Study objectives: To determine the prevalence and
factors associated with chemotherapy use in elderly patients presenting
with advanced lung cancer.
Design: A retrospective
cohort study using administrative data.
patients: We analyzed the medical bills for the 6,308 Medicare
patients > 65 years old with diagnosed stage IV non-small cell lung
cancer (NSCLC) in the 11 SEER (survival, epidemiology, and end results)
regions between 1991 and 1993. The main outcome measure, chemotherapy
administration, was identified by the relevant medical billing codes.
Patient sociodemographic and disease characteristics were obtained from
the SEER database and census data.
22% of patients received chemotherapy at some time for their
metastatic NSCLC. As expected, younger patients and those with fewer
comorbid conditions were more likely to receive chemotherapy. However,
several nonmedical factors, such as nonblack race, higher socioeconomic
status, treatment in a teaching hospital, and living in the
Seattle/Puget Sound or Los Angeles SEER regions, also significantly
increased a patient’s likelihood of receiving chemotherapy.
Conclusion: Compared to previous reports, the prevalence of
chemotherapy use for advanced NSCLC appears to be increasing. However,
despite uniform health insurance coverage, there is wide variation in
the utilization of palliative chemotherapy among Medicare patients, and
nonmedical factors are strong predictors of whether a patient receives
chemotherapy. While it is impossible to know the appropriate rate of
usage, nonmedical factors should only influence a patient’s likelihood
of receiving treatment if they reflect patient treatment preference.
Research to further clarify the costs, benefits, and patient
preferences for chemotherapy in this patient population is warranted in
order to minimize the effect of nonmedical biases on management