Systematic review and meta-analysis of equity and cancer survival among Veterans Health Administration patients

In the US, Black patients with cancer consistently experience worse survival compared with White patients, even after adjusting for age, sex, and disease stage. Systematic review and meta-analysis investigated whether these disparities also exist among patients receiving care in the Veterans Health Administration (VHA), an integrated health system designed to provide near-equal access to care. In PubMed from January 2015 through April 2022, the authors identified 39 studies including 603,256 veterans with cancer treated between 1983 and 2017, with a mean 29.0% 9range 8.9-55.0) of patients categorized as Black. The studies compared overall survival (OS) and cancer-specific survival (CSS) between Black versus non-Black. Black veterans were found to have better OS (HR 0.95; 95% CI 0.89-0.97) and CSS (0.94; 0.90-0.98) than non-Black veterans. Survival advantages for Black veterans were observed across several cancer types, including bladder, laryngeal, lung, oropharyngeal, prostate, and plasma cell cancers. Between-study heterogeneity was low to moderated. The author conclude that among cancer patients receiving care through VHA, survival outcomes were generally similar or better for Black compared with non-Black veterans. These findings suggest that integrated health care systems providing near-equitable access to comprehensive cancer care can substantially reduce or eliminate disparities in cancer outcomes.