Document Detail

Use of new treatment modalities for non-small cell lung cancer care in the Medicare population.
MedLine Citation:
PMID:  23187634     Owner:  NLM     Status:  MEDLINE    
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.
Michael T Vest; Jeph Herrin; Pamela R Soulos; Roy H Decker; Lynn Tanoue; Gaetane Michaud; Anthony W Kim; Frank Detterbeck; Daniel Morgensztern; Cary P Gross
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Chest     Volume:  143     ISSN:  1931-3543     ISO Abbreviation:  Chest     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-03-15     Completed Date:  2013-06-20     Revised Date:  2014-05-05    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  429-35     Citation Subset:  AIM; IM    
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MeSH Terms
Aged, 80 and over
Carcinoma, Non-Small-Cell Lung / pathology,  therapy*
Combined Modality Therapy
Linear Models
Lung Neoplasms / pathology,  therapy*
Neoplasm Staging
Radiosurgery / utilization*
Radiotherapy, Intensity-Modulated / utilization*
Retrospective Studies
SEER Program
Thoracic Surgery, Video-Assisted / utilization*
United States
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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