Virk G

Background: Right-sided colon cancer (RC) is derived from the mid-gut, while left-sided colon cancer (LC) originates from the hindgut. LC has been associated with better survival compared to RC. The effect of primary tumor sidedness on colorectal cancer (CRC) survival rates has not been studied in VA hospitals.

Methods: Data from the National VA Cancer Cube Registry was studied. 65,940 cases of CRC were diagnosed between 2001 and 2015. ICD codes C18 to C20 were used to delineate patients with RC vs. LC. RC was defined as cancer from the cecum to the hepatic flexure, LC from the splenic flexure to the rectum with transverse cancer in between flexures. Local IRB approval was obtained.

Results: Of the total number of CRC, 30.3% were RC and 58.8% were LC. RC constituted 36.3% of cases in women and 30.1% of cases in men. RC was diagnosed after the age of 70 years in 51.8% of cases, compared with 38.5% of LC. LC constituted 56.0% of CRC in blacks, and 59.4% in whites. RC was more likely to be diagnosed at more advanced stage, with 60.84% of cases diagnosed at stage II-IV, compared to 51.82% of LC. Stage IV RC has worse one year survival as compared with LC (50.5% vs 42.2% surviving less than one year, respectively)

Conclusions: RC is associated with female gender, older age, poorer functional status, and more advanced stage at diagnosis. LC was associated with white race. Stage IV RC had worse one-year survival than LC colon cancer.

Background: Right-sided colon cancer (RC) is derived from the mid-gut, while left-sided colon cancer (LC) originates from the hindgut. LC has been associated with better survival compared to RC. The effect of primary tumor sidedness on colorectal cancer (CRC) survival rates has not been studied in VA hospitals.

Methods: Data from the National VA Cancer Cube Registry was studied. 65,940 cases of CRC were diagnosed between 2001 and 2015. ICD codes C18 to C20 were used to delineate patients with RC vs. LC. RC was defined as cancer from the cecum to the hepatic flexure, LC from the splenic flexure to the rectum with transverse cancer in between flexures. Local IRB approval was obtained.

Results: Of the total number of CRC, 30.3% were RC and 58.8% were LC. RC constituted 36.3% of cases in women and 30.1% of cases in men. RC was diagnosed after the age of 70 years in 51.8% of cases, compared with 38.5% of LC. LC constituted 56.0% of CRC in blacks, and 59.4% in whites. RC was more likely to be diagnosed at more advanced stage, with 60.84% of cases diagnosed at stage II-IV, compared to 51.82% of LC. Stage IV RC has worse one year survival as compared with LC (50.5% vs 42.2% surviving less than one year, respectively)

Conclusions: RC is associated with female gender, older age, poorer functional status, and more advanced stage at diagnosis. LC was associated with white race. Stage IV RC had worse one-year survival than LC colon cancer.

Background: Right-sided colon cancer (RC) is derived from the mid-gut, while left-sided colon cancer (LC) originates from the hindgut. LC has been associated with better survival compared to RC. The effect of primary tumor sidedness on colorectal cancer (CRC) survival rates has not been studied in VA hospitals.

Methods: Data from the National VA Cancer Cube Registry was studied. 65,940 cases of CRC were diagnosed between 2001 and 2015. ICD codes C18 to C20 were used to delineate patients with RC vs. LC. RC was defined as cancer from the cecum to the hepatic flexure, LC from the splenic flexure to the rectum with transverse cancer in between flexures. Local IRB approval was obtained.

Results: Of the total number of CRC, 30.3% were RC and 58.8% were LC. RC constituted 36.3% of cases in women and 30.1% of cases in men. RC was diagnosed after the age of 70 years in 51.8% of cases, compared with 38.5% of LC. LC constituted 56.0% of CRC in blacks, and 59.4% in whites. RC was more likely to be diagnosed at more advanced stage, with 60.84% of cases diagnosed at stage II-IV, compared to 51.82% of LC. Stage IV RC has worse one year survival as compared with LC (50.5% vs 42.2% surviving less than one year, respectively)

Conclusions: RC is associated with female gender, older age, poorer functional status, and more advanced stage at diagnosis. LC was associated with white race. Stage IV RC had worse one-year survival than LC colon cancer.

