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Localized Pancreatic Cancer among Military Beneficiaries: A National Cancer Database Analysis.

R Connor Chick1, Patrick W Underwood1, Robert W Krell2

  • 1Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH 43210, United States.

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Summary

Military beneficiaries with localized pancreatic cancer had worse survival and treatment outcomes compared to privately insured patients. This study highlights potential disparities in care for this population.

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Area of Science:

  • Oncology
  • Health Services Research
  • Health Disparities

Background:

  • Sociodemographic factors, including health insurance, significantly impact pancreatic ductal adenocarcinoma (PDAC) outcomes.
  • Military beneficiaries (servicemembers, veterans, families) often receive care in civilian settings, with TRICARE or VA as payors.
  • Understanding outcomes in this population is crucial for addressing potential healthcare inequities.

Purpose of the Study:

  • To examine survival and treatment outcomes for military beneficiaries with localized pancreatic cancer treated in civilian hospitals.
  • To compare outcomes between military beneficiaries and privately insured patients.
  • To identify potential disparities in care access and treatment for military-affiliated individuals.

Main Methods:

  • Analysis of the National Cancer Database (2010-2020) for patients aged <65 with stage I-III PDAC.
  • Inclusion of patients with private or other government insurance.
  • Stage-stratified overall survival analyzed using Kaplan-Meier and Cox models; logistic regression for therapy receipt and postoperative mortality; propensity score matching applied.

Main Results:

  • Military beneficiaries were more likely male, Black, from low-income/rural areas, traveled further, and started treatment later.
  • They were less likely to receive chemotherapy or surgery.
  • Military beneficiaries had higher 30/90-day postoperative mortality, worse median overall survival (14.7 vs. 18.5 months), and inferior risk-adjusted survival post-matching.

Conclusions:

  • Military beneficiaries with localized pancreatic cancer face poorer treatment receipt, higher postoperative mortality, and worse survival outcomes than privately insured individuals.
  • Further research is essential to investigate and address disparities in access and outcomes for military beneficiaries.
  • Policy evaluation is needed to mitigate these identified gaps in care.