A study by Lin et al comparing patients with colon cancer enrolled in the U.S. Military Health System, which provides universal health-care to its beneficiaries, with those in the general population has found that patients in the Military Health System had an 18% lower risk of death compared with patients in the general population. In addition, the survival benefit was even greater for Black patients in the health system, who were 26% less likely to die of colon cancer than those in the general population. The patients with universal health-care coverage were also more likely to be diagnosed with earlier-stage disease. The study results were published in Cancer Epidemiology, Biomarkers & Prevention.
Excluding some types of skin cancer, colorectal cancer is the third most common cancer diagnosed in men and women in the United States, and the third leading cause of cancer-related death. Studies show that access to health care through insurance is associated with improved survival outcomes among patients with cancer. In addition, patients diagnosed with 1 of the 10 most deadly cancers—including colorectal cancer—without health insurance or insured through Medicaid have poorer survival outcomes than those with private insurance.
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Study Methodology
The researchers used data from the Department of Defense’s Automated Central Tumor Registry (ACTUR), a cancer registry that tracks patients who are diagnosed with cancer and/or receive treatment at military treatment facilities, and from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program. They matched 11,907 patients with colon cancer in ACTUR to 23,814 patients in the SEER database. All of the patients were diagnosed between 1987 and 2013.
The researchers used a multivariable Cox regression model to estimate all-cause mortality for patients in ACTUR compared with patients in SEER.
ACTUR vs SEER Outcomes
After a median follow-up of 56 months for the patients in ACTUR and 49 months for patients in SEER, the researchers found that the patients with colon cancer in ACTUR had an 18% lower risk of death compared with the patients in SEER. The lower risk of death was consistent across age groups, sex, race, and year of diagnosis.
The survival benefit was greater for Black patients in the ACTUR database, who were 26% less likely to die of colon cancer than those in the SEER database. Among White patients, the survival benefit in the patients in ACTUR was the same as in the overall study population. They were 18% less likely than the patients in SEER to die of colon cancer.
The researchers also compared tumor stage at diagnosis to determine whether having universal health-care coverage resulted in earlier diagnosis. They found that patients within the military health system were more likely than patients in the general population to be diagnosed with stage I colon cancer—22.67% vs 18.64%, respectively—and were less likely to be diagnosed with stage IV colon cancer—18.74% vs 21.63%, respectively.
KEY POINTS
- Patients with colon cancer enrolled in the U.S. Military Health System had an 18% lower risk of death compared with patients in the general population.
- Black patients enrolled in the Military Health System were 26% less likely to die of colon cancer than those in the general population.
- Access to universal health care is important in improving survival of patients with colon cancer.
The Benefits of Universal Health Care
“The Military Health System provides medical care with minimal or usually no financial barriers,” said study co-author Craig D. Shriver, MD, FACS, FSSO, a retired U.S. Army colonel and Professor and Director of the Murtha Cancer Center at Uniformed Services University of the Health Sciences in Bethesda, Maryland. “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 [patients with] colon cancer by looking at novel ways to implement change at multiple levels. What’s more, when medical care is universally provided to all patients, racial disparity in colon cancer outcomes can be reduced.”
Jie Lin, PhD, MPH, Associate Professor at Uniformed Services University of the Health Sciences in Bethesda, Maryland, is the corresponding author of this study.
Disclosure: Funding for this study was provided by the John P. Murtha Cancer Center Research Program at the Uniformed Services University of the Health Sciences and the National Cancer Institute. For full disclosures of the study authors, visit cebp.aacrjournals.org.
