Using Claims Data to Evaluate Radiation Therapy Utilization at the End of Life

描述(由申请人提供)：拟议的工作寻求使用监测流行病学和最终结果-联邦医疗保险和德克萨斯州癌症登记-联邦医疗保险链接数据库来分析索赔数据，以评估生命末期放射治疗的利用率和成本，以及在生命末期使用先进的放射治疗技术。将要研究的特定先进放射技术将是调强放射治疗(IMRT)，这是一种复杂而昂贵的方式，但没有证实有姑息治疗的好处，尽管研究人员发现57%的放射肿瘤学家使用这种方式进行姑息治疗。这笔赠款将使用诊断和程序代码对索赔数据进行分析，以使用索赔数据来确定在美国患有五种最常见癌症死亡原因(乳腺癌、结直肠癌、肺癌、胰腺癌和前列腺癌)的癌症患者在生命末期接受过度激进的放射治疗的情况。具体目标是：1)评估在生命最后30天接受放射治疗的使用率(即接受比例)、使用强度(即治疗次数)，以及可能与生命最后30天接受放射治疗有关的费用以及社会人口和医疗服务因素；以及2)探讨在生命最后30天接受放射治疗的癌症患者使用调强放疗的趋势。回归模型将用于 确定可能与生命末期接受放射治疗或调强放射治疗显著相关的社会人口和卫生服务特征。目前，没有来自美国队列的数据报告了RT的使用情况和先进的放射治疗技术的传播，如IMRT，在生命结束时。因此，这项拟议的工作将提供关于美国老年患者生命末期护理的独特的、基于人群的数据。长期目标包括建立数据和方法，作为更大的R-01研究提案的前期工作，利用索赔数据来分析与癌症患者生命末期放射治疗利用和先进放射治疗技术相关的成本和成本效益。

DESCRIPTION (provided by applicant): The proposed work seeks to use the Surveillance Epidemiology and End Results-Medicare and Texas Cancer Registry-Medicare linked databases to analyze claims data to evaluate radiation therapy utilization and costs at the end of life as well as the use of advanced radiation therapy technology at the end of life. The specific advanced radiation techonology to be studied will be intensity modulated radiation therapy (IMRT) a complex and expensive modality without proven palliative benefit, despite the fact that investigators have found that 57% of radiation oncologists use this modality for palliation. This grant will perform analyses of claims data using diagnosis and procedure codes to use the claims data to ascertain what may represent over-aggressive radiation therapy treatment at the end of life for cancer patients with the five most common causes of cancer death in the United states (breast, colorectal, lung, pancreatic, and prostate cancers). The specific aims are: 1) to assess the utilization (i.e., proportion receiving), intensity of utilization (i.e., number of treatements) of radiation therapy in the last 30 days of life, and costs as well as socio-demographic and health services factors that may be associated with radiation therapy receipt in the last 30 days of life; and 2) to explore the trends in IMRT utilization among cancers patients receiving radiation therapy in the last 30 days of life. Regression models will be used to determine socio-demographic and health services characteristics that may be significantly associated with receipt of radiation therapy or IMRT at the end of life. Currently, there are no data from U.S. cohorts reporting on RT utilization and advanced radiation therapy technology diffusion, such as IMRT, at the end of life. Thus, this proposed work would provide unique, population-based data regarding end of life care for elderly patients in the U.S. Long-term objectives include establishing data and methodology to serve as preliminary work toward a larger R-01 study proposal to employ claims data to analyze the costs and cost effectiveness associated with radiation therapy utilization and advanced radiation therapy technologies at the end of life for cancer patients.