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

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。随着治疗选择的扩大，临床医生、患者和决策者都面临着艰难的决定。尽管新的放射方式有望产生更好的抗癌效果，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疗法对患者健康的影响是否与其成本相称。需要一种新的方法，在疗效证据仍在发展的情况下评估治疗的扩散：根据获益的可能性评估利用和成本。一些有较高合并症负担的老年患者获益较少，更积极的治疗可能会带来更大的风险。我们提出了一项基于人群的老年乳腺癌、肺癌或前列腺癌患者的研究，纳入医疗服务收费计划，以解决以下目标，特别强调复杂患者：目标1：确定1996-2005年诊断的患者中，作为临床因素的功能，接受新放疗方式治疗的患者比例的变化以及总体治疗方法。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；目的3：确定2006- 2008年乳腺癌、肺癌和前列腺癌初始治疗的医疗保险费用总额，以及这些费用中与放疗方式相关的比例；目的4：比较不同放射治疗方式的疗效。这项回顾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数据库将用于描述2005年诊断出的癌症和合并症患者的癌症治疗变化。我们还将获得2006-2008年间100%的乳腺癌、肺癌或前列腺癌医疗保险按服务收费受益人的样本，提供对癌症治疗、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学上的严格分析，包括多层次的分层模型，以解释医生和地理水平上的患者聚集。先前的癌症治疗评估没有将癌症和合并症状态纳入癌症治疗获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，从而为干预提供潜在目标，以提高治疗策略的有效性和效率。

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.