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

描述(由申请人提供)：对于局限性乳腺癌、肺癌和前列腺癌患者，近年来已经开发了几种新的治疗方案。随着护理选择的扩大，临床医生、患者和政策制定者都会遇到困难的决定。尽管人们希望较新的放射治疗方法能产生更好的抗癌效果、减少副作用，或者两者兼而有之，但目前尚不清楚这些昂贵的新疗法是否会对患者的健康产生与其成本相称的影响。在疗效证据仍在开发中的情况下，需要一种新的方法来评估治疗的传播：根据受益的可能性评估利用和成本。一些合并症负担较重的老年患者将获得较少的好处，如果进行更积极的治疗，可能会有更大的风险。我们建议对参加联邦医疗保险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，以解决以下目标，并特别强调复杂的患者：目标1：确定1996-2005年诊断的患者中临床因素的函数，使用较新的放射治疗方式和综合治疗方法的患者比例的变化。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百分比的增加相关；目标2：确定与采用新的放射治疗方式相关的因素，包括提供者、卫生系统和非临床患者因素；目标3：确定2006-08年度乳腺癌、肺癌和前列腺癌初始护理服务计划的医疗保险费用的总成本，以及这些费用中与放射治疗方式相关的比例；目标4：比较各种放射治疗方式的有效性。这项回溯性的纵向研究将使用从医疗保险和医疗补助服务中心(CMS)和国家癌症研究所获得的基于人群的数据。这个SEER-Medicare数据库将被用来根据2005年确诊患者的癌症和合并症水平来描述癌症治疗的变化。我们还将获得2006-2008年期间患有乳腺癌、肺癌或前列腺癌的联邦医疗保险服务收费受益人的100%样本，提供对癌症护理、成本和比较结果的全面和及时的评估。一个经验丰富的研究团队将进行方法上的严格分析，其中包括多层次、分层建模，以说明在医生和地理水平上的患者聚集。先前对癌症治疗的评估没有将癌症和合并症状况纳入癌症治疗受益可能性的综合评估。解决这些知识差距对于了解影响采用这些技术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--提供潜在的干预目标，以提高治疗战略的有效性和效率。 与公共卫生相关：新的昂贵的放射疗法经常被用于治疗患有肺癌、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好处、它们的成本或与其使用相关的因素知之甚少。这项拟议的研究使用了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的新放射治疗方式作为健康状况的函数，以努力改善关于癌症治疗的决策。

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.