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

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Abstract
Background: Pancreatic ductal adenocarcinoma outcomes are influenced by sociodemographic factors, including health insurance. Military beneficiaries, which include servicemembers, veterans, and their families, are often treated in civilian settings with TRICARE or Veterans Affairs acting as an insurance payor. We sought to examine outcomes among military and veteran beneficiaries with localized pancreatic cancer treated in civilian hospitals using the National Cancer Database. Materials and Methods: Patients age <65 with stage I-III PDAC from 2010 to 2020 with private or other government insurance were included. Stage-stratified overall survival was analyzed using the Kaplan-Meier and multivariate Cox proportional hazards model. Logistic regression models were used to examine receipt of therapy and postoperative mortality. Survival analysis was examined after propensity score matching. Results: Among 21,691 patients meeting inclusion criteria, 781 had other government insurance. Military beneficiaries were more likely than privately insured patients to be male and Black, and to live in low-income and rural areas. They traveled further for care and started treatment later. Furthermore, military beneficiaries were less likely to receive chemotherapy and undergo surgery. After adjusting for clinicopathologic factors, postoperative mortality was higher for military beneficiaries at 30 days (odds ratio 3.51, 95% confidence interval 1.70-7.27) and 90 days (odds ratio 3.36, 95% confidence interval 1.89-5.96). Median overall survival for privately insured patients was 18.5 months versus 14.7 for military (P < .001). Military insurance remained independently associated with worse overall survival (hazard ratio 1.15, 95% CI 1.03-1.29; P = .015). After propensity score matching, stage-stratified overall survival remained inferior for military beneficiaries (P = .004). Conclusions: Among patients with localized pancreatic cancer, military beneficiaries were less likely to receive cancer treatment, had worse postoperative mortality, and experienced worse risk-adjusted overall survival versus individuals with private insurance. Further research is needed to investigate potential disparities in access to care and treatment outcomes among military beneficiaries and to evaluate policies aimed at closing this gap.

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