Abstract
Background Several studies have demonstrated that chemotherapy prolongs survival by upwards of 3 months in patients with advanced (stage IIIb–IV) non-small cell lung cancer (NSCLC), but often at considerable costs. Analyses of SEER-Medicare data suggests that only 25% of older patients receive chemotherapy, however, little is known about how these treatment rates compare to younger patients and to those receiving care in an HMO.
Aims Using the HMO Cancer Research Network’s (CRN) Virtual Data Warehouse (VDW) at 4 CRN sites, we examine the characteristics of stage lIIb–IV NSCLC patients who receive chemotherapy, and we assess the first-line chemotherapy patterns overtime.
Methods Patients aged =21 years with stage IIIb and IV NSCLC diagnosed between 2000–2007 at 4 CRN sites were included in the analysis. Patients were followed from diagnosis date through the end of 2008 (or death or disenrollment). Patient characteristics, clinical information, chemotherapy treatment data, and mortality were obtained from the CRN Virtual Data Warehouse. Current Procedural Terminology codes and National Drug Codes from the VDW were used to identify chemotherapy regimens. Descriptive statistics were performed to describe the study samples, both overall, overtime, and by subgroups (age category, stage, etc). Differences in the proportion of patients receiving various chemotherapy regimens, (by health plan, age category, stage, etc) were tested using parametric and non-parametric statistics.
Results Preliminary finding suggest, that while slightly more than half of our study population received chemotherapy, the proportions varied by stage and age, with younger patients (<65) and those diagnosed at a lower stage (lllb) were significantly more likely to receive treatment. The most common first line treatment was Carboplatin and paclitaxel. However, with the introduction of taxenes, monoclonal antibodies, antimetabolites, and targeted agents in the later years of the study period, the distribution of first line therapy changed significantly overtime.
Conclusions The findings from this analysis could have significant clinical and policy relevance given that NSCLC is the number one cause of cancer death. Future analyses will compare the variation in treatment patterns overtime for CRN enrollees as compared to SEER-Medicare, NCCN data and ASCO guidelines.
