Michael T Vest1, Jeph Herrin2, Pamela R Soulos3, Roy H Decker4, Lynn Tanoue1, Gaetane Michaud1, Anthony W Kim5, Frank Detterbeck6, Daniel Morgensztern7, Cary P Gross8. 1. Department of Internal Medicine, Section of Pulmonary and Critical Care Medicine, New Haven, CT. 2. Department of Internal Medicine, Section of Cardiology, New Haven, CT; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT; Health Research and Educational Trust, Chicago, IL. 3. Department of Internal Medicine, Section of General Internal Medicine, New Haven, CT; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT. 4. Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT; Department of Therapeutic Radiology, New Haven, CT. 5. Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT; Department of Surgery, Section of Thoracic Surgery, New Haven, CT. 6. Department of Surgery, Section of Thoracic Surgery, New Haven, CT. 7. Department of Internal Medicine, Section of Medical Oncology, New Haven, CT; Yale Cancer Center, Yale School of Medicine, New Haven, CT. 8. Department of Internal Medicine, Section of General Internal Medicine, New Haven, CT; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT. Electronic address: cary.gross@yale.edu.
Abstract
BACKGROUND: Many older patients with early stage non-small cell lung cancer (NSCLC) do not receive curative therapy. New surgical techniques and radiation therapy modalities, such as video-assisted thoracoscopic surgery (VATS), potentially allow more patients to receive treatment. The adoption of these techniques and their impact on access to cancer care among Medicare beneficiaries with stage I NSCLC are unknown. METHODS: We used the Surveillance, Epidemiology and End Results-Medicare database to identify patients with stage I NSCLC diagnosed between 1998 and 2007. We assessed temporal trends and created hierarchical generalized linear models of the relationship between patient, clinical, and regional factors and type of treatment. RESULTS: The sample comprised 13,458 patients with a mean age of 75.7 years. The proportion of patients not receiving any local treatment increased from 14.6% in 1998 to 18.3% in 2007. The overall use of surgical resection declined from 75.2% to 67.3% ( P , .001), although the proportion of patients undergoing VATS increased from 11.3% to 32.0%. Similarly, although the use of new radiation modalities increased from 0% to 5.2%, the overall use of radiation remained stable. The oldest patients were less likely to receive surgical vs no treatment (OR, 0.12; 95% CI, 0.09-0.16) and more likely to receive radiation vs surgery (OR, 13.61; 95% CI, 9.75-19.0). CONCLUSION: From 1998 to 2007, the overall proportion of older patients with stage I NSCLC receiving curative local therapy decreased, despite the dissemination of newer, less-invasive forms of surgery and radiation.
BACKGROUND: Many older patients with early stage non-small cell lung cancer (NSCLC) do not receive curative therapy. New surgical techniques and radiation therapy modalities, such as video-assisted thoracoscopic surgery (VATS), potentially allow more patients to receive treatment. The adoption of these techniques and their impact on access to cancer care among Medicare beneficiaries with stage I NSCLC are unknown. METHODS: We used the Surveillance, Epidemiology and End Results-Medicare database to identify patients with stage I NSCLC diagnosed between 1998 and 2007. We assessed temporal trends and created hierarchical generalized linear models of the relationship between patient, clinical, and regional factors and type of treatment. RESULTS: The sample comprised 13,458 patients with a mean age of 75.7 years. The proportion of patients not receiving any local treatment increased from 14.6% in 1998 to 18.3% in 2007. The overall use of surgical resection declined from 75.2% to 67.3% ( P , .001), although the proportion of patients undergoing VATS increased from 11.3% to 32.0%. Similarly, although the use of new radiation modalities increased from 0% to 5.2%, the overall use of radiation remained stable. The oldest patients were less likely to receive surgical vs no treatment (OR, 0.12; 95% CI, 0.09-0.16) and more likely to receive radiation vs surgery (OR, 13.61; 95% CI, 9.75-19.0). CONCLUSION: From 1998 to 2007, the overall proportion of older patients with stage I NSCLC receiving curative local therapy decreased, despite the dissemination of newer, less-invasive forms of surgery and radiation.
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