TY - JOUR
T1 - Differences in initial treatment patterns and outcomes of lung cancer in the elderly
AU - Smith, Thomas J.
AU - Penberthy, Lynne
AU - Desch, Christopher E.
AU - Whittemore, Martha
AU - Newschaffer, Craig
AU - Hillner, Bruce E.
AU - McClish, Donna
AU - Retchin, Sheldon M.
N1 - Funding Information:
Supported in part by a grant from the Agency for Health Care Policy and Research (ROl HS 06714) (TJS, LP, CED, MW, CN, BEH, DM, SMR), a grant from the Office of Cancer Communications, National Cancer Institute (RFP CO 94388-63) (TJS), a Career Development Award (TJS) and a Faculty Research Award from the American Cancer Society (BEH).
PY - 1995/12
Y1 - 1995/12
N2 - Background: Non-small cell lung cancer (NSCLC) accounts for substantial deaths and costs in the elderly greater than 65 years old. The current practice of NSCLC treatment in a Medicare population was examined to ascertain important areas of practice variation, and differences in clinical outcome and costs. Methods: Data from incident cases of NSCLC from the Virginia Cancer Registry (VCR), 1985-1989, were matched with claims from Medicare Part A and B, census tract data and the Area Resource File. Multivariate models were created to include clinical data, demographics, and access information. Results: For patients with locoregional disease, increasing age was associated with lower likelihood of therapy (odds ratio (OR) 0.35; confidence intervals (CI) 0.29,0.43), thoracotomy (OR 0.27; CI 0.21,0.34), and more use of radiation therapy compared to surgery (OR 1.69; CI 1.39,2.03). Low education levels were associated with less likelihood of treatment (OR 0.78; CI 0.66,0.94), or radiation instead of surgery (OR 1.22; CI 1.05,1.47). Patients in urban areas were less likely to receive therapy (OR 0.67; CI 0.49,0.92). For distant disease, increasing age was also associated with lower likelihood of treatment (OR 0.48; CI 0.41,0.56), as was increasing co-morbidity (OR 0.84; CI 0.75,0.93). Distance to radiation oncologists made no difference in radiotherapy utilization. Two year survival according to therapy was surgery 66%, radiation 15%, no therapy 17%. Conclusions: Patterns of care, and survival according to therapy, vary widely for elderly NSCLC patients. Age, low education, higher co-morbidity and urban residence all decrease the likelihood of surgical therapy for locoregional NSCLC. Despite the availability of coverage through the Medicare program, use of therapies and survival is not uniform for all beneficiaries. Possible discrimination by age, co-morbid illnesses not recorded in the Medicare files, or patient and provider choice could all be involved; administrative billing files cannot resolve these important differences.
AB - Background: Non-small cell lung cancer (NSCLC) accounts for substantial deaths and costs in the elderly greater than 65 years old. The current practice of NSCLC treatment in a Medicare population was examined to ascertain important areas of practice variation, and differences in clinical outcome and costs. Methods: Data from incident cases of NSCLC from the Virginia Cancer Registry (VCR), 1985-1989, were matched with claims from Medicare Part A and B, census tract data and the Area Resource File. Multivariate models were created to include clinical data, demographics, and access information. Results: For patients with locoregional disease, increasing age was associated with lower likelihood of therapy (odds ratio (OR) 0.35; confidence intervals (CI) 0.29,0.43), thoracotomy (OR 0.27; CI 0.21,0.34), and more use of radiation therapy compared to surgery (OR 1.69; CI 1.39,2.03). Low education levels were associated with less likelihood of treatment (OR 0.78; CI 0.66,0.94), or radiation instead of surgery (OR 1.22; CI 1.05,1.47). Patients in urban areas were less likely to receive therapy (OR 0.67; CI 0.49,0.92). For distant disease, increasing age was also associated with lower likelihood of treatment (OR 0.48; CI 0.41,0.56), as was increasing co-morbidity (OR 0.84; CI 0.75,0.93). Distance to radiation oncologists made no difference in radiotherapy utilization. Two year survival according to therapy was surgery 66%, radiation 15%, no therapy 17%. Conclusions: Patterns of care, and survival according to therapy, vary widely for elderly NSCLC patients. Age, low education, higher co-morbidity and urban residence all decrease the likelihood of surgical therapy for locoregional NSCLC. Despite the availability of coverage through the Medicare program, use of therapies and survival is not uniform for all beneficiaries. Possible discrimination by age, co-morbid illnesses not recorded in the Medicare files, or patient and provider choice could all be involved; administrative billing files cannot resolve these important differences.
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U2 - 10.1016/0169-5002(95)00496-3
DO - 10.1016/0169-5002(95)00496-3
M3 - Article
C2 - 8719064
AN - SCOPUS:0029188255
SN - 0169-5002
VL - 13
SP - 235
EP - 252
JO - Lung Cancer
JF - Lung Cancer
IS - 3
ER -