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

BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.