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Ancira G, Romain J, Pham K, Thornton JA, DeStefano CB. Survival of U.S. Military Service Members With Lymphoma. Mil Med 2023; 188:e3407-e3410. [PMID: 37256781 DOI: 10.1093/milmed/usad199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 05/03/2023] [Accepted: 05/12/2023] [Indexed: 06/02/2023] Open
Abstract
INTRODUCTION Cancer is a prominent cause of mortality in today's active duty service members (ADSMs), killing over 700 ADSMs between 2004 and 2015. Hence, more research is needed to better understand the survival of U.S. service members with cancer. Lymphoma is the most common hematologic malignancy diagnosed in ADSMs, serving as a good cancer type to study. MATERIALS AND METHODS The Department of Defense tumor registry and the Surveillance, Epidemiology, and End Result (SEER) databases were retrospectively accessed to analyze overall survival (OS) of ADSMs with lymphoma and to compare outcomes with matched civilians. ADSMs with Hodgkin lymphoma (HL), diffuse large B-cell lymphoma (DLBCL), and indolent lymphoma diagnosed between 1997 and 2017 were included, and SEER comparator patients were matched by age, sex, race, stage, and year of diagnosis using a 4:1 ratio of civilians to ADSMs. RESULTS There were 1,170, 443, and 284 ADSMs with HL, DLBCL, and indolent lymphoma, respectively, and all three groups had superior OS when compared to their matched civilian counterparts with 35%, 49%, and 48% reductions in the risk of death, respectively. There were no differences in ADSM survival based on race, sex, or rank, despite disparities being pervasive in the civilian sector. CONCLUSIONS Service members with lymphoma have superior survival than their matched civilian counterparts, without evident racial or sex disparities. Results of this study are favorable in terms of readiness. Further research on cancer mortality in ADSMs is needed to improve long-term outcomes.
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Affiliation(s)
- Gilbert Ancira
- Department of Hematology/Oncology, San Antonio Uniformed Service Health Consortium, San Antonio, TX 78234, USA
| | - Joshua Romain
- Department of Hematology/Oncology, David Grant USAF Medical Center, Fairfield, CA 94533, USA
| | - Kevin Pham
- Clinical Investigation Facility, David Grant USAF Medical Center, Fairfield, CA 94533, USA
| | - Jennifer A Thornton
- Clinical Investigation Facility, David Grant USAF Medical Center, Fairfield, CA 94533, USA
| | - Christin B DeStefano
- Department of Hematology/Oncology, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
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Eaglehouse YL, Shriver CD, Lin J, Bytnar JA, Darmon S, McGlynn KA, Zhu K. MilCanEpi: Increased Capability for Cancer Care Research in the Department of Defense. JCO Clin Cancer Inform 2023; 7:e2300035. [PMID: 37582239 PMCID: PMC10569781 DOI: 10.1200/cci.23.00035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/23/2023] [Accepted: 06/29/2023] [Indexed: 08/17/2023] Open
Abstract
The Military Health System (MHS) of the US Department of Defense (DoD) provides comprehensive medical care to over nine million beneficiaries, including active-duty members, reservists, activated National Guard, military retirees, and their family members. The MHS generates an extensive database containing administrative claims and medical encounter data, while the DoD also maintains a cancer registry that collects information about the occurrence of cancer among its beneficiaries who receive care at military treatment facilities. Collating data from the two sources diminishes the limitations of using registry or medical claims data alone for cancer research and extends their usage. To facilitate cancer research using the unique military health resources, a computer interface linking the two databases has been developed, called Military Cancer Epidemiology, or MilCanEpi. The intent of this article is to provide an overview of the MilCanEpi data system, describing its components, structure, potential uses, and limitations.
