Chemotherapy use, outcomes, and costs for older persons with advanced non-small-cell lung cancer: Evidence from surveillance, epidemiology and end results-medicare

Scott D. Ramsey, Nadia Howlader, Ruth Etzioni, Bonnie Donato

Research output: Contribution to journalArticle

132 Citations (Scopus)

Abstract

Purpose: There is limited published documentation regarding US community patterns of care for older patients with advanced non-small-cell lung cancer (NSCLC). Using the Surveillance, Epidemiology and End Results (SEER) -Medicare database, we examined community treatment patterns for advanced NSCLC, focusing on chemotherapy. Methods: Patients with locally advanced or metastatic (TNM system stages IIIb and IV) NSCLC diagnosed between January 1, 1994, and December 31, 1999, were stratified based on chemotherapy agents received during the first 3 months following diagnosis. Cox proportional hazards models were used to compare survival, controlling for age, sex, race, noncancer comorbidity, stage at diagnosis, SEER region, and receipt of cancer-related surgery or radiation therapy in the first 3 months following diagnosis. Lifetime medical costs were calculated for each group. Results: 14,875 patients met inclusion criteria: 7,411 (49.8%) stage III and 7,464 (50.2%) stage IV at diagnosis. Thirty-one percent received chemotherapy, 8% received surgery, and 53% received radiation therapy either as initial or adjuvant treatment. Persons ≥ 75 years of age, females, African Americans, and those with more than one comorbidity were significantly less likely to receive chemotherapy (P < .01). Survival was inferior for those who did not receive a platinum-containing agent (P < .01). Lifetime costs were highest for those receiving platinum + taxane combinations, exceeding other regimens by more than $10,000 per patient. Conclusion: Chemotherapy prolongs survival in community settings, but is underutilized for persons with advanced NSCLC. Reasons for lower use in minorities and variation across regions deserve further study.

Original languageEnglish (US)
Pages (from-to)4971-4978
Number of pages8
JournalJournal of Clinical Oncology
Volume22
Issue number24
DOIs
StatePublished - Dec 15 2004
Externally publishedYes

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Medicare
Non-Small Cell Lung Carcinoma
Epidemiology
Costs and Cost Analysis
Drug Therapy
Platinum
Survival
Comorbidity
Radiotherapy
Proportional Hazards Models
Documentation
African Americans
Patient Care
Databases
Therapeutics
Neoplasms

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Chemotherapy use, outcomes, and costs for older persons with advanced non-small-cell lung cancer : Evidence from surveillance, epidemiology and end results-medicare. / Ramsey, Scott D.; Howlader, Nadia; Etzioni, Ruth; Donato, Bonnie.

In: Journal of Clinical Oncology, Vol. 22, No. 24, 15.12.2004, p. 4971-4978.

Research output: Contribution to journalArticle

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abstract = "Purpose: There is limited published documentation regarding US community patterns of care for older patients with advanced non-small-cell lung cancer (NSCLC). Using the Surveillance, Epidemiology and End Results (SEER) -Medicare database, we examined community treatment patterns for advanced NSCLC, focusing on chemotherapy. Methods: Patients with locally advanced or metastatic (TNM system stages IIIb and IV) NSCLC diagnosed between January 1, 1994, and December 31, 1999, were stratified based on chemotherapy agents received during the first 3 months following diagnosis. Cox proportional hazards models were used to compare survival, controlling for age, sex, race, noncancer comorbidity, stage at diagnosis, SEER region, and receipt of cancer-related surgery or radiation therapy in the first 3 months following diagnosis. Lifetime medical costs were calculated for each group. Results: 14,875 patients met inclusion criteria: 7,411 (49.8{\%}) stage III and 7,464 (50.2{\%}) stage IV at diagnosis. Thirty-one percent received chemotherapy, 8{\%} received surgery, and 53{\%} received radiation therapy either as initial or adjuvant treatment. Persons ≥ 75 years of age, females, African Americans, and those with more than one comorbidity were significantly less likely to receive chemotherapy (P < .01). Survival was inferior for those who did not receive a platinum-containing agent (P < .01). Lifetime costs were highest for those receiving platinum + taxane combinations, exceeding other regimens by more than $10,000 per patient. Conclusion: Chemotherapy prolongs survival in community settings, but is underutilized for persons with advanced NSCLC. Reasons for lower use in minorities and variation across regions deserve further study.",
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