TY - JOUR
T1 - Geographic variation in the use of adjuvant therapy among elderly patients with resected non-small cell lung cancer
AU - Schroeder, Mary C.
AU - Tien, Yu Yu
AU - Wright, Kara
AU - Halfdanarson, Thorvardur R.
AU - Abu-Hejleh, Taher
AU - Brooks, John M.
N1 - Funding Information:
This work was supported by the Holden Comprehensive Cancer Center’s Population Science Pilot Award through the National Cancer Institute of the National Institutes of Health under award number P30CA086862.
Funding Information:
This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database.
Funding Information:
Dr. Halfdanarson has held a consulting or advisory role with Novartis and has received research funding from Boston Biomedical and Temkira to his institution. Dr. Abu-Hejleh has received honoraria from Qessential Medical Market Research and research funding from Novartis, Lilly, Genentech, and Merck to his institution. None of these entities funded any part of this work. The authors report no conflict of interest.
Publisher Copyright:
© 2016 Elsevier Ireland Ltd.
PY - 2016/5/1
Y1 - 2016/5/1
N2 - Objectives: The purpose of this study was to assess to what extent geographic variation in adjuvant treatment for non-small cell lung cancer (NSCLC) patients would remain, after controlling for patient and area-level characteristics. Materials and methods: A retrospective cohort of 18,410 Medicare beneficiaries with resected, stage I-IIIA NSCLC was identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Adjuvant therapies were classified as adjuvant chemotherapy (ACT), postoperative radiation therapy (PORT), or no adjuvant therapy. Predicted treatment probabilities were estimated for each patient given their clinical, demographic, and area-level characteristics with multivariate logistic regression. Area Treatment Ratios were used to estimate the propensity of patients in a local area to receive an adjuvant treatment, controlling for characteristics of patients in the area. Areas were categorized as low-, mid- and high-use and mapped for two representative SEER registries. Results: Overall, 10%, 12%, and 78% of patients received ACT, PORT and no adjuvant therapy, respectively. Age, sex, stage, type and year of surgery, and comorbidity were associated with adjuvant treatment use. Even after adjusting for patient characteristics, substantial geographic treatment variation remained. High- and low-use areas were tightly juxtaposed within and across SEER registries, often within the same county. In some local areas, patients were up to eight times more likely to receive adjuvant therapy than expected, given their characteristics. On the other hand, almost a quarter of patients lived in local areas in which patients were more than three times less likely to receive ACT than would be predicted. Conclusion: Controlling for patient and area-level covariates did not remove geographic variation in adjuvant therapies for resected NSCLC patients. A greater proportion of patients were treated less than expected, rather than more than expected. Further research is needed to better understand its causes and potential impact on outcomes.
AB - Objectives: The purpose of this study was to assess to what extent geographic variation in adjuvant treatment for non-small cell lung cancer (NSCLC) patients would remain, after controlling for patient and area-level characteristics. Materials and methods: A retrospective cohort of 18,410 Medicare beneficiaries with resected, stage I-IIIA NSCLC was identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Adjuvant therapies were classified as adjuvant chemotherapy (ACT), postoperative radiation therapy (PORT), or no adjuvant therapy. Predicted treatment probabilities were estimated for each patient given their clinical, demographic, and area-level characteristics with multivariate logistic regression. Area Treatment Ratios were used to estimate the propensity of patients in a local area to receive an adjuvant treatment, controlling for characteristics of patients in the area. Areas were categorized as low-, mid- and high-use and mapped for two representative SEER registries. Results: Overall, 10%, 12%, and 78% of patients received ACT, PORT and no adjuvant therapy, respectively. Age, sex, stage, type and year of surgery, and comorbidity were associated with adjuvant treatment use. Even after adjusting for patient characteristics, substantial geographic treatment variation remained. High- and low-use areas were tightly juxtaposed within and across SEER registries, often within the same county. In some local areas, patients were up to eight times more likely to receive adjuvant therapy than expected, given their characteristics. On the other hand, almost a quarter of patients lived in local areas in which patients were more than three times less likely to receive ACT than would be predicted. Conclusion: Controlling for patient and area-level covariates did not remove geographic variation in adjuvant therapies for resected NSCLC patients. A greater proportion of patients were treated less than expected, rather than more than expected. Further research is needed to better understand its causes and potential impact on outcomes.
KW - Adjuvant therapy
KW - Elderly patients
KW - Geographic treatment variation
KW - Non-small cell lung cancer
KW - SEER-Medicare
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U2 - 10.1016/j.lungcan.2016.02.010
DO - 10.1016/j.lungcan.2016.02.010
M3 - Article
C2 - 27040848
AN - SCOPUS:84959364246
SN - 0169-5002
VL - 95
SP - 28
EP - 34
JO - Lung Cancer
JF - Lung Cancer
ER -