Jocelyn Ginter, sterile processing technician, decontaminates instruments at Brooke Army Medical Center. A BAMC study found that active-duty servicemembers with lymphoma was better than that of civilians. DoD photo by Jason W. Edwards
FORT SAM HOUSTON, TX — U.S. military servicemembers diagnosed with lymphoma have superior overall survival compared with their civilian counterparts, according to a recent study.
The article published in the journal Military Medicine analyzed overall survival of active-duty military personnel with Hodgkin lymphoma and non-Hodgkin lymphoma. It also assessed disparities for survival and compared overall survival with matched U.S. civilians. The researchers for the study were affiliated with Brooke Army Medical Center at Fort Sam Houston, TX.1
The participants were active-duty servicemembers with Hodgkin lymphoma, diffuse large B-cell lymphoma and indolent lymphomas and matched civilian counterparts. The data were obtained from the DoD tumor registry and the Surveillance, Epidemiology and End Result database.
Cancer is a prominent cause of mortality in current active-duty servicemembers, with more than 700 deaths between 2004 and 2015. It’s estimated that “nearly 1,000 U.S. active duty service members are diagnosed with cancer each year, impacting readiness owing to therapy, transfers, surveillance and medical retirement,” the study reported.
More research is needed to better understand the survival of U.S. military servicemembers with cancer. Lymphoma is a good cancer type to study, because it’s “the most common hematologic malignancy diagnosed in active duty military service members,” according to the study.
“The study found that U.S. military service members with Hodgkin lymphoma, diffuse large B-cell lymphoma and indolent lymphoma had superior overall survival as compared to their matched civilian counterparts,” Gilbert Ancira, MD, a hematologist/oncologist physician fellow at Brooke Army Medical Center, told U.S. Medicine. “Of more interest were the findings that, within the active-duty servicemembers’ population, there was no difference in survival based on race, sex or rank (our surrogate for socioeconomic status). This differs from what has been reported in the civilian sector.”
In the study, 1,170 active duty servicemembers had Hodgkin lymphoma, 443 had diffuse large B-cell lymphoma, and 284 had indolent lymphoma. All three groups had superior overall survival compared with matched civilian counterparts, with a 35% reduction in the risk of death from Hodgkin lymphoma, a 49% reduction in the risk of death from diffuse large B-cell lymphoma and a 48% reduction in the risk of death from indolent lymphoma, the study reported.
“The most important findings are that active-duty service members with lymphoma have improved overall survival compared to civilian counterparts and that the care provided has not resulted in disparities in overall survival based on race, sex or rank,” Ancira wrote in an email.
No Disparities of Care
In the civilian sector, on the other hand, disparities have been prevalent among lymphoma patients, according to the study.
The study’s results are significant because they showed not only improved overall survival compared to civilian sector data, but also that the improved overall survival was unbiased based on race, sex or rank. There is a component in the care delivered to this population that has led to unbiased outcomes, Ancira added.
“Active-duty servicemembers can rest assured they are receiving excellent, unbiased care for their lymphoma when compared to civilian counterparts,” Ancira said. “The study implies that active duty servicemembers do not face the same disparities as civilian matched counterparts based on race, sex or rank (our surrogate for socioeconomic status). Thus, further study into the differences in the care delivered to this population needs to be studied in order to improve the medical care provided across all sectors.”
For healthcare professionals caring for U.S. military servicemembers with lymphoma, Ancira recommended striving to continue “providing excellent, unbiased care to this population” and “review components of the medical care provided that led to these outcomes.”
“As both physicians and military officers, it is our responsibility to ensure we are delivering quality medical care to our active duty servicemembers,” Ancira advised. “It is also equally important that the care delivered is equally distributed to the servicemembers. Studying and reviewing our results is crucial to adjust where needed and to maintain practice patterns that are successful.”
Ancira noted some limitations of the study, explaining, “It is important to note that this is a retrospective study and thus is susceptible to various forms of bias. It is also important to note that there are a lot of variables that are different between and within these populations. Contributing the results seen in this study to one variable and implementation of such variable would be premature.”
To further decrease cancer mortality in active-duty servicemembers and improve long-term survival, it’s important to “better understand the setting of diagnosis (in theater, within or outside the continental U.S.), tumor characteristics (i.e., stage at diagnosis), timing of treatment, and treatments received (including clinical trial enrollment),” according to the study.
- 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.