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Original Research: Lung Cancer |

Use of New Treatment Modalities for Non-small Cell Lung Cancer Care in the Medicare PopulationLung Cancer Treatment Modalities

Michael T. Vest, DO, FCCP; Jeph Herrin, PhD; Pamela R. Soulos, MPH; Roy H. Decker, PhD, MD; Lynn Tanoue, MD, FCCP; Gaetane Michaud, MD, FCCP; Anthony W. Kim, MD, FCCP; Frank Detterbeck, MD, FCCP; Daniel Morgensztern, MD; Cary P. Gross, MD
Author and Funding Information

From the Department of Internal Medicine (Drs Vest, Tanoue, and Michaud), Section of Pulmonary and Critical Care Medicine; Department of Internal Medicine (Dr Herrin), Section of Cardiology; Department of Internal Medicine (Ms Soulos and Dr Gross), Section of General Internal Medicine; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center (Drs Herrin, Decker, Kim, and Gross and Ms Soulos); Department of Therapeutic Radiology (Dr Decker); Department of Surgery (Drs Kim and Detterbeck), Section of Thoracic Surgery; Department of Internal Medicine (Dr Morgensztern), Section of Medical Oncology; and Yale Cancer Center (Dr Morgensztern), Yale School of Medicine, New Haven, CT; and Health Research and Educational Trust (Dr Herrin), Chicago, IL.

Correspondence to: Cary P. Gross, MD, Yale School of Medicine, 333 Cedar St, PO Box 208093, New Haven, CT 06520-8057; e-mail: cary.gross@yale.edu


Funding/Support: This work was supported by a grant from the National Cancer Institute [R01CA149045].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


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

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