TY - JOUR
T1 - Factors associated with adherence to chemotherapy guidelines in patients with non-small cell lung cancer
AU - Salloum, Ramzi G.
AU - Smith, Thomas J.
AU - Jensen, Gail A.
AU - Lafata, Jennifer Elston
N1 - Funding Information:
This article was based in part on a doctoral dissertation submitted by Ramzi G. Salloum to the Department of Economics at Wayne State University. This work was supported by the Fund for Henry Ford, the National Cancer Institute – National Institutes of Health under grant ( NIH R01 CA114204-03 ), and by the Student Award Program from the Blue Cross and Blue Shield of Michigan Foundation under grant ( 1705.SAP ). We thank Elizabeth Dobie and Nonna Akkerman for their assistance with data acquisition.
PY - 2012/2
Y1 - 2012/2
N2 - Background: Evidence-based guidelines recommend chemotherapy for medically fit patients with stages II-IV non-small cell lung cancer (NSCLC). Adherence to chemotherapy guidelines has rarely been studied among large populations, mainly because performance status (PS), a key component in assessing chemotherapy appropriateness, is missing from claims-based datasets. Among a large cohort of patients with known PS, we describe first line chemotherapy use relative to guideline recommendations and identify patient factors associated with guideline concordant use. Patients and methods: Insured patients, ages 50+, with stages II-IV NSCLC between 2000 and 2007 were identified via tumor registry (n= 406). Chart abstracted PS, automated medical claims, Census tract information, and travel distance were linked to tumor registry data. Chemotherapy was considered appropriate for patients with PS 0-2. Multivariate logit models were fit to evaluate patient characteristics associated with chemotherapy over- and under-use per guideline recommendations. Tests of statistical significance were two sided. Results: Overall compliance with first line chemotherapy guidelines was 71%. Significant (p< 0.05) predictors of chemotherapy underuse (19%) included increasing age (odds ratio [OR], 1.09), higher income (OR, 1.02), diagnosed before 2003 (OR, 2.05), and vehicle access (OR, 6.96) in the patient's neighborhood. Significant predictors of chemotherapy overuse (10%) included decreasing age (OR, 0.92), diagnosed after 2003 (OR, 3.24), and higher income (OR, 1.05) in the patient's neighborhood. Among NSCLC patients 29% do not receive guideline recommended chemotherapy treatment missing opportunities for cure or beneficial palliation, or receiving chemotherapy with more risk of harm than benefit. Care concordant with guidelines is influenced by age, economic considerations such as income and transportation barriers.
AB - Background: Evidence-based guidelines recommend chemotherapy for medically fit patients with stages II-IV non-small cell lung cancer (NSCLC). Adherence to chemotherapy guidelines has rarely been studied among large populations, mainly because performance status (PS), a key component in assessing chemotherapy appropriateness, is missing from claims-based datasets. Among a large cohort of patients with known PS, we describe first line chemotherapy use relative to guideline recommendations and identify patient factors associated with guideline concordant use. Patients and methods: Insured patients, ages 50+, with stages II-IV NSCLC between 2000 and 2007 were identified via tumor registry (n= 406). Chart abstracted PS, automated medical claims, Census tract information, and travel distance were linked to tumor registry data. Chemotherapy was considered appropriate for patients with PS 0-2. Multivariate logit models were fit to evaluate patient characteristics associated with chemotherapy over- and under-use per guideline recommendations. Tests of statistical significance were two sided. Results: Overall compliance with first line chemotherapy guidelines was 71%. Significant (p< 0.05) predictors of chemotherapy underuse (19%) included increasing age (odds ratio [OR], 1.09), higher income (OR, 1.02), diagnosed before 2003 (OR, 2.05), and vehicle access (OR, 6.96) in the patient's neighborhood. Significant predictors of chemotherapy overuse (10%) included decreasing age (OR, 0.92), diagnosed after 2003 (OR, 3.24), and higher income (OR, 1.05) in the patient's neighborhood. Among NSCLC patients 29% do not receive guideline recommended chemotherapy treatment missing opportunities for cure or beneficial palliation, or receiving chemotherapy with more risk of harm than benefit. Care concordant with guidelines is influenced by age, economic considerations such as income and transportation barriers.
KW - Chemotherapy
KW - Guideline adherence
KW - Non-small cell lung cancer
KW - Overuse
KW - Performance status
KW - Underuse
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U2 - 10.1016/j.lungcan.2011.07.005
DO - 10.1016/j.lungcan.2011.07.005
M3 - Article
C2 - 21816502
AN - SCOPUS:84855450604
SN - 0169-5002
VL - 75
SP - 255
EP - 260
JO - Lung Cancer
JF - Lung Cancer
IS - 2
ER -