This project is a large four-year program evaluation of the quality and costs of cancer care within the Veterans Administration (VA). With these analyses, we will identify ways in which the VA might improve care for cancer patients. We are studying five cancer sites: breast, colorectal, lung, prostate, and two hematological malignancies.  In addition to the main Harvard team, we are working with several experts at the Dana-Farber Cancer Institute and Abt Associates.

We are currently analyzing data with the following objectives:

• assess the extent to which patients with the above cancers are receiving recommended “processes of care” during their initial evaluation and immediate follow-up period;
  
  
• compare these results across geographic areas (Veteran Integrated Service Networks [VISNs]) within the VA;
  
  
• compare these results with similar individuals cared for in the private sector (Medicare);
  
  
• compare, where possible, survival differences by VISN and in relationship to the private sector;
  
  
• determine the extent to which volume (for example, of surgery, radiation oncology treatments, chemotherapy treatments) affects complications and outcomes;
  
  
• determine the extent to which several structural or organizational aspects of care are available to VA patients—for example, specialized forms of radiation oncology treatment, hospice services (in- and outpatient), on-site specialists, tumor boards—and compare these with the private sector;
  
  
• evaluate the participation of veterans in national clinical trials and compare the outcomes (primarily survival) of veterans and nonveterans in these trials;
  
  
• evaluate differences across VA facilities and VISNs in the use of drugs that are indicated or not indicated by the FDA;
  
  
• explore possible reasons for “underuse” (if present) in the VA (for example, use of adjuvant therapy for patients with colon and rectal cancer).

For this evaluation, we are using several sources of data: general administrative data from the VA and Medicare, the VA tumor registry, the SEER-Medicare data, a survey of provider sites in the VA, several additional VA data sources (for example, ECRP, medical records), and a national survey describing availability of imaging equipment in virtually all institutions in this country.