Impact of the year 2000 medicare policy change on older patient enrollment to cancer clinical trials

Joseph M. Unger, Charles A. Coltman, John J. Crowley, Laura F. Hutchins, Silvana Martino, Robert B. Livingston, John S. Macdonald, Charles Blanke, David R. Gandara, E. David Crawford, Kathy S. Albain

Research output: Contribution to journalArticle

78 Citations (Scopus)

Abstract

Purpose: A prior analysis by the Southwest Oncology Group (SWOG) showed that women and African American patients were adequately represented on cancer clinical treatment trials but that older patients were substantially underrepresented. Twenty-five percent of patients ≥ 65 years old were enrolled onto SWOG trials from 1993 to 1996, whereas 63% of all patients with cancer were ≥ 65 years old. Recognition of this under-representation led to a change in Medicare policy in 2000 to include coverage of routine patient care costs of clinical trials. We conducted an updated analysis of accrual trends. Methods: The proportions of enrollment onto SWOG treatment trials by sex, race/ethnicity, and age (≥ 65 years) were computed for the years 1997 to 2000; corresponding rates in the United States were derived from US Census and National Cancer Institute Surveillance, Epidemiology, and End Results data. Additionally, method of payment data were analyzed over time (1993 to 2003) to assess whether patterns in method of payment changed with the new Year 2000 Medicare policy on clinical trials coverage. Results: The results showed continued adequate representation by sex and race/ethnicity. Older patient accrual on SWOG trials increased significantly since 2000, with 31 % of patients ≥ 65 years old enrolled from 1997 to 2000 and 38% enrolled from 2001 to 2003 (v 25% from 1993 to 1996). The percentage of patients using Medicare plus supplemental insurance also increased beginning in 2000, whereas the percentage of patients using Medicare alone remained the same. Conclusion: Method of payment analyses provided evidence that the Year 2000 Medicare policy change had a positive impact, but only for those patients with supplemental private coverage of coinsurance costs. Improvements in the Medicare payment structure could further increase older patient participation in clinical trials.

Original languageEnglish (US)
Pages (from-to)141-144
Number of pages4
JournalJournal of Clinical Oncology
Volume24
Issue number1
DOIs
StatePublished - Jan 1 2006

Fingerprint

Medicare
Clinical Trials
Neoplasms
Deductibles and Coinsurance
Patient Participation
Costs and Cost Analysis
National Cancer Institute (U.S.)
Censuses
Insurance
African Americans
Patient Care
Epidemiology
Therapeutics

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Unger, J. M., Coltman, C. A., Crowley, J. J., Hutchins, L. F., Martino, S., Livingston, R. B., ... Albain, K. S. (2006). Impact of the year 2000 medicare policy change on older patient enrollment to cancer clinical trials. Journal of Clinical Oncology, 24(1), 141-144. https://doi.org/10.1200/JCO.2005.02.8928

Impact of the year 2000 medicare policy change on older patient enrollment to cancer clinical trials. / Unger, Joseph M.; Coltman, Charles A.; Crowley, John J.; Hutchins, Laura F.; Martino, Silvana; Livingston, Robert B.; Macdonald, John S.; Blanke, Charles; Gandara, David R.; Crawford, E. David; Albain, Kathy S.

In: Journal of Clinical Oncology, Vol. 24, No. 1, 01.01.2006, p. 141-144.

Research output: Contribution to journalArticle

Unger, JM, Coltman, CA, Crowley, JJ, Hutchins, LF, Martino, S, Livingston, RB, Macdonald, JS, Blanke, C, Gandara, DR, Crawford, ED & Albain, KS 2006, 'Impact of the year 2000 medicare policy change on older patient enrollment to cancer clinical trials', Journal of Clinical Oncology, vol. 24, no. 1, pp. 141-144. https://doi.org/10.1200/JCO.2005.02.8928
Unger, Joseph M. ; Coltman, Charles A. ; Crowley, John J. ; Hutchins, Laura F. ; Martino, Silvana ; Livingston, Robert B. ; Macdonald, John S. ; Blanke, Charles ; Gandara, David R. ; Crawford, E. David ; Albain, Kathy S. / Impact of the year 2000 medicare policy change on older patient enrollment to cancer clinical trials. In: Journal of Clinical Oncology. 2006 ; Vol. 24, No. 1. pp. 141-144.
@article{cd5ace851dcc4b1991676404d0b30c91,
title = "Impact of the year 2000 medicare policy change on older patient enrollment to cancer clinical trials",
abstract = "Purpose: A prior analysis by the Southwest Oncology Group (SWOG) showed that women and African American patients were adequately represented on cancer clinical treatment trials but that older patients were substantially underrepresented. Twenty-five percent of patients ≥ 65 years old were enrolled onto SWOG trials from 1993 to 1996, whereas 63{\%} of all patients with cancer were ≥ 65 years old. Recognition of this under-representation led to a change in Medicare policy in 2000 to include coverage of routine patient care costs of clinical trials. We conducted an updated analysis of accrual trends. Methods: The proportions of enrollment onto SWOG treatment trials by sex, race/ethnicity, and age (≥ 65 years) were computed for the years 1997 to 2000; corresponding rates in the United States were derived from US Census and National Cancer Institute Surveillance, Epidemiology, and End Results data. Additionally, method of payment data were analyzed over time (1993 to 2003) to assess whether patterns in method of payment changed with the new Year 2000 Medicare policy on clinical trials coverage. Results: The results showed continued adequate representation by sex and race/ethnicity. Older patient accrual on SWOG trials increased significantly since 2000, with 31 {\%} of patients ≥ 65 years old enrolled from 1997 to 2000 and 38{\%} enrolled from 2001 to 2003 (v 25{\%} from 1993 to 1996). The percentage of patients using Medicare plus supplemental insurance also increased beginning in 2000, whereas the percentage of patients using Medicare alone remained the same. Conclusion: Method of payment analyses provided evidence that the Year 2000 Medicare policy change had a positive impact, but only for those patients with supplemental private coverage of coinsurance costs. Improvements in the Medicare payment structure could further increase older patient participation in clinical trials.",
author = "Unger, {Joseph M.} and Coltman, {Charles A.} and Crowley, {John J.} and Hutchins, {Laura F.} and Silvana Martino and Livingston, {Robert B.} and Macdonald, {John S.} and Charles Blanke and Gandara, {David R.} and Crawford, {E. David} and Albain, {Kathy S.}",
year = "2006",
month = "1",
day = "1",
doi = "10.1200/JCO.2005.02.8928",
language = "English (US)",
volume = "24",
pages = "141--144",
journal = "Journal of Clinical Oncology",
issn = "0732-183X",
publisher = "American Society of Clinical Oncology",
number = "1",

