Military insurance and melanoma outcomes in the national cancer database

Introduction Melanoma is one of the most common cancers among military servicemembers and veterans. These individuals are increasingly required to seek cancer care in civilian settings. The aim of this study is to examine treatment patterns and outcomes among MB with melanoma and explore the influence of demographic or treatment differences on outcomes. Methods Using the National Cancer Database, patients age < 65 with stage I-IV cutaneous melanoma with private (PI) or Other Government insurance (i.e. MB), no prior malignancies, and Charlson-Deyo score < 3 were included. Overall survival (OS) was evaluated using Kaplan-Meier estimates and multivariate Cox proportional hazards models. Propensity score matching (PSM) was performed and survival analyses were repeated. Results Of 110,246 patients meeting inclusion criteria, 2009 were MB. MB were more likely than PI to be male, live in lower income areas, present at later stages, have fragmented care, travel further, and have a treatment delay > 33 days (all p < 0.001). MB was an independent predictor of stage III/IV at diagnosis (OR 1.38, p < 0.001). 5-year OS was worse for MB compared with PI (85.9 % vs. 90.3 %, p < 0.001). After adjusting for demographic and treatment variables, MB remained an independent predictor of reduced OS (HR 1.39, p < 0.001). There was no difference in OS between MB and PI in the PSM analysis. Conclusions MB with cutaneous melanoma have significantly worse OS compared with PI. MB have more advanced stage presentation, care fragmentation, distance traveled, and treatment delay. Despite universal insurance coverage, MB with melanoma face additional challenges when treated outside federal facilities.