SAN ANTONIO –Active-duty servicemembers diagnosed with lymphoma within the MHS had better overall survival than a matched civilian cohort, but the authors of a study with that finding emphasized that more information is needed to ensure optimal treatment for those patients.
“To decrease cancer mortality in ADSMs and improve long-term survival, better understandings 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) are needed,” wrote the San Antonio Uniformed Service Health Consortium-led researchers. Results were published in the journal Military Medicine.1
The study pointed out that cancer is a leading of mortality in the military, killing more than 700 active-duty servicemembers (ADSMs) between 2004 and 2015. “Hence, more research is needed to better understand the survival of U.S. service members with cancer,” according to the authors, who added, “Lymphoma is the most common hematologic malignancy diagnosed in ADSMs, serving as a good cancer type to study.”
To reach the conclusions, the study team retrospectively accessed the DoD tumor registry and the Surveillance, Epidemiology, and End Result (SEER) databases to analyze the overall survival (OS) of ADSMs with lymphoma and to compare outcomes with matched civilians. Included in the review 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.
The study identified 1,170, 443, and 284 ADSMs with HL, DLBCL, and indolent lymphoma, respectively, adding that 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. No differences in ADSM survival occurred based on race, sex, or rank, even though such disparities were common in the civilian sector.
“Servicemembers with lymphoma have superior survival than their matched civilian counterparts, without evident racial or sex disparities,” the researchers concluded. “Results of this study are favorable in terms of readiness. Further research on cancer mortality in ADSMs is needed to improve long-term outcomes.”
An estimated 1,000 U.S. ADSMs are diagnosed with cancer each year, according to the study, which noted that readiness is affected due to therapy, transfers, surveillance, and medical retirement. Between 2005 and 2014, the researchers pointed out, non-Hodgkin lymphoma (NHL) was the most common hematologic malignancy diagnosed in ADSMs.1
“While multiple studies have assessed the incidence of cancer in ADSMs, very few have assessed cancer-specific mortality in this population,” the study advised. “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 researchers said their data are consistent with other studies showing superior survival of patients with multiple solid tumors (including retirees and dependents) diagnosed within the MHS as compared with the civilian population.
1. 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.
