Use and Outcomes of Radiation Therapy for Medicare Patients with Common Cancers

常见癌症医疗保险患者放射治疗的使用和结果

• 批准号: 8257069
• 负责人: Cary P. Gross
• 金额: $ 36.92万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-06-01 至 2014-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8257069
• 关键词: Accounting; Address; Adopted; Adoption; Adverse effects; Adverse event; Affect; Benefits and Risks; Brachytherapy; Breast; Caring; Certificate of Need; Chronic Disease; Clinical; Comorbidity; Complex; Data; Databases; Decision Making; Development; Diagnosis; Diffusion; Effectiveness; Elderly; Enrollment; Face; Fee-for-Service Plans; Health; Health Status; Health system; Healthcare Systems; Hospitals; Incidence; Insurance; Intensity-Modulated Radiotherapy; Intervention; Knowledge; Longitudinal Studies; Malignant Neoplasms; Malignant neoplasm of lung; Malignant neoplasm of prostate; Managed Care; Marketing; Medicare; Modality; Modeling; National Cancer Institute; Operative Surgical Procedures; Outcome; Patients; Penetration; Physicians; Policies; Policy Maker; Prognostic Factor; Prostate; Protons; Provider; Radiation; Radiation Oncologist; Radiation therapy; Radiosurgery; Recurrence; Research; Risk; Risk Factors; Sampling; Socioeconomic Status; Staging; Techniques; Technology; Time; Training; Treatment Cost; Treatment outcome; Treatment-Related Cancer; United States Centers for Medicare and Medicaid Services; Variant; Work; aggressive therapy; base; beneficiary; cancer care; cancer therapy; cancer type; chemotherapeutic agent; clinical care; clinical practice; clinically relevant; comparative; compare effectiveness; cost; cost effectiveness; experience; improved; innovation; malignant breast neoplasm; new technology; novel strategies; older patient; population based; programs; proton beam; public health relevance; treatment center; treatment strategy

DESCRIPTION (provided by applicant): For patients with localized breast, lung, and prostate cancer, several new treatment options have been developed in recent years. As care options expand, clinicians, patients, and policy-makers encounter difficult decisions. Despite the hope of superior efficacy against cancer, decreased side effects, or both generated by newer radiation modalities, it is unclear whether these new, expensive therapies will have an impact on patient health that is commensurate with their cost. A new approach is needed for evaluating diffusion of treatments while evidence of efficacy is still in development: evaluating utilization and costs according to likelihood of benefit. Some older patients with a higher burden of comorbidity will receive less benefit, and perhaps greater risk with more aggressive therapy. We propose a population based study of older persons with breast, lung, or prostate cancer enrolled in the Medicare fee-for-service program, in order to address the following aims with a particular emphasis on complex patients: Aim 1: To identify, as a function of clinical factors among patients diagnosed in 1996-2005, changes in the proportion of patients treated with newer radiation modalities as well as in over-all treatment approaches. We will also examine whether the use of new treatment modalities is associated with increases in the percentage of patients receiving cancer therapy; Aim 2: To identify factors associated with adoption of new radiation modalities including provider, health system, and non-clinical patient factors; Aim 3: To determine the total costs to the Medicare fee for service program for initial care of breast, lung, and prostate cancer in 2006-08 and the proportion of these costs that are associated with radiation modalities; Aim 4: To compare the effectiveness of radiation treatment modalities. This retrospective, longitudinal study will use population-based data obtained from the Center for Medicare and Medicaid Services (CMS) and the National Cancer Institute. This SEER-Medicare database will be used to delineate changes in cancer therapy according to cancer and comorbidity strata for patients diagnosed through 2005. We will also obtain a 100% sample of Medicare fee-for-service beneficiaries with breast, lung, or prostate cancer during 2006-2008, providing a comprehensive and timely assessment of cancer care, costs, and comparative outcomes. An experienced study team will conduct a methodologically rigorous analysis that includes multilevel, hierarchical modeling to account for clustering of patients at the physician and geographic level. Prior assessments of cancer care have not incorporated both cancer and comorbidity status into a comprehensive assessment of likelihood of benefit of cancer therapy. Addressing these knowledge gaps is critical for understanding the patient and health-system factors that affect the adoption of these technologies, as well as the implications for costs and outcomes - providing potential targets for intervention to improve the effectiveness and efficiency of treatment strategies. PUBLIC HEALTH RELEVANCE: New and expensive radiation therapies are frequently being used to treat older persons with cancers of the lung, prostate or breast. However, little is known about the risks and benefits of these therapies, their costs, or factors associated with their use. The proposed study, using data from both National Cancer Institute as well as Center for Medicare and Medicaid Services, will examine new radiation therapy modalities among Medicare beneficiaries as a function of health status, in an effort to improve decision making about cancer treatments.

