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Lung Cancer. 2015 Dec;90(3):442-50. doi: 10.1016/j.lungcan.2015.09.017. Epub 2015 Sep 21.

Racial and geographic disparities in the patterns of care and costs at the end of life for patients with lung cancer in 2007-2010 after the 2006 introduction of bevacizumab.

Author information

1
Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center, Houston, TX, USA; Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center, Houston, TX, USA. Electronic address: Xianglin.L.Du@uth.tmc.edu.
2
Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center, Houston, TX, USA.

Abstract

OBJECTIVES:

To examine racial/ethnic and geographical disparities in cancer care and costs during the last 6 months of life for lung cancer decedents after the Food and Drug Administration's approval of expensive bevacizumab in October 2006.

METHODS:

We identified 37,393 cases from the Surveillance, Epidemiology and End Results (SEER) cancer registries and Medicare linked databases who were diagnosed with non-small cell lung cancer of all stages in 1991-2009 and died between July 2007 and December 2010.

RESULTS:

Overall, the proportion of patients receiving chemotherapy/targeted therapy (31.0%), bevacizumab (4.6%), growth factors (16.0%), surgery (2.8%), and hospice care (60.9) in the last 6 months of life was higher in whites than in other ethnic populations. Hospitalization rate was higher in blacks (83.2%) than in whites (76.0%) and others (78.0%). Those from metro areas had slightly higher percentages of receiving chemotherapy/targeted therapy, bevacizumab, growth factors, and hospice care, but had a higher hospitalization rate and lower emergency care visit. Mean total health care cost was $42,749 for the last 6 months of life in patients with lung cancer. Adjusted mean health care cost in the last 6 months of life was significantly higher in blacks or other ethnic population as compared to whites.

CONCLUSION:

There were substantial racial/ethnic and geographic disparities in the types of cancer care and costs in the last 6 months of life among lung cancer decedents, regardless of the length of survival times and hospice care status. A clinical guideline may help the appropriate use of costly treatment modalities and minimize racial/geographic disparities.

KEYWORDS:

Cost; Disparities; End of life care; Lung cancer; Treatment

PMID:
26439736
DOI:
10.1016/j.lungcan.2015.09.017
[Indexed for MEDLINE]

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