Backgroud: Metastatic pancreatic cancer (MPC) is associated with an extremely high mortality. Current NCCN guidelines recommend systemic therapy, as it is superior to best supportive care. Undertreatment of MPC continues to be an issue. Recent treatment and survival data of MPC in VA hospitals have not been published. The relationship between MPC treatment and survival and the American College of Surgeons’ (ACS) Committee on Cancer (CoC) accreditation in VA hospitals has not been studied.

Methods: Nationwide data from the National VA Cancer Cube Registry was analyzed. 6,775 patients were diagnosed with MPC between 2000 and 2014. CoC accreditation of each VA hospital was obtained using the ACS website.

Results: MPC constitutes 52.31% of all pancreatic cancer diagnosed (6,775/12,951 cases). The near totality were men (97.44%). The > 70-years age group and the 60-70-years age group were the most common ages at diagnosis with 39.39% and 38.02%, respectively. The proportion of early-onset pancreatic cancer was 2.84%. When compared to all stages of pancreatic cancer, stage IV pancreatic cancer had a lower proportion of cancer originating from the head of the pancreas (39.44% versus 50.63%) and more originating from the tail (17.99% versus 13.39%). Tumors originating from head of the pancreas are more likely to cause biliary symptoms and thus are more likely to be caught at an earlier stage. Overall, treatment rate in the VA at the national level with first-line chemotherapy was 37.61%. The rate of treatment over the years has increased in a linear fashion from 33.01% in 2000 to 41.95% in 2014. This has corresponded with an increase of 1-5 years survival of 9.29% in 2000 to 22.99% in 2014 and 5-10 years survival from 0.96% in 2000 to 6.00% in 2012. Treatment rates in CoC accredited and non-CoC accredited VA hospitals were similar (38.94% and 38.12%, respectively). Survival rates in CoC accredited and non-COC accredited VAs were similar with a 1-5 years survival rate of
8.89% and 8.57%, respectively.

Conclusions: Treatment and survival of MPC have risen significantly in the past decade at VA hospitals. CoC accreditation is not associated with a change in treatment or survival rates.

Backgroud: Metastatic pancreatic cancer (MPC) is associated with an extremely high mortality. Current NCCN guidelines recommend systemic therapy, as it is superior to best supportive care. Undertreatment of MPC continues to be an issue. Recent treatment and survival data of MPC in VA hospitals have not been published. The relationship between MPC treatment and survival and the American College of Surgeons’ (ACS) Committee on Cancer (CoC) accreditation in VA hospitals has not been studied.

Methods: Nationwide data from the National VA Cancer Cube Registry was analyzed. 6,775 patients were diagnosed with MPC between 2000 and 2014. CoC accreditation of each VA hospital was obtained using the ACS website.

Results: MPC constitutes 52.31% of all pancreatic cancer diagnosed (6,775/12,951 cases). The near totality were men (97.44%). The > 70-years age group and the 60-70-years age group were the most common ages at diagnosis with 39.39% and 38.02%, respectively. The proportion of early-onset pancreatic cancer was 2.84%. When compared to all stages of pancreatic cancer, stage IV pancreatic cancer had a lower proportion of cancer originating from the head of the pancreas (39.44% versus 50.63%) and more originating from the tail (17.99% versus 13.39%). Tumors originating from head of the pancreas are more likely to cause biliary symptoms and thus are more likely to be caught at an earlier stage. Overall, treatment rate in the VA at the national level with first-line chemotherapy was 37.61%. The rate of treatment over the years has increased in a linear fashion from 33.01% in 2000 to 41.95% in 2014. This has corresponded with an increase of 1-5 years survival of 9.29% in 2000 to 22.99% in 2014 and 5-10 years survival from 0.96% in 2000 to 6.00% in 2012. Treatment rates in CoC accredited and non-CoC accredited VA hospitals were similar (38.94% and 38.12%, respectively). Survival rates in CoC accredited and non-COC accredited VAs were similar with a 1-5 years survival rate of
8.89% and 8.57%, respectively.

