Study Finds Lower Risk of Death for Colon Cancer Patients in the U.S. Military Health System

The study found that the survival advantage over the general population was even greater for Black patients.

Colon cancer patients enrolled in the U.S. military’s universal health care system had an 18 percent lower risk of death compared to colon cancer patients in the general population, and the survival advantage was even greater for Black patients, according to a study published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research (AACR). 

“Our findings provide solid evidence of the benefits of access to universal health care,” said study author Craig D. Shriver, MD, a retired U.S. Army colonel and director of the Murtha Cancer Center at the Uniformed Services University of the Health Sciences (USUHS) in Bethesda, Maryland. “What’s more, when medical care is universally provided to all patients, racial disparity in colon cancer outcomes can be reduced.”

Previous research has shown that patients without health insurance or with Medicaid experience poorer survival from colon cancer than patients with private insurance. Little research has examined outcomes from the U.S. Military Health System (MHS), which provides universal health care for active-duty service members, retirees, National Guard members, and their family members. 

To compare survival between patients with colon cancer in the Military Health System and those in the general population, the researchers evaluated data from the Department of Defense’s Automated Central Tumor Registry (ACTUR), matching 11,907 ACTUR patients to 23,814 patients in the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database. All patients were diagnosed with colon cancer between January 1, 1987, and December 31, 2013. 

After a median follow-up time of 56 months for ACTUR patients and 49 months for SEER patients, the researchers found that the ACTUR patients with colon cancer had an 18 percent lower risk of death compared with the SEER patients. The lower risk of death was consistent across age groups, gender, race, and year of diagnosis.

The survival benefit tended to be greater for Black patients, who typically have poorer colon cancer survival than white Americans. Black patients in the ACTUR database were 26 percent less likely to die of colon cancer than those in the SEER database. Among white patients, the survival benefit for ACTUR patients was the same as in the overall study population; they were 18 percent less likely than the SEER patients to die of colon cancer. 

While this study did not aim to compare survival between racial groups within ACTUR, previous research found that in the Military Health System, older Blacks and whites with colon cancer had similar overall survival.

Shriver explained that access to health care has been implicated as one factor in the disparities in cancer survival between Black and white Americans; therefore, the availability of universal health care through the military health system had a larger positive effect on the Black study population. 

“The survival benefit of Blacks in our study suggests that a universal health care system may be helpful to reduce racial disparity,” Shriver said, adding that previous studies on lung cancer and glioma in the MHS showed similar success in reducing disparities. 

“The Military Health System provides medical care with minimal or usually no financial barriers. Thus, our findings provide solid evidence of the benefits of access to universal health care, which can be helpful evidence for policymakers looking to improve the outcomes of colon cancer patients by looking at novel ways to implement change at multiple levels,” Shriver said.