Service and Suffering: Comparative Analyses of Health-Related Quality of Life Among Veteran and Civilian Cancer...

Veterans report greater comorbidity and psychosocial burden but have enhanced healthcare access through the Veterans Health Administration (VHA). We sought to characterize health-related quality of life (HRQoL) differences between veteran and civilian cancer survivors.

We analyzed cancer survivors from the 2017-2022 Behavioral Risk Factor Surveillance System. Outcomes included fair/poor general health, poor physical health, poor mental health, and activity-limiting poor health. Sex-stratified, survey-weighted Poisson regression with robust variance estimated incidence rate ratios (IRRs) for day-count outcomes and prevalence ratios (PRs) for binary outcomes, controlling for sociodemographic and clinical covariates.

Among 65,613 survivors (32,710 men; 32,903 women), 11,213 men (34.3%) and 753 women (2.3%) were veterans. Male veterans were older than civilian men (≥ 75 y: 54.4% vs. 25.9%), less likely to be employed (20.1% vs. 39.6%) or be college graduates (41.9% vs. 47.5%), and frequently reported history of cerebrovascular accident (9.8% vs. 5.7%) or coronary artery disease (25.4% vs. 15.9%) (all p < 0.001). Compared with female civilians, female veterans reported no differences in education, employment status, or history of chronic conditions (p > 0.05). Among female cancer survivors, veteran status was associated with higher prevalence of poor physical-health (aPR 1.35, 95% CI 1.02-1.77) and poor mental-health (aPR 1.45, 95% CI 1.06-1.98). Among males, veteran status was not associated with poor physical or mental health (all p > 0.05).

The findings highlight the importance of sex-responsive survivorship care integrating chronic-disease management, mental-health support, and social-risk screening across VHA and civilian systems.