Conclusions: Treatment and survival of MPC have risen significantly in the past decade at VA hospitals. CoC accreditation is not associated with a change in treatment or survival rates.

Backgroud: Metastatic pancreatic cancer (MPC) is associated with an extremely high mortality. Current NCCN guidelines recommend systemic therapy, as it is superior to best supportive care. Undertreatment of MPC continues to be an issue. Recent treatment and survival data of MPC in VA hospitals have not been published. The relationship between MPC treatment and survival and the American College of Surgeons’ (ACS) Committee on Cancer (CoC) accreditation in VA hospitals has not been studied.

Methods: Nationwide data from the National VA Cancer Cube Registry was analyzed. 6,775 patients were diagnosed with MPC between 2000 and 2014. CoC accreditation of each VA hospital was obtained using the ACS website.

Results: MPC constitutes 52.31% of all pancreatic cancer diagnosed (6,775/12,951 cases). The near totality were men (97.44%). The > 70-years age group and the 60-70-years age group were the most common ages at diagnosis with 39.39% and 38.02%, respectively. The proportion of early-onset pancreatic cancer was 2.84%. When compared to all stages of pancreatic cancer, stage IV pancreatic cancer had a lower proportion of cancer originating from the head of the pancreas (39.44% versus 50.63%) and more originating from the tail (17.99% versus 13.39%). Tumors originating from head of the pancreas are more likely to cause biliary symptoms and thus are more likely to be caught at an earlier stage. Overall, treatment rate in the VA at the national level with first-line chemotherapy was 37.61%. The rate of treatment over the years has increased in a linear fashion from 33.01% in 2000 to 41.95% in 2014. This has corresponded with an increase of 1-5 years survival of 9.29% in 2000 to 22.99% in 2014 and 5-10 years survival from 0.96% in 2000 to 6.00% in 2012. Treatment rates in CoC accredited and non-CoC accredited VA hospitals were similar (38.94% and 38.12%, respectively). Survival rates in CoC accredited and non-COC accredited VAs were similar with a 1-5 years survival rate of
8.89% and 8.57%, respectively.

Conclusions: Treatment and survival of MPC have risen significantly in the past decade at VA hospitals. CoC accreditation is not associated with a change in treatment or survival rates.

Background: USPSTF recommends against continuing screening for colorectal cancer (CRC) past 75 years in adequately screened individuals. Research has shown that onetime screening for elderly who have never been screened appears to be cost effective until 86 years of age. Survival and staging data that compare elderly vs younger populations has not been published.

Objective: (1) To compare staging (0-4) of CRC in groups of 60-69, 70-79, and 80 to 89-year-olds; (2) To compare survival outcomes (5-10 years) in stages 0-2 for these age groups after treatment (ie, surgery); (3) To compare surgical and no treatment (ie, no surgery) survival outcomes in these age groups

Methods: Male veterans were selected from Veterans Affairs National Cancer Cube Registry. 22,735 patients within 60-69, 18,390 within 70-79 and 10,057 within 80-89 years were diagnosed with CRC within years 2000-2015 with majority being stages 1 and 2. Surgical and survival data were obtained only for stage 0-2 as surgery is currently the standard of treatment for these stages.

Results: After surgery, 5- to 10-year survival for 60-69 age group averaged about 34.4% (95% CI, 31.94-36.85) for stage 0-2. Similarly, for 70-79 and 80-89 age group it was 30.86% (95% CI, 29.54-32.19) and 25.45% (95% CI, 24.77-25.69), respectively. The 5- to 10-year survival data for patients not undergoing surgery was 1.03%, 0.81%, and 0.95% for age groups 60-69, 70-79 and 80-89, respectively.

