Comparative study of survival among small cell lung cancer patients in the U.S. military health system and those in the surveillance, epidemiology, and end results (SEER) program

Jie Lin; Christine Kamamia; Derek W Brown; Stephanie Shao; Katherine A McGlynn; Joel A Nations; Corey A Carter; Craig D Shriver; Kangmin Zhu

doi:10.1016/j.annepidem.2021.09.010

Comparative study of survival among small cell lung cancer patients in the U.S. military health system and those in the surveillance, epidemiology, and end results (SEER) program

Ann Epidemiol. 2021 Dec:64:132-139. doi: 10.1016/j.annepidem.2021.09.010. Epub 2021 Sep 20.

Authors

Jie Lin¹, Christine Kamamia², Derek W Brown³, Stephanie Shao², Katherine A McGlynn⁴, Joel A Nations⁵, Corey A Carter⁵, Craig D Shriver⁶, Kangmin Zhu⁷

Affiliations

¹ John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD. Electronic address: jie.lin.ctr@usuhs.edu.
² John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD.
³ John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD; Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD.
⁴ Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD.
⁵ John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD.
⁶ John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD.
⁷ John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD. Electronic address: kangmin.zhu@usuhs.edu.

PMID: 34547444
DOI: 10.1016/j.annepidem.2021.09.010

Abstract

Purpose: The U.S. military health system provides universal health care access to beneficiaries. However, whether the universal access has translated into improved patient outcome is unknown. We compared survival of small-cell lung cancer patients in the military health system with that in the U.S. general population. Stage and receipt of cancer treatment were also compared to see if they could contribute to survival difference.

Methods: The data were obtained from The Department of Defense's Automated Central Tumor Registry (ACTUR) and the national Surveillance, Epidemiology, and End Results (SEER) program, respectively. ACTUR (N = 3040) and SEER patients (N = 12,160) were matched on age, sex, race and diagnosis year. Multivariable Cox regression model was used to compare all-cause mortality between ACTUR and SEER. Multivariable logistic regression was performed to compare cancer stage and treatment.

Results: ACTUR patients exhibited significantly better survival than SEER counterparts (HR = 0.77, 95% CI= 0.71-0.83). ACTUR and SEER patients had similar stage, but ACTUR patients were more likely to receive radiation treatment (OR = 1.26, 95% CI = 1.12-1.42). The survival advantage of ACTUR patients remained across all tumor stages and radiation groups.

Conclusions: Survival of small-cell lung cancer patients with universal health care access had better survival than similar patients in the U.S. general population. Future studies are warranted to identify factors that may contribute to the improved survival.

Keywords: SEER program; Small-cell lung cancer; Survival; Universal health care system.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Humans
Lung Neoplasms* / therapy
Military Health Services*
Neoplasm Staging
Proportional Hazards Models
SEER Program
Small Cell Lung Carcinoma* / epidemiology
Small Cell Lung Carcinoma* / therapy
United States / epidemiology