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

描述（由申请人提供）：拟议的工作旨在使用监测流行病学和最终结果-医疗保险和德克萨斯州癌症登记-医疗保险链接数据库来分析索赔数据，以评估放射治疗在生命末期的利用和成本，以及在生命末期使用先进的放射治疗技术。要研究的具体先进放射技术将是强度调制放射治疗（IMRT），这是一种复杂且昂贵的方式，没有被证实的缓解效果，尽管研究人员发现57%的放射肿瘤学家使用这种方式来缓解。该基金将使用诊断和程序代码对索赔数据进行分析，以使用索赔数据确定美国五种最常见的癌症死亡原因（乳腺癌、结肠直肠癌、肺癌、胰腺癌和前列腺癌）的癌症患者在生命末期过度积极的放射治疗治疗。具体目标是：1)评估生命最后30天内放射治疗的利用情况（即接受的比例）、利用强度（即治疗次数）、费用以及可能与生命最后30天内接受放射治疗有关的社会人口和卫生服务因素；2)探讨接受放射治疗的癌症患者在生命最后30天内使用IMRT的趋势。回归模型将用于

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. PUBLIC HEALTH RELEVANCE: In this proposal we submit our research plan to use claims data in the Surveillance Epidemiology and End Results-Medicare linked databases to investigate radiation therapy utilization and costs at the end of life for patients dying of breast colorectal, lung, pancreas, and prostate cancer. We will study the proportion of patients receiving radiation therapy in the last 30 days of life as well as the number of treatments they are given and the socio-demographic and health services factors that may be associated with its use. We also propose to investigate the utilization of intensity modulated radiation therapy (IMRT) at the end of life as well as sociodemographic and health services factors potentially associated with use of this complex and expensive emerging radiation therapy technology at the end of life.