A new study led by a UCLA-VA collaborative team found that a healthcare system designed to provide more consistent access to comprehensive multidisciplinary cancer care can help eliminate longstanding racial gaps in cancer survival in the United States. An analysis of more than 600,000 Veterans receiving cancer care through the Veterans Health Administration (VHA) found that Black Veterans had survival outcomes that were similar to, and in some cases slightly better than, those of White and non-Black Veterans across multiple cancer types.
Published in JAMA Network Open, the findings demonstrated that when patients receive care within a system designed to reduce financial and logistical barriers, racial differences in cancer survival are essentially eliminated.
"In nearly every other corner of American medicine, Black patients are dying from cancer at higher rates than White patients — even when we control for age, sex and stage at diagnosis," said Drew Moghanaki, MD, MPH, FASTRO, who is a professor and endowed chair of thoracic radiation oncology research at the UCLA Health Jonsson Comprehensive Cancer Center and senior author of the study. "What we find inside the VA is the opposite of that, and it tells us something important: that racial disparities are not inevitable. They are the product of fragmented healthcare systems that rely on insurance status, creating unequal access to care that disproportionately affects Black Americans. What these data show is that when access is made equal, similar outcomes can follow regardless of race."
Why it matters
Racial disparities in cancer survival are among the most persistent shortfalls of American medicine. Black patients in the United States are more likely to die from cancer than White patients across nearly every tumor type, a gap researchers have linked to structural barriers including lack of insurance, geographic distance from specialty care, delayed diagnosis, and differential treatment intensity. The VHA, one of the nation's largest healthcare systems, serves approximately 9 million enrolled Veterans regardless of their ability to pay, offers a rare natural experiment: a large, integrated system in the U.S. in which financial and logistical barriers to care are substantially reduced for all patients.
The study led by Moghanakis’ team tested whether that structural equality would translate into survival equality — and found that it did, with results that exceeded expectations.
What the study did
The researchers conducted a systematic review and meta-analysis of peer-reviewed studies that included cancer survival outcomes among Veterans receiving care through the VHA, which provides eligible Veterans with access to cancer screening, diagnostic testing, surgery, radiation therapy, medical oncology services and supportive resources such as transportation assistance, housing support and telemedicine.
The researchers conducted the analysis to determine whether the survival disparities seen in the broader U.S. population persist among Veterans receiving care through a health system designed to provide more equitable access to care.
The review identified 39 eligible studies representing 603,256 Veterans with cancer treated between 1983 and 2017, with results published through 2022. Twenty-nine studies contained sufficient data to be included in the meta-analysis to compare overall survival and cancer-specific survival between Black Veterans and White or non-Black Veterans across multiple cancer types, including prostate, lung, pancreatic, bladder, breast and head and neck cancers.
What they found
The analysis found that Black Veterans with cancer receiving care through the VHA had survival outcomes that were comparable to or slightly better than those of White or non-Black Veterans.
Across all cancers included in the meta-analysis, Black Veterans experienced a 7% lower risk of death from any cause and a 6% lower risk of death from cancer compared with White or non-Black Veterans. The survival advantage was especially notable among Veterans with prostate cancer, which accounted for the largest proportion of studies included in the analysis and was also observed across several cancer types, including lung, bladder and plasma cell cancers.
What this means for patients
The findings suggest that reducing barriers to cancer care can play an important role in improving outcomes and narrowing longstanding racial disparities in cancer survival.
While the study cannot determine exactly which aspects of the VA health system contributed to the findings, the researchers say the results highlight the potential value of integrated care models that reduce financial burdens, improve access to specialists and provide supportive services that help patients receive timely treatment.
“We hope these findings can help inform efforts to improve cancer care delivery more broadly by identifying approaches that ensure all patients — regardless of race or background — have access to the resources needed to receive high-quality cancer care,” said Moghanaki.
About the researchers
Moghanaki is also part of the VA Greater Los Angeles Healthcare System. The study’s first author is Alyssa Jasmine Bullard, a research health science specialist with the Cooperative Studies Program Epidemiology Center (CSPEC) at the Durham VA Health Care System in North Carolina. Other UCLA authors are Dr. Haley Tupper, Dr. Luca Valle, Dr. Isla Garraway and Dr. Donna Washington. Tupper, Valle and Garraway are members of the UCLA Health Jonsson Comprehensive Cancer Center. All four authors are affiliated with the VA Greater Los Angeles Healthcare System. The study also included collaborators from Tufts Medical Center, RAND Corporation, Virginia Commonwealth University Massey Comprehensive Cancer Center and Cedars-Sinai Medical Center.