Conclusions: The highest number of CRC cases diagnosed across each age group was stage 1 with stage 2 being second. In the surgical treatment group survival was statistically different for 80-89 age group as compared to 60-69 and 70-79, though octogenarians did have a surprisingly high mean of 25.45% suggesting early detection and treatment will help survival. Survival data from no-treatment cases showed an immense drop in survival for patients not undergoing surgery, suggesting that these candidates may have other reasons or comorbid conditions leading to their demise.

Background: USPSTF recommends against continuing screening for colorectal cancer (CRC) past 75 years in adequately screened individuals. Research has shown that onetime screening for elderly who have never been screened appears to be cost effective until 86 years of age. Survival and staging data that compare elderly vs younger populations has not been published.

Objective: (1) To compare staging (0-4) of CRC in groups of 60-69, 70-79, and 80 to 89-year-olds; (2) To compare survival outcomes (5-10 years) in stages 0-2 for these age groups after treatment (ie, surgery); (3) To compare surgical and no treatment (ie, no surgery) survival outcomes in these age groups

Methods: Male veterans were selected from Veterans Affairs National Cancer Cube Registry. 22,735 patients within 60-69, 18,390 within 70-79 and 10,057 within 80-89 years were diagnosed with CRC within years 2000-2015 with majority being stages 1 and 2. Surgical and survival data were obtained only for stage 0-2 as surgery is currently the standard of treatment for these stages.

Results: After surgery, 5- to 10-year survival for 60-69 age group averaged about 34.4% (95% CI, 31.94-36.85) for stage 0-2. Similarly, for 70-79 and 80-89 age group it was 30.86% (95% CI, 29.54-32.19) and 25.45% (95% CI, 24.77-25.69), respectively. The 5- to 10-year survival data for patients not undergoing surgery was 1.03%, 0.81%, and 0.95% for age groups 60-69, 70-79 and 80-89, respectively.

Conclusions: The highest number of CRC cases diagnosed across each age group was stage 1 with stage 2 being second. In the surgical treatment group survival was statistically different for 80-89 age group as compared to 60-69 and 70-79, though octogenarians did have a surprisingly high mean of 25.45% suggesting early detection and treatment will help survival. Survival data from no-treatment cases showed an immense drop in survival for patients not undergoing surgery, suggesting that these candidates may have other reasons or comorbid conditions leading to their demise.

Background: USPSTF recommends against continuing screening for colorectal cancer (CRC) past 75 years in adequately screened individuals. Research has shown that onetime screening for elderly who have never been screened appears to be cost effective until 86 years of age. Survival and staging data that compare elderly vs younger populations has not been published.

Objective: (1) To compare staging (0-4) of CRC in groups of 60-69, 70-79, and 80 to 89-year-olds; (2) To compare survival outcomes (5-10 years) in stages 0-2 for these age groups after treatment (ie, surgery); (3) To compare surgical and no treatment (ie, no surgery) survival outcomes in these age groups

Methods: Male veterans were selected from Veterans Affairs National Cancer Cube Registry. 22,735 patients within 60-69, 18,390 within 70-79 and 10,057 within 80-89 years were diagnosed with CRC within years 2000-2015 with majority being stages 1 and 2. Surgical and survival data were obtained only for stage 0-2 as surgery is currently the standard of treatment for these stages.

Results: After surgery, 5- to 10-year survival for 60-69 age group averaged about 34.4% (95% CI, 31.94-36.85) for stage 0-2. Similarly, for 70-79 and 80-89 age group it was 30.86% (95% CI, 29.54-32.19) and 25.45% (95% CI, 24.77-25.69), respectively. The 5- to 10-year survival data for patients not undergoing surgery was 1.03%, 0.81%, and 0.95% for age groups 60-69, 70-79 and 80-89, respectively.

Conclusions: The highest number of CRC cases diagnosed across each age group was stage 1 with stage 2 being second. In the surgical treatment group survival was statistically different for 80-89 age group as compared to 60-69 and 70-79, though octogenarians did have a surprisingly high mean of 25.45% suggesting early detection and treatment will help survival. Survival data from no-treatment cases showed an immense drop in survival for patients not undergoing surgery, suggesting that these candidates may have other reasons or comorbid conditions leading to their demise.