Abstract 3296: Survival among lung cancer patients in the U.S. Military Health System: a comparison with the SEER population
Authors: Lin Jie , Kamamia Christine , Brown Derek , Shao Stephanie , McGlynn Katherine A. , Nations Joel A. , Carter Corey A. , Shriver Craig D. , Zhu Kangmin 
Published: July 2017

Abstract
The U.S. military health system (MHS) provides universal access to its beneficiaries. However, little is known about whether the universal access has translated into improved patient outcomes. We compared survival among non-small cell lung cancer (NSCLC) cases in MHS with that of NSCLC cases from the general U.S. population. The MHS data were obtained from The Department of Defense’s (DoD) Automated Central Tumor Registry (ACTUR). The U.S. population data were drawn from the National Cancer Institute’s (NCI) Surveillance, Epidemiology, and End Results (SEER) program18 registries (1973- 2012) which represents 27.8% of the U.S. population. NSCLC patients in ACTUR and SEER who were diagnosed between January 1, 1987 and December 31, 2012 were included. The ACTUR and SEER cases were then matched by age group, sex, race, and year of diagnosis group at a matching ratio of 1:4, which comprised of 16,257 cases from ACTUR and 65,028 cases from SEER. Kaplan-Meir curves and log-rank test were used to compare overall survival between the two populations. Multivariable Cox proportional hazards models for matched data were used to estimate hazard ratios (HRs) and 95% CI with adjustment for potential confounders. Compared to the SEER cases, the ACTUR cases were more likely to be diagnosed at stage I or stage II (P&lt;0.0001) and less likely to be diagnosed at stage IV. ACTUR cases also had a lower percentage of poorly differentiated tumors than did SEER cases, who had a higher percentage of well differentiated and moderately differentiated tumors (P&lt;0.0001). Kaplan-Meir survival curves showed significantly better survival among ACTUR cases than SEER cases (Log Rank P&lt;0.001). In Cox proportional hazards model analysis, ACTUR cases exhibited significantly better overall survival than did SEER cases (HR=0.78, 95% CI=0.76 to 0.81). The survival advantage of ACTUR cases remained after stratification on cancer stage, age group, sex and race. Further analyses revealed that ACTUR cases were more likely to receive surgery for early-stage (stages I and II) tumors (OR=1.41, 95% CI =1.28 to 1.55), and radiation therapy for late stage (stages III to IV) tumors (OR=1.09, 95% CI=1.03 to 1.15). Our results suggest that the survival of NSCLC patients in the MHS is better than that in the general population, implying that lung cancer care and programs within the MHS has translated into improved patient outcomes.
Citation Format: Jie Lin, Christine Kamamia, Derek Brown, Stephanie Shao, Katherine A. McGlynn, Joel A. Nations, Corey A. Carter, Craig D. Shriver, Kangmin Zhu. Survival among lung cancer patients in the U.S. Military Health System: a comparison with the SEER population [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3296. doi:10.1158/1538-7445.AM2017-3296