpose/Objectives: Surgery and radiotherapy are the mainstays of treatment for stage I non-small cell lung cancer (NSCLC). While surgical resection is the treatment of choice, radiotherapy remains an option for high risk surgical candidates. We aim to analyze the use of selected primary treatment modalities at VA, community, and academic hospitals. To our knowledge, we are the largest study to compare the utilization of surgery and radiotherapy among hospital types for treatment of stage I NSCLC from 2003-2013.

Materials/Methods: This retrospective study employed the NCDB, a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society. 148,797 patients treated for stage I NSCLC at VA, community, or academic hospitals between 2003-2013 were identified. The Pearson’s chi-square test was used to determine significance.

Results: Of patients treated at the VA, community, and academic hospitals, 56.0%, 47.8%, and 42.2%, respectively, had one or more comorbid condition(s). Median distance traveled ranges (miles) were 25-49, 5-9, and 10-24, respectively. Median age ranges (years) were 60-69, 70-79, and 70-79, respectively. 96.9% were male at the VA, compared to 49.6% at community and 46.7% at academic hospitals. Slightly more patients were treated with surgery alone at the VA (60.2%) compared to community hospitals (51.5%; P < .0001); a smaller proportion of patients were treated with surgery at the VA compared to academic hospitals (64.4%; P < .0001). More patients were treated with radiation alone at the VA (16.8%) compared to academic (15.1%) and community (12.2%) hospitals (P < .0001). Patients received less combination therapy at VA hospitals (0.9%) compared to academic (1.8%) and community (1.8%) hospitals (P < .0001). The remaining patients (approximately 30%) received one of several permutations that combined 2 or more of the following treatment modalities: hormone therapy, chemotherapy, biological response modifier therapy, radiotherapy, and surgery.

Conclusion: Although there are minor differences in the proportion of patients receiving each treatment modality, use of radiotherapy and surgery to treat stage I NSCLC is relatively consistent among VA, community, and academic hospitals. Future studies should explore the treatment modalities excluded from this study, compare radiotherapy to stereotactic radiosurgery, and examine how treatment modality affects recurrence and survival.

Background: Recent evidence from the Government Performance Review Act Report on Oncology has shown an earlier detection of colorectal, lung, and prostate cancer in Veterans Administration Hospitals (VAHs) versus other SEER hospitals despite similar incidence rates.

Purpose: Assess melanoma screening by looking at incidence of stages at diagnosis. Earlier detection of melanoma compared to other hospitals may suggest better screening in VAHs.

Methods: Community Programs (CCP) receive 100-500 newly diagnosed cancer cases per year. Hospitals receiving 500+ patients are either Academic Comprehensive Programs (ACP) or Comprehensive Community Cancer Programs (CCCP). Using NCDB (2003-2013), which includes > 70% of newly diagnosed cancer patients, we utilized chi-square analysis and compared stage at diagnosis for patients with melanoma.

Results: VA hospitals consistently detect higher rates of early stage melanoma with 41% stage 0 and 73% stage 0/I versus the average of 27.75% stage 0 and 67.25% stage 0/I between all hospitals (P < .01). VA hospitals also consistently detect lower rates of late stage melanoma stage IV between all hospitals (P < .01).

Implications: This is the first study showing higher rates of early diagnosis of melanoma in VAH versus other hospital types in NCDB by looking at staging. Early stage melanoma was detected at greater frequencies and late stage melanoma at lower frequencies in VA hospitals. This may suggest better screening, resulting in better prognosis, for patients treated in VAH. 27.5% less patients were stage IV in VAH than the calculated average. If we apply the percentage of VAH stage IV melanoma to all other hospitals, good screening in VAH may have prevented 5,138 patients from becoming stage IV.

Background: Recent evidence from the Government Performance Review Act Report on Oncology has shown an earlier detection of colorectal, lung, and prostate cancer in Veterans Administration Hospitals (VAHs) versus other SEER hospitals despite similar incidence rates.

