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、肺癌和前列腺癌患者，近年来开发了几种新的治疗方案。随着护理选择的扩大，临床医生、患者和政策制定者会遇到困难的决定。尽管人们希望新的放射方式能够具有更好的抗癌功效、减少副作用或两者兼而有之，但目前尚不清楚这些新的、昂贵的疗法是否会对患者健康产生与其成本相称的影响。在疗效证据仍在开发中时，需要一种新方法来评估治疗的扩散：根据获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接受更积极的治疗时获益较少，而且可能面临更大的风险。我们建议对参加 Medicare 按服务收费计划的患有乳腺癌、肺癌或前列腺癌的老年人进行一项基于人群的研究，以实现以下目标，特别强调复杂的患者： 目标 1：根据 1996 年至 2005 年诊断的患者中的临床因素，确定接受新放射方式治疗的患者比例以及总体治疗方法的变化。我们还将研究新治疗方式的使用是否与接受癌症治疗的患者比例的增加有关；目标 2：确定与采用新放射方式相关的因素，包括提供者、卫生系统和非临床患者因素；目标 3：确定 2006-08 年乳腺癌、肺癌和前列腺癌初始护理医疗保险服务计划费用的总费用以及这些费用中与放射方式相关的比例；目标 4：比较放射治疗方式的有效性。这项回顾性纵向研究将使用从医疗保险和医疗补助服务中心 (CMS) 以及国家癌症研究所获得的基于人群的数据。该 SEER-Medicare 数据库将用于根据 2005 年诊断的患者的癌症和合并症层次来描述癌症治疗的变化。我们还将获得 2006 年至 2008 年期间患有乳腺癌、肺癌或前列腺癌的 Medicare 按服务收费受益人的 100% 样本，对癌症护理、费用和比较结果提供全面、及时的评估。经验丰富的研究团队将进行方法论上严格的分析，包括多层次、分层建模，以解释医生和地理层面的患者聚类情况。先前对癌症治疗的评估并未将癌症和合并症状况纳入对癌症治疗获益可能性的综合评估中。解决这些知识差距对于了解影响这些技术采用的患者和卫生系统因素以及对成本和结果的影响至关重要，为干预提供潜在目标，以提高治疗策略的有效性和效率。 公共卫生相关性：新型且昂贵的放射疗法经常用于治疗患有肺癌、前列腺癌或乳腺癌的老年人。然而，人们对这些疗法的风险和益处、其成本或与其使用相关的因素知之甚少。拟议的研究利用来自国家癌症研究所以及医疗保险和医疗补助服务中心的数据，将检查医疗保险受益人中新的放射治疗方式作为健康状况的函数，以努力改善癌症治疗的决策。

项目成果

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

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

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

Physician's peer exposure and the adoption of a new cancer treatment modality.

• DOI: 10.1002/cncr.29409
• 发表时间: 2015-08-15
• 期刊: Cancer
• 影响因子: 6.2
• 作者: Pollack CE;Soulos PR;Gross CP
• 通讯作者: Gross CP