描述（由申请人提供）：对于局部乳腺癌，肺和前列腺癌的患者，近年来已经开发了几种新的治疗选择。随着护理选择的扩展，临床医生，患者和决策者会遇到艰难的决定。尽管希望对癌症产生卓越的效力，副作用减少或既由新的辐射方式产生，但尚不清楚这些新的，昂贵的疗法是否会对患者健康产生与成本相称的影响。需要一种新的方法来评估治疗的扩散，而功效证据仍在开发中：根据利益的可能性评估利用率和成本。一些合并症负担较高的老年患者将获得更少的收益，并且通过更具侵略性的治疗可能会更大的风险。我们提出了一项基于人群的研究，对医疗保险收费计划的乳腺癌，肺或前列腺癌的老年人进行研究，以解决以下目标，并特别强调复杂的患者：目标1：确定，作为1996-2005诊断的患者的临床因素的函数，在1996- 2005年诊断出的患者在治疗的患者中受到了新的辐射模态的变化，以及新的态度模态。我们还将检查使用新治疗方式是否与接受癌症治疗的患者百分比增加有关；目标2：确定与采用新辐射方式有关的因素，包括提供商，卫生系统和非临床患者因素；目标3：确定2006 - 08年乳腺癌，肺和前列腺癌的初始护理计划的Medicare费用总成本，以及与辐射方式相关的这些成本的比例；目标4：比较辐射处理方式的有效性。这项回顾性纵向研究将使用从医疗保险和医疗补助中心（CMS）和国家癌症研究所获得的基于人群的数据。根据癌症和合并症的阶层，该观点数据库将用于划定癌症治疗的变化，以诊断为2005年诊断的患者。我们还将获得100％的乳腺癌，肺部或前列腺癌的Medicare Fee-Service-Service-Service-Service受益人，在2006- 2008年期间，可全面评估癌症护理，成本和比较成本，成本和比较。一个经验丰富的研究团队将进行一项在方法上进行严格的分析，其中包括多级，分层建模，以说明医师和地理水平的患者聚类。对癌症护理的事先评估尚未将癌症和合并症状态纳入对癌症治疗受益可能性的全面评估。解决这些知识差距对于理解影响这些技术采用的患者和健康系统因素至关重要，以及对成本和成本和结果的影响 - 提供了潜在的干预目标，以提高治疗策略的有效性和效率。 公共卫生相关性：新的且昂贵的辐射疗法经常被用来用肺癌，前列腺或乳房癌症治疗老年人。但是，对于这些疗法的风险和收益，它们的成本或与使用相关的因素的风险和收益知之甚少。拟议的研究使用来自国家癌症研究所的数据以及医疗保险和医疗补助服务中心，将研究医疗保险受益人之间的新放射治疗方式，以促进健康状况，以改善对癌症治疗的决策。

项目成果

The relation between age and androgen deprivation therapy use among men in the Medicare population receiving radiation therapy for prostate cancer.

接受前列腺癌放射治疗的医疗保险人群中男性年龄与雄激素剥夺疗法使用之间的关系。

• DOI: 10.1016/j.jgo.2012.08.007
• 发表时间: 2013
• 期刊: Journal of geriatric oncology
• 影响因子: 3
• 作者: Quon,JenniferL;Yu,JamesB;Soulos,PamelaR;Gross,CaryP
• 通讯作者: Gross,CaryP

Regional Medicare Expenditures and Survival Among Older Women With Localized Breast Cancer.

• DOI: 10.1097/mlr.0000000000000822
• 发表时间: 2017-12
• 期刊: Medical care
• 影响因子: 3
• 作者: Tannenbaum S;Soulos PR;Herrin J;Mougalian S;Long JB;Wang R;Ma X;Gross CP;Xu X
• 通讯作者: Xu X

Thoroughness of mediastinal staging in stage IIIA non-small cell lung cancer.

• DOI: 10.1097/jto.0b013e318236ecbb
• 发表时间: 2012-01
• 期刊: Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer
• 作者: Vest MT;Tanoue L;Soulos PR;Kim AW;Detterbeck F;Morgensztern D;Gross CP
• 通讯作者: Gross CP

Reply to L.W. Cuttino et al.

回复 L.W.

• DOI: 10.1200/jco.2013.49.0441
• 发表时间: 2013
• 期刊: Journal of clinical oncology : official journal of the American Society of Clinical Oncology
• 作者: Presley,CarolynJ;Soulos,PamelaR;Herrin,Jeph;Roberts,KennethB;Yu,JamesB;Gross,CaryP
• 通讯作者: Gross,CaryP

Reply to K. Quan et al, S.p. Collins et al, C.R. King et al, S. Arcangeli et Al, D.B. Fuller, and D. Vordermark.

回复 K. Quan 等人，S.p.

• DOI: 10.1200/jco.2014.57.6108
• 发表时间: 2014
• 期刊: Journal of clinical oncology : official journal of the American Society of Clinical Oncology
• 作者: Yu,JamesB;Cramer,LauraD;Herrin,Jeph;Soulos,PamelaR;Potosky,ArnoldL;Gross,CaryP
• 通讯作者: Gross,CaryP