Purpose: Assess melanoma screening by looking at incidence of stages at diagnosis. Earlier detection of melanoma compared to other hospitals may suggest better screening in VAHs.

Methods: Community Programs (CCP) receive 100-500 newly diagnosed cancer cases per year. Hospitals receiving 500+ patients are either Academic Comprehensive Programs (ACP) or Comprehensive Community Cancer Programs (CCCP). Using NCDB (2003-2013), which includes > 70% of newly diagnosed cancer patients, we utilized chi-square analysis and compared stage at diagnosis for patients with melanoma.

Results: VA hospitals consistently detect higher rates of early stage melanoma with 41% stage 0 and 73% stage 0/I versus the average of 27.75% stage 0 and 67.25% stage 0/I between all hospitals (P < .01). VA hospitals also consistently detect lower rates of late stage melanoma stage IV between all hospitals (P < .01).

Implications: This is the first study showing higher rates of early diagnosis of melanoma in VAH versus other hospital types in NCDB by looking at staging. Early stage melanoma was detected at greater frequencies and late stage melanoma at lower frequencies in VA hospitals. This may suggest better screening, resulting in better prognosis, for patients treated in VAH. 27.5% less patients were stage IV in VAH than the calculated average. If we apply the percentage of VAH stage IV melanoma to all other hospitals, good screening in VAH may have prevented 5,138 patients from becoming stage IV.

Background: Recent evidence from the Government Performance Review Act Report on Oncology has shown an earlier detection of colorectal, lung, and prostate cancer in Veterans Administration Hospitals (VAHs) versus other SEER hospitals despite similar incidence rates.

Purpose: Assess melanoma screening by looking at incidence of stages at diagnosis. Earlier detection of melanoma compared to other hospitals may suggest better screening in VAHs.

Methods: Community Programs (CCP) receive 100-500 newly diagnosed cancer cases per year. Hospitals receiving 500+ patients are either Academic Comprehensive Programs (ACP) or Comprehensive Community Cancer Programs (CCCP). Using NCDB (2003-2013), which includes > 70% of newly diagnosed cancer patients, we utilized chi-square analysis and compared stage at diagnosis for patients with melanoma.

Results: VA hospitals consistently detect higher rates of early stage melanoma with 41% stage 0 and 73% stage 0/I versus the average of 27.75% stage 0 and 67.25% stage 0/I between all hospitals (P < .01). VA hospitals also consistently detect lower rates of late stage melanoma stage IV between all hospitals (P < .01).

Implications: This is the first study showing higher rates of early diagnosis of melanoma in VAH versus other hospital types in NCDB by looking at staging. Early stage melanoma was detected at greater frequencies and late stage melanoma at lower frequencies in VA hospitals. This may suggest better screening, resulting in better prognosis, for patients treated in VAH. 27.5% less patients were stage IV in VAH than the calculated average. If we apply the percentage of VAH stage IV melanoma to all other hospitals, good screening in VAH may have prevented 5,138 patients from becoming stage IV.

Background: Winchester et al (1999) showed that 61% of stage 4 pancreatic cancer patients in the National Cancer Data Base (NCDB) from 1985-95 received no treatment.

Methods: NCDB was queried to evaluate treatment of stage 4 pancreatic cancer from years 2003-2013. The study included 1,525 hospitals and 61,063 patients, of which 47 hospitals and 1,528 patients were from VA hospitals. Chi-square tests were run to compare patients at all hospitals not receiving treatment to VA patients.

