SAN ANTONIO – More than 700 active-duty U.S. servicemembers died between 2004 and 2015 of cancer, with lymphoma being the most common hematologic malignancy diagnosed, according to a new study.
Researchers from the San Antonio Uniformed Service Health Consortium and colleagues retrospectively accessed the DoD tumor registry and the Surveillance, Epidemiology, and End Result (SEER) databases to analyze overall survival (OS) of active-duty service members (ADSMs) with lymphoma and to compare outcomes with matched civilians. Included were ADSMs with Hodgkin lymphoma (HL), diffuse large B-cell lymphoma (DLBCL), and indolent lymphoma diagnosed between 1997 and 2017; SEER comparator patients were matched by age, sex, race, stage, and year of diagnosis using a 4:1 ratio of civilians to ADSMs.
“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,” the authors reported in Military Medicine. “There were no differences in ADSM survival based on race, sex, or rank, despite disparities being pervasive in the civilian sector.”1
The study concluded that servicemembers 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.”
Background information in the recent study estimated that nearly 1000 U.S. ADSMs are diagnosed with cancer each year, which impacts readiness due to therapy, transfers, surveillance, and medical retirement.
“Between 2005 and 2014, non-Hodgkin lymphoma (NHL) was the most common hematologic malignancy diagnosed in ADSMs,” the authors wrote. “While multiple studies have assessed the incidence of cancer in ADSMs, very few have assessed cancer-specific mortality in this population. From 2014 to 2019, cancer was the leading cause of death in U.S. Army female ADSMs and the third leading cause of death in U.S. Army male ADSMs behind suicide and accidents, highlighting the need to better understand cancer mortality in ADSMs.”
The study emphasized that, despite ADSMs being a relatively young and healthy cohort with access to comprehensive health care, “cancer remains an important cause of morbidity and mortality” and directly impacts readiness.
As to why military personnel fared better with lymphoma, the researchers posited, “It is possible that regular interface with providers during annual periodic health assessments and access to free, comprehensive care within the equal-access MHS ameliorated any racial, sex, or socioeconomic disparities that otherwise exist in civilian health care. Similarly, there were no disparities in OS by rank. Even though officers were older than enlisted members at lymphoma diagnosis, this difference is small and not expected to influence OS, especially since most servicemembers were under the ages of 60 and 45 years, which portend adverse outcomes in DLBCL/indolent lymphoma and HL per the International Prognostic Index and International Prognostic Score, respectively.”
The authors suggested that, to decrease cancer mortality in ADSMs and improve long-term survival, the military should have a better understanding of the setting of diagnosis (in theater, within or outside the continental USA), tumor characteristics (i.e., stage at diagnosis), timing of treatment, and treatments received (including clinical trial enrollment).
- Ancira G, Romain J, Pham K, Thornton JA, DeStefano CB. Survival of U.S. Military Service Members With Lymphoma. Mil Med. 2023 May 31:usad199. doi: 10.1093/milmed/usad199. Epub ahead of print. PMID: 37256781.