To the Editor: The results reported by Dr Jha and colleagues1 are similar to our previous findings that among 46 000 male patients treated for cancer in the VA system from 1958 to 1963 there were no significant differences in 5-year relative cancer survival rates for localized disease in 5 solid tumor sites (stomach, colon, rectum, lung, and prostate; bladder cancer was an exception).
In limiting the analysis to localized disease, we were attempting to control for severity of disease, in the same way that Jha et al used a comorbidity index. Unfortunately, we did not have other risk factor data, such as marital or financial status, but ancillary national data showed, to our surprise, that the income disparity between black and white patients hospitalized in the VA was as wide as it was for those hospitalized outside the VA, or, for that matter, hospitalized nonveterans. At the time, we hypothesized that the lack of treatment differences by race in VA hospitals accounted for the lack of racial disparity in cancer survival. The recent findings of Jha et al appear to lend further support to our earlier hypothesis.
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