Survival among patients with multiple myeloma in the U.S. military health system compared to the Surveillance, Epidemiology, and End Results (SEER) program.

person Alexander Dew Walter Reed National Military Medical Center, Bethesda, MD info_outline Alexander Dew, Sarah Darmon, Jie Lin, Jason Ware, Joseph Lee Roswarski, Craig D Shriver, Kangmin Zhu, Alden Vincent Chiu

Authors person Alexander Dew Walter Reed National Military Medical Center, Bethesda, MD info_outline Alexander Dew, Sarah Darmon, Jie Lin, Jason Ware, Joseph Lee Roswarski, Craig D Shriver, Kangmin Zhu, Alden Vincent Chiu Organizations Walter Reed National Military Medical Center, Bethesda, MD, Uniformed Services University of the Health Sciences, Bethesda, MD, WRNMMC, Washington, DC, Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences,, Bethesda, MD, Uniformed Svcs Univ, Bethesda, MD, Naval Medcl Ctr San Diego, San Diego, CA Abstract Disclosures Research Funding Other Background: Multiple myeloma (MM) is the second most common hematologic malignancy and remains incurable despite therapeutic advances. The US Military Health System (MHS) provides universal healthcare to beneficiaries and has been associated with improved survival across multiple malignancies. It is unknown whether access to universal healthcare via the MHS translates to improved survival for MM patients. We sought to answer this question by comparing survival data from the Department of Defense’s Automated Central Tumor Registry (ACTUR) and the NCI’s SEER database. Methods: Patients 18 years and older diagnosed with histologically confirmed MM between 1987-2013 were identified in ACTUR (N=1,488) and SEER (N=2,976) databases. Two SEER patients were matched to an ACTUR patient by age group, sex, race, and diagnosis year group. Five and 10-year survival was compared between ACTUR and SEER patients using Kaplan-Meier curves and log-rank tests. Cox proportional hazard model was used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) adjusted for potential confounders of age at diagnosis, sex, race and diagnosis year. The proportional hazards assumption for the analysis was assessed with log-log survival curves. Results: Median survival in the ACTUR patients was 47.1 months (95% CI: 43.9-50.4) compared to 33.0 months (95% CI: 32.0-35.0) in the SEER group. Five and 10-year survival was superior in patients from the ACTUR group compared to the SEER group with an aHR of 0.74 (95% CI: 0.68-0.81) and 0.79 (95% CI: 0.74-0.85) after adjustment for potential confounders, respectively. The survival advantage of ACTUR patients was preserved when stratified by age, sex, race, and diagnosis year. Conclusions: Patients treated with MM in the MHS had superior 5 and 10-year overall survival when compared to the general population. This benefit remained despite age, sex, race, and diagnosis year. Our study findings suggest the benefits of universal healthcare provided by the MHS improve survival among MM patients. Further research is warranted to delineate factors which improve survival and reduce disparity in the treatment of MM patients. Five and 10-year survival stratified for age, sex and race. 5-year survival 10-year survival Database N aHR (95%CI) aHR(95%CI) Dataset SEER 2976 Reference Reference ACTUR 1488 0.74 (0.68-0.81) 0.79 (0.74-0.85) By Age Age < 65 SEER 1655 Reference Reference ACTUR 865 0.71 (0.63, 0.80) 0.78 (0.71, 0.87) Age >= 65 SEER 1321 Reference Reference ACTUR 623 0.83 (0.74, 0.93) 0.86 (0.78, 0.96) By Sex Male SEER 1888 Reference Reference ACTUR 944 0.80 (0.72, 0.89) 0.84 (0.77, 0.92) Female SEER 1088 Reference Reference ACTUR 544 0.70 (0.61, 0.80) 0.78 (0.69, 0.88) By Race White SEER 1962 Reference Reference ACTUR 981 0.79 (0.72, 0.87) 0.83 (0.76, 0.91) Black SEER 726 Reference Reference ACTUR 363 0.72 (0.60, 0.86) 0.80 (0.68, 0.93)