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Chest. 2013 Feb 1;143(2):429-435. doi: 10.1378/chest.12-1149.

Use of new treatment modalities for non-small cell lung cancer care in the Medicare population.

Author information

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.

PMID:
23187634
PMCID:
PMC3566996
DOI:
10.1378/chest.12-1149
[Indexed for MEDLINE]
Free PMC Article

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