在 Medicare 人群中使用新的治疗模式治疗非小细胞肺癌。

Use of new treatment modalities for non-small cell lung cancer care in the Medicare population.

机构信息

Department of Internal Medicine, Section of Pulmonary and Critical Care Medicine, New Haven, CT.

Department of Internal Medicine, Section of Cardiology, New Haven, CT; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT; Health Research and Educational Trust, Chicago, IL.

出版信息

Chest. 2013 Feb 1;143(2):429-435. doi: 10.1378/chest.12-1149.

DOI:10.1378/chest.12-1149

PMID:23187634

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3566996/

Abstract

BACKGROUND

Many older patients with early stage non-small cell lung cancer (NSCLC) do not receive curative therapy. New surgical techniques and radiation therapy modalities, such as video-assisted thoracoscopic surgery (VATS), potentially allow more patients to receive treatment. The adoption of these techniques and their impact on access to cancer care among Medicare beneficiaries with stage I NSCLC are unknown.

METHODS

We used the Surveillance, Epidemiology and End Results-Medicare database to identify patients with stage I NSCLC diagnosed between 1998 and 2007. We assessed temporal trends and created hierarchical generalized linear models of the relationship between patient, clinical, and regional factors and type of treatment.

RESULTS

The sample comprised 13,458 patients with a mean age of 75.7 years. The proportion of patients not receiving any local treatment increased from 14.6% in 1998 to 18.3% in 2007. The overall use of surgical resection declined from 75.2% to 67.3% ( P , .001), although the proportion of patients undergoing VATS increased from 11.3% to 32.0%. Similarly, although the use of new radiation modalities increased from 0% to 5.2%, the overall use of radiation remained stable. The oldest patients were less likely to receive surgical vs no treatment (OR, 0.12; 95% CI, 0.09-0.16) and more likely to receive radiation vs surgery (OR, 13.61; 95% CI, 9.75-19.0).

CONCLUSION

From 1998 to 2007, the overall proportion of older patients with stage I NSCLC receiving curative local therapy decreased, despite the dissemination of newer, less-invasive forms of surgery and radiation.

摘要

背景

许多患有早期非小细胞肺癌（NSCLC）的老年患者并未接受根治性治疗。新的手术技术和放疗方式，如电视辅助胸腔镜手术（VATS），可能使更多患者能够接受治疗。这些技术的采用及其对 Medicare 受益人群中 I 期 NSCLC 患者获得癌症治疗的影响尚不清楚。

方法

我们使用监测、流行病学和最终结果-医疗保险数据库，确定了 1998 年至 2007 年间诊断为 I 期 NSCLC 的患者。我们评估了时间趋势，并建立了患者、临床和区域因素与治疗类型之间关系的层次广义线性模型。

结果

样本包括 13458 例平均年龄为 75.7 岁的 I 期 NSCLC 患者。未接受任何局部治疗的患者比例从 1998 年的 14.6%增加到 2007 年的 18.3%。手术切除的总体使用率从 75.2%降至 67.3%（P<0.001），尽管 VATS 患者比例从 11.3%增至 32.0%。同样，尽管新放疗方式的使用率从 0%增至 5.2%，但总体放疗使用率保持稳定。最年长的患者接受手术治疗而非不治疗的可能性较小（OR，0.12；95%CI，0.09-0.16），而接受放疗而非手术治疗的可能性较大（OR，13.61；95%CI，9.75-19.0）。