Do Medicare Claims Measure Cancer Relapse Patients: An External Validation Study

医疗保险索赔是否可以衡量癌症复发患者:一项外部验证研究

基本信息

  • 批准号:
    8298162
  • 负责人:
  • 金额:
    $ 22.12万
  • 依托单位:
  • 依托单位国家:
    美国
  • 项目类别:
  • 财政年份:
    2011
  • 资助国家:
    美国
  • 起止时间:
    2011-07-06 至 2014-06-30
  • 项目状态:
    已结题

项目摘要

DESCRIPTION (provided by applicant): Medicare spent nearly a billion dollars in 2002 on chemotherapy for newly diagnosed elderly breast, colorectal, and lung cancer patients, but surprisingly little is known about the extent to which cancer chemotherapies help or harm such patients. This unsettling paradox is the result of the well-described under- enrollment of the elderly on the clinical trials of chemotherapy. In the absence of trials with representative patients, treating oncologists, patients, and policy-makers are left to extrapolate results of clinical trials conducted in younger and comparatively healthier individuals to the general population with cancer, who tend to be older and have greater comorbid disease burdens. Many basic results of this common extrapolation are unknown. For example oncologists lack even basic observational studies reporting the disease-free survival (DFS) of elderly colorectal (CRC) and breast cancer patients following receipt standard adjuvant chemotherapy. DFS is one of the MOST important end-points in adjuvant chemotherapy in trials, representing the time to cancer relapse or death. Thus, it is relevant to clinicians treating patients in the usual care setting. In this application, our broad aim is to determine whether observational Medicare administrative data may be used to accurately measure DFS in elderly patients with CRC and cancer breast. If it is found to be accurate, the DFS algorithm may meaningful advance research in "cancer in the elderly" which increasing relies on Medicare data sources. In our work, we study two types of Medicare patients, a highly select cohort of 1,539 elderly breast and CRC patients who were treated with adjuvant chemotherapy in the clinical trial setting and a less select patient cohort of 1,250 elderly patients with the same site and stage-specific cancers and treated with nominally identical adjuvant chemotherapy, but in the usual care setting. By studying these two disparate cohorts, we specifically acknowledge that a valid DFS algorithm that performs well in the clinical trial cohort may not perform well in usual care patients, who form the majority of cancer patients in the United States and who are the focus of a wealth of observational Medicare-based studies of cancer in the elderly. If we find that DFS can be accurately measured in Medicare data, we will provide a critical tool to accelerate research in several fields relevance to cancer in the elderly. Among the fruits of these types of the research will be a clearer understanding of (1) trial efficacy vs. effectiveness which is relevant to both clinical trialists and treating physicians; (2) the clinical effectiveness (CE) of different therapies applied to usual care elderly patients; (3) the patterns of cancer care; (4) the quality of care delivered; and (6) the cost and benefit of specific chemotherapy regimens in the elderly. Regarding the latter, if a therapy does not extend DFS or indeed if it accelerates death, Medicare administrators would need to revisit its reimbursement. Developing an accurate DFS algorithm is a predicate to extending our existing work that examines the risks and benefits of cancer chemotherapy in usual care elderly patients, which touches, to some extent, on all area noted above.
描述(由申请人提供): 2002年,医疗保险花费了近10亿美元用于新诊断的老年乳腺癌、结肠直肠癌和肺癌患者的化疗,但令人惊讶的是,人们对癌症化疗对这些患者的帮助或伤害程度知之甚少。这种令人不安的悖论是由于老年人在化疗临床试验中的招募不足。在没有代表性患者的试验的情况下,治疗肿瘤学家,患者和政策制定者只能将在年轻和相对健康的个体中进行的临床试验结果外推到患有癌症的一般人群中,这些人群往往年龄较大,合并症负担更大。这种常见的外推法的许多基本结果是未知的。例如,肿瘤学家甚至缺乏基本的观察性研究报告老年结直肠癌(CRC)和乳腺癌患者接受标准辅助化疗后的无病生存率(DFS)。DFS是临床试验中辅助化疗最重要的终点之一,代表癌症复发或死亡的时间。因此,它与在常规护理环境中治疗患者的临床医生相关。 在本申请中,我们的主要目的是确定观察性医疗保险管理数据是否可用于准确测量CRC和乳腺癌老年患者的DFS。如果它被发现是准确的,DFS算法可能有意义的推进研究“老年人癌症”,越来越依赖于医疗保险数据源。在我们的工作中,我们研究了两种类型的医疗保险患者,一种是在临床试验环境中接受辅助化疗的1,539名老年乳腺癌和CRC患者的高度选择队列,另一种是1,250名老年患者的选择较少的患者队列,这些患者患有相同部位和阶段特异性癌症,并接受名义上相同的辅助化疗,但在常规护理环境中。通过研究这两个不同的队列,我们特别承认,在临床试验队列中表现良好的有效DFS算法可能在常规护理患者中表现不佳,这些患者构成了美国大多数癌症患者,并且是大量基于Medicare的老年癌症观察性研究的重点。 如果我们发现DFS可以在医疗保险数据中准确测量,我们将提供一个关键工具来加速与老年人癌症相关的几个领域的研究。这些类型的研究成果将更清楚地了解(1)与临床试验者和治疗医生相关的试验有效性与有效性;(2)应用于常规护理老年患者的不同疗法的临床有效性(CE);(3)癌症护理模式;(4)提供的护理质量;(5)治疗的有效性(CE)。(6)老年人特定化疗方案的成本效益。关于后者,如果治疗没有延长DFS,或者确实加速了死亡,医疗保险管理人员将需要重新考虑其报销。开发准确的DFS算法是扩展我们现有工作的前提,该工作在常规护理老年患者中检查癌症化疗的风险和益处,在某种程度上涉及上述所有领域。