}

TY - JOUR

T1 - Impact of the year 2000 medicare policy change on older patient enrollment to cancer clinical trials

AU - Unger, Joseph M.

AU - Coltman, Charles A.

AU - Crowley, John J.

AU - Hutchins, Laura F.

AU - Martino, Silvana

AU - Livingston, Robert B.

AU - Macdonald, John S.

AU - Blanke, Charles

AU - Gandara, David R.

AU - Crawford, E. David

AU - Albain, Kathy S.

PY - 2006/1/1

Y1 - 2006/1/1

N2 - Purpose: A prior analysis by the Southwest Oncology Group (SWOG) showed that women and African American patients were adequately represented on cancer clinical treatment trials but that older patients were substantially underrepresented. Twenty-five percent of patients ≥ 65 years old were enrolled onto SWOG trials from 1993 to 1996, whereas 63% of all patients with cancer were ≥ 65 years old. Recognition of this under-representation led to a change in Medicare policy in 2000 to include coverage of routine patient care costs of clinical trials. We conducted an updated analysis of accrual trends. Methods: The proportions of enrollment onto SWOG treatment trials by sex, race/ethnicity, and age (≥ 65 years) were computed for the years 1997 to 2000; corresponding rates in the United States were derived from US Census and National Cancer Institute Surveillance, Epidemiology, and End Results data. Additionally, method of payment data were analyzed over time (1993 to 2003) to assess whether patterns in method of payment changed with the new Year 2000 Medicare policy on clinical trials coverage. Results: The results showed continued adequate representation by sex and race/ethnicity. Older patient accrual on SWOG trials increased significantly since 2000, with 31 % of patients ≥ 65 years old enrolled from 1997 to 2000 and 38% enrolled from 2001 to 2003 (v 25% from 1993 to 1996). The percentage of patients using Medicare plus supplemental insurance also increased beginning in 2000, whereas the percentage of patients using Medicare alone remained the same. Conclusion: Method of payment analyses provided evidence that the Year 2000 Medicare policy change had a positive impact, but only for those patients with supplemental private coverage of coinsurance costs. Improvements in the Medicare payment structure could further increase older patient participation in clinical trials.

AB - Purpose: A prior analysis by the Southwest Oncology Group (SWOG) showed that women and African American patients were adequately represented on cancer clinical treatment trials but that older patients were substantially underrepresented. Twenty-five percent of patients ≥ 65 years old were enrolled onto SWOG trials from 1993 to 1996, whereas 63% of all patients with cancer were ≥ 65 years old. Recognition of this under-representation led to a change in Medicare policy in 2000 to include coverage of routine patient care costs of clinical trials. We conducted an updated analysis of accrual trends. Methods: The proportions of enrollment onto SWOG treatment trials by sex, race/ethnicity, and age (≥ 65 years) were computed for the years 1997 to 2000; corresponding rates in the United States were derived from US Census and National Cancer Institute Surveillance, Epidemiology, and End Results data. Additionally, method of payment data were analyzed over time (1993 to 2003) to assess whether patterns in method of payment changed with the new Year 2000 Medicare policy on clinical trials coverage. Results: The results showed continued adequate representation by sex and race/ethnicity. Older patient accrual on SWOG trials increased significantly since 2000, with 31 % of patients ≥ 65 years old enrolled from 1997 to 2000 and 38% enrolled from 2001 to 2003 (v 25% from 1993 to 1996). The percentage of patients using Medicare plus supplemental insurance also increased beginning in 2000, whereas the percentage of patients using Medicare alone remained the same. Conclusion: Method of payment analyses provided evidence that the Year 2000 Medicare policy change had a positive impact, but only for those patients with supplemental private coverage of coinsurance costs. Improvements in the Medicare payment structure could further increase older patient participation in clinical trials.

UR - http://www.scopus.com/inward/record.url?scp=33644847203&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33644847203&partnerID=8YFLogxK

U2 - 10.1200/JCO.2005.02.8928

DO - 10.1200/JCO.2005.02.8928

M3 - Article

VL - 24

SP - 141

EP - 144

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

SN - 0732-183X

IS - 1

ER -