Chest. 2012 Sep 3. doi: 10.1378/chest.12-1149. [Epub ahead of print]
Use of New Treatment Modalities for Non-Small Cell Lung Cancer Care in the Medicare Population.
Vest MT, Herrin J, Soulos PR, Decker RH, Tanoue L, Michaud G, Kim AW, Detterbeck F, Morgensztern D, Gross CP.
Abstract
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 is 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:
There were 13,458 patients in our sample (mean age 75.7). 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<0.001), although the proportion of surgery patients undergoing VATS increased from 11.3% to 32.0%. Similarly, while the use of new radiation modalities increased from nil to 5.2%, the overall use of radiation remained stable. The oldest patients were less likely to receive surgery compared to no treatment (OR 0.12 (95% CI 0.09-0.16)) and more likely to receive radiation compared to surgery (OR 13.61 (95% CI 9.75-19.0)).
CONCLUSION:
From 1998-2007, 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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