项目成果

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ELIZABETH B LAMONT其他文献

ELIZABETH B LAMONT的其他文献

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{{ truncateString('ELIZABETH B LAMONT', 18)}}的其他基金

Comparative Effectiveness of Treatment Regimens in Lung Cancer
肺癌治疗方案的比较疗效
  • 批准号:
    8668628
  • 财政年份:
    2014
  • 资助金额:
    $ 22.12万
  • 项目类别:
Do Medicare Claims Measure Cancer Relapse Patients: An External Validation Study
医疗保险索赔是否可以衡量癌症复发患者:一项外部验证研究
  • 批准号:
    8189221
  • 财政年份:
    2011
  • 资助金额:
    $ 22.12万
  • 项目类别:
Population-Based Assessment of Cancer Trial Generalizability in the Elderly
基于人群的老年人癌症试验普遍性评估
  • 批准号:
    7886643
  • 财政年份:
    2008
  • 资助金额:
    $ 22.12万
  • 项目类别:
Population-Based Assessment of Cancer Trial Generalizability in the Elderly
基于人群的老年人癌症试验普遍性评估
  • 批准号:
    8139008
  • 财政年份:
    2008
  • 资助金额:
    $ 22.12万
  • 项目类别:
Population-Based Assessment of Cancer Trial Generalizability in the Elderly
基于人群的老年人癌症试验普遍性评估
  • 批准号:
    8300738
  • 财政年份:
    2008
  • 资助金额:
    $ 22.12万
  • 项目类别:
Population-Based Assessment of Cancer Trial Generalizability in the Elderly
基于人群的老年人癌症试验普遍性评估
  • 批准号:
    7693782
  • 财政年份:
    2008
  • 资助金额:
    $ 22.12万
  • 项目类别:
Development of Hierarchical Neighborhood Data Regarding Cancer in the Elderly
有关老年人癌症的分层邻域数据的开发
  • 批准号:
    7493419
  • 财政年份:
    2007
  • 资助金额:
    $ 22.12万
  • 项目类别:
Development of Hierarchical Neighborhood Data Regarding Cancer in the Elderly
有关老年人癌症的分层邻域数据的开发
  • 批准号:
    7293270
  • 财政年份:
    2007
  • 资助金额:
    $ 22.12万
  • 项目类别:
Do Medicare Claims Measure Chemotherapy Use and Outcomes
医疗保险索赔是否衡量化疗的使用和结果
  • 批准号:
    6422828
  • 财政年份:
    2002
  • 资助金额:
    $ 22.12万
  • 项目类别:
Do Medicare Claims Measure Chemotherapy Use and Outcomes
医疗保险索赔是否衡量化疗的使用和结果
  • 批准号:
    6620895
  • 财政年份:
    2002
  • 资助金额:
    $ 22.12万
  • 项目类别:

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用于辅助化疗筛选的显微结直肠癌肝转移 3D 工程模型
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