Bone Sarcoma Survival in the US Military Health System: Comparison With the SEER Program

Ashley B Anderson; Eungjae Kim; Amie B Park; Kangmin Zhu; Jie Lin; Craig D Shriver; Benjamin K Potter

doi:10.5435/JAAOS-D-23-00897

Bone Sarcoma Survival in the US Military Health System: Comparison With the SEER Program

J Am Acad Orthop Surg. 2024 Apr 25. doi: 10.5435/JAAOS-D-23-00897. Online ahead of print.

Authors

Ashley B Anderson¹, Eungjae Kim, Amie B Park, Kangmin Zhu, Jie Lin, Craig D Shriver, Benjamin K Potter

Affiliation

¹ From the Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD (Anderson, Kim, Zhu, Lin, Shriver, and Potter), Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD (Park, Zhu, and Lin), John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD (Zhu, Lin, and Shriver), and the Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD (Zhu and Lin).

PMID: 38684126
DOI: 10.5435/JAAOS-D-23-00897

Abstract

Background: Access to care is associated with cancer survival. The US Military Health System (MHS) provides universal health care to all beneficiaries. However, it is unknown whether survival among patients with bone sarcoma in a health system providing universal care is better than that in the general population. The aim of the study was to compare survival of patients with bone sarcoma in the US MHS with that of the US general population.

Methods: The MHS data were obtained from the Department of Defense Automated Central Tumor Registry (ACTUR). The US general population data were obtained from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry. Adult patients were defined as those aged 25 years or older with a histologically confirmed musculoskeletal bone sarcoma diagnosed from January 1, 1987, to December 31, 2013. Kaplan-Meier survival curves and multivariable Cox proportional hazards models were used to compare the overall survival of the two populations.

Results: The final analysis included 2,273 bone sarcoma cases from ACTUR and 9,092 bone sarcoma cases from SEER. ACTUR patients had significant lower 5-year all-cause death (hazard ratio = 0.72; 95% CI, 0.66 to 0.78) after adjustment for the potential confounders. ACTUR patients with bone sarcoma also exhibited significantly lower risk of all-cause death during the entire follow-up period than the SEER patients (hazard ratio = 0.75; 95% CI, 0.6 to 0.81).

Conclusions: MHS beneficiaries with bone sarcoma may have longer survival than SEER patients. Our findings support the role of universal access to high-quality care in improving bone sarcoma outcomes.