Evaluation of Practice Variations and Costs for Cancer. Abstract, ExecutiveSummary, Final Report and Appendices

摘要

The primary objective of the study was to determine non-oncologic factors thataffect the choice of cancer treatment in the Medicare elderly. Data from incident cases of lung, breast, colon and prostate cancer, in the Virginia Cancer Registry between 1985 and 1989, were linked with claims from Medicare files. Analyses of 19,674 cases showed that age was the most important determinant of treatment, aside from clinical issues like stage and tumor size. Comorbidity also played an important role for therapeutic choice, but did not explain the reduced intensity of treatment related to age to a substantial degree. Other variables describing socioeconomic status, access to care, and location had significant effects on some treatment decisions, but not others. There was also evidence of changing treatment patterns. Data for prostate cancer showed rates of surgery and radiation therapy rose between 1985 and 1989 despite the controversy about their effectiveness. Data on outcomes showed that the use of surgery for the treatment of lung cancer clearly prolonged survival. In conclusion, analyses of claims and clinical data confirm that elderly patients with cancer receive less aggressive therapies, even after adjusting for comorbidity.