Abstract
Geographic variation in the adjuvant treatment of NSCLC over time
Journal of clinical oncology, Vol.31(15_suppl), pp.6542-6542
05/20/2013
DOI: 10.1200/jco.2013.31.15_suppl.6542
Abstract
6542
Background: Adjuvant chemotherapy (ACT) and postoperative radiotherapy (PORT) are used in the treatment of resected NSCLC to reduce risk of relapse, but guideline-based recommendations for these treatment modalities have varied over time. ACT is now recommended for stage II-IIIA NSCLC following resection based on phase III trial results which, starting in 2003, showed improved survival. Conversely PORT recommendations have been rescinded due largely to a 1998 Lancet meta-analysis. In this study we explore the rates of these two adjuvant treatment modalities across areas over time. Methods: Using SEER-Medicare data we identified 18,410 patients diagnosed 1992-2007 with resected NSCLC. Adjuvant treatment was defined as the first treatment received within 4 months of surgery. The study period was divided into 3 eras: 1992-1998, 1999-2003, and 2004-2007. Area treatment rates were calculated using the 50 patients closest to each zip code, adjusting for patient and area characteristics. Areas were then ranked and divided into quintiles. Percent differences were calculated to measure the variation between the highest and lowest quintiles. Results: Between 1992-1998 when the results of the phase III ACT trials were still unknown and utilization of ACT was low, areas with the highest treatment rates were 35 times more likely than areas with the lowest rates to administer ACT. After 2003 ACT use increased swiftly and geographic variation fell. In contrast, PORT utilization rates have declined and become more geographically dispersed since 1998. Receiving no adjuvant treatment was highest between 1999-2003, after the Lancet PORT meta-analysis and before the major ACT trials. Conclusions: NSCLC adjuvant treatment has been shifting from PORT to ACT. The positive results of the ACT trials and publication of treatment guidelines have increased usage and reduced geographic variation in ACT use. Geographic variation in PORT use however has increased over time, although overall usage has decreased. [Table: see text]
Details
- Title: Subtitle
- Geographic variation in the adjuvant treatment of NSCLC over time
- Creators
- Mary C. Schroeder - University of IowaYu-Yu Tien - University of IowaThorvardur Ragnar Halfdanarson - Mayo Clinic, Scottsdale AZ.Taher Abu Hejleh - University of IowaMatthew Nattinger - University of IowaJohn Brooks - University of Iowa
- Resource Type
- Abstract
- Publication Details
- Journal of clinical oncology, Vol.31(15_suppl), pp.6542-6542
- DOI
- 10.1200/jco.2013.31.15_suppl.6542
- ISSN
- 0732-183X
- eISSN
- 1527-7755
- Language
- English
- Date published
- 05/20/2013
- Academic Unit
- Hematology, Oncology, and Blood & Marrow Transplantation; Pharmacy Practice and Science; Internal Medicine
- Record Identifier
- 9984366342802771
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