Results: More stage 4 pancreatic patients at the VA received no treatment compared to the average in 2003-2013 (58.5% vs 46.8%). However, the VA was still lower than the 61% Winchester found in the 1990s. The percentage of patients within each age group that did not
receive treatment was at least 10% greater at the VA compared to other hospitals. VA patients had lower incomes, greater distances traveled to hospitals, and lived in areas that had more people without a high school degree compared to patients at all hospitals. 19.5% of VA patients,
versus 6.5% of all hospital patients, traveled over 100 miles for care. 22.3% of VA patients, compared to 15.7% of all hospital patients, had an income of less than $36,000. 21.1% of VA patients, compared to 14.5% of all hospital patients had lower education as shown by living in areas where more than 23% of the population did not graduate high school. (all P < .05)

Implications: The majority of stage IV pancreatic patients at the VA are not treated. VA patients with stage 4 pancreatic cancer who did not receive treatment traveled greater distances for care, had less education, and had lower incomes compared to those at other hospitals. Further investigation must be done to determine ways to provide better care to veterans facing pancreatic cancer.

Background: Winchester et al (1999) showed that 61% of stage 4 pancreatic cancer patients in the National Cancer Data Base (NCDB) from 1985-95 received no treatment.

Methods: NCDB was queried to evaluate treatment of stage 4 pancreatic cancer from years 2003-2013. The study included 1,525 hospitals and 61,063 patients, of which 47 hospitals and 1,528 patients were from VA hospitals. Chi-square tests were run to compare patients at all hospitals not receiving treatment to VA patients.

Results: More stage 4 pancreatic patients at the VA received no treatment compared to the average in 2003-2013 (58.5% vs 46.8%). However, the VA was still lower than the 61% Winchester found in the 1990s. The percentage of patients within each age group that did not
receive treatment was at least 10% greater at the VA compared to other hospitals. VA patients had lower incomes, greater distances traveled to hospitals, and lived in areas that had more people without a high school degree compared to patients at all hospitals. 19.5% of VA patients,
versus 6.5% of all hospital patients, traveled over 100 miles for care. 22.3% of VA patients, compared to 15.7% of all hospital patients, had an income of less than $36,000. 21.1% of VA patients, compared to 14.5% of all hospital patients had lower education as shown by living in areas where more than 23% of the population did not graduate high school. (all P < .05)

Implications: The majority of stage IV pancreatic patients at the VA are not treated. VA patients with stage 4 pancreatic cancer who did not receive treatment traveled greater distances for care, had less education, and had lower incomes compared to those at other hospitals. Further investigation must be done to determine ways to provide better care to veterans facing pancreatic cancer.

Background: Winchester et al (1999) showed that 61% of stage 4 pancreatic cancer patients in the National Cancer Data Base (NCDB) from 1985-95 received no treatment.

Methods: NCDB was queried to evaluate treatment of stage 4 pancreatic cancer from years 2003-2013. The study included 1,525 hospitals and 61,063 patients, of which 47 hospitals and 1,528 patients were from VA hospitals. Chi-square tests were run to compare patients at all hospitals not receiving treatment to VA patients.

Results: More stage 4 pancreatic patients at the VA received no treatment compared to the average in 2003-2013 (58.5% vs 46.8%). However, the VA was still lower than the 61% Winchester found in the 1990s. The percentage of patients within each age group that did not
receive treatment was at least 10% greater at the VA compared to other hospitals. VA patients had lower incomes, greater distances traveled to hospitals, and lived in areas that had more people without a high school degree compared to patients at all hospitals. 19.5% of VA patients,
versus 6.5% of all hospital patients, traveled over 100 miles for care. 22.3% of VA patients, compared to 15.7% of all hospital patients, had an income of less than $36,000. 21.1% of VA patients, compared to 14.5% of all hospital patients had lower education as shown by living in areas where more than 23% of the population did not graduate high school. (all P < .05)

Implications: The majority of stage IV pancreatic patients at the VA are not treated. VA patients with stage 4 pancreatic cancer who did not receive treatment traveled greater distances for care, had less education, and had lower incomes compared to those at other hospitals. Further investigation must be done to determine ways to provide better care to veterans facing pancreatic cancer.