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Affiliation(s)
- Yvonne L. Eaglehouse
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Craig D. Shriver
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD
| | - Jie Lin
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
- Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Julie A. Bytnar
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Sarah Darmon
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Katherine A. McGlynn
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
| | - Kangmin Zhu
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
- Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
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Anderson AB, Park AB, Zhu K, Lin J, Shriver CD, Potter BK. Soft-tissue Sarcoma Survival in the US Military Health System: Comparison With the SEER Program. J Am Acad Orthop Surg Glob Res Rev 2022; 6:e22.00122. [PMID: 35727910 PMCID: PMC10566816 DOI: 10.5435/jaaosglobal-d-22-00122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 04/28/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The US Military Health System (MHS) provides universal health care to beneficiaries. Few studies have evaluated the potential influence of access to universal care on survival outcomes for sarcoma. This study compared the survival of adult patients with soft-tissue sarcoma in the MHS with the US general population. METHODS MHS data were obtained from the Department of Defense Automated Central Tumor Registry (ACTUR). US population data were obtained from the National Cancer Institute's Surveillance, Epidemiology, and End Results registry. Patients who were 25 years or older with a histologically confirmed musculoskeletal soft-tissue sarcoma were matched based on age, sex, and race. Kaplan-Meier survival curves and Cox proportional hazards models were used to compare 5-year survival in the two groups. RESULTS Adult patients in ACTUR had markedly lower 5-year mortality for soft-tissue sarcomas (hazard ratio=0.82; 95% confidence interval, 0.73 to 0.92) after adjustment for potential confounders. Lower 5-year mortality was found in most demographic subgroups for ACTUR patients compared with Surveillance, Epidemiology, and End Results patients. CONCLUSION Five-year survival in the MHS compared with the US general population may suggest an important role of universal health care in improving the survival of patients with soft-tissue sarcoma.
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Affiliation(s)
- Ashley B. Anderson
- From the Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center (Dr. Anderson, Dr. Park, Dr. Zhu, Dr. Lin, Dr. Shriver, and Dr. Potter); the Henry M. Jackson Foundation for the Advancement of Military Medicine (Dr. Park, Dr. Zhu, and Dr. Lin); the John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center (Dr. Zhu, Dr. Lin, and Dr. Shriver); and the Department of Preventive Medicine and Biostatistics (Dr. Zhu and Dr. Lin), Uniformed Services University of the Health Sciences
| | - Amie B. Park
- From the Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center (Dr. Anderson, Dr. Park, Dr. Zhu, Dr. Lin, Dr. Shriver, and Dr. Potter); the Henry M. Jackson Foundation for the Advancement of Military Medicine (Dr. Park, Dr. Zhu, and Dr. Lin); the John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center (Dr. Zhu, Dr. Lin, and Dr. Shriver); and the Department of Preventive Medicine and Biostatistics (Dr. Zhu and Dr. Lin), Uniformed Services University of the Health Sciences
| | - Kangmin Zhu
- From the Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center (Dr. Anderson, Dr. Park, Dr. Zhu, Dr. Lin, Dr. Shriver, and Dr. Potter); the Henry M. Jackson Foundation for the Advancement of Military Medicine (Dr. Park, Dr. Zhu, and Dr. Lin); the John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center (Dr. Zhu, Dr. Lin, and Dr. Shriver); and the Department of Preventive Medicine and Biostatistics (Dr. Zhu and Dr. Lin), Uniformed Services University of the Health Sciences
| | - Jie Lin
- From the Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center (Dr. Anderson, Dr. Park, Dr. Zhu, Dr. Lin, Dr. Shriver, and Dr. Potter); the Henry M. Jackson Foundation for the Advancement of Military Medicine (Dr. Park, Dr. Zhu, and Dr. Lin); the John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center (Dr. Zhu, Dr. Lin, and Dr. Shriver); and the Department of Preventive Medicine and Biostatistics (Dr. Zhu and Dr. Lin), Uniformed Services University of the Health Sciences
| | - Craig D. Shriver
- From the Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center (Dr. Anderson, Dr. Park, Dr. Zhu, Dr. Lin, Dr. Shriver, and Dr. Potter); the Henry M. Jackson Foundation for the Advancement of Military Medicine (Dr. Park, Dr. Zhu, and Dr. Lin); the John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center (Dr. Zhu, Dr. Lin, and Dr. Shriver); and the Department of Preventive Medicine and Biostatistics (Dr. Zhu and Dr. Lin), Uniformed Services University of the Health Sciences
| | - Benjamin K. Potter
- From the Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center (Dr. Anderson, Dr. Park, Dr. Zhu, Dr. Lin, Dr. Shriver, and Dr. Potter); the Henry M. Jackson Foundation for the Advancement of Military Medicine (Dr. Park, Dr. Zhu, and Dr. Lin); the John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center (Dr. Zhu, Dr. Lin, and Dr. Shriver); and the Department of Preventive Medicine and Biostatistics (Dr. Zhu and Dr. Lin), Uniformed Services University of the Health Sciences
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