title: A comparison of patterns of care of nonsmall cell lung carcinoma patients in a younger and Medigap commercially insured cohort.
abstract: BACKGROUND
  The objective of this study was to examine and compare lifetime treatment patterns and hospitalization of incident nonsmall cell lung carcinoma (NSCLC) between pre-Medicare eligible (age < 65 years) and supplemental Medigap (age > or = 65 years) enrollees in a commercially insured cohort using insurance claims.
  
  
  METHODS
  Claims from Virginia Blue Cross and Blue Shield beneficiaries with NSCLC submitted between 1989-1991 were merged with records from the Virginia Cancer Registry (VCR). Data from the VCR identified incident cases, disease stage, and type of tumor. Initial treatment categories were stratified using Physicians' Current Procedural Terminology codes.
  
  
  RESULTS
  There were 1706 incident NSCLC patients; 349 were age < or = 64 years ("younger") and 1212 were age > or = 65 years ("elderly"). Having commercial insurance was not associated with any survival advantage compared with national averages at 2 years. In comparison with elderly patients, younger patients more often were treated with surgery for local disease (80.2% vs. 54.8%) and surgery alone or in combination with radiation for regional disease (51.9% vs. 32.0%). Radiation was used more often in elderly patients compared with younger patients with local disease (30.5% vs. 14.0%) but less often in patients with distant disease (76.2% vs. 54.9%). Compared with elderly patients, younger patients presenting with distant disease received more chemotherapy (18.8% vs. 5.1%; P <0.001); late palliative use of chemotherapy or radiation occurred in only 4-8% of younger patients. Compared with elderly patients, younger patients with regional or distant disease spent more days in the hospital (compared with national averages at 2 years: regional disease, 30.0 vs. 23.9 days; distant disease, 33.0 vs. 21.4 days; P <0.0001).
  
  
  CONCLUSIONS
  The results of this study show that more comprehensive health insurance is not associated with better outcomes in patients with NSCLC. Age specific trends for greater use of surgery, radiation, and total hospitalization in younger patients is consistent with other reports. Commercial health care claims supplemented by clinical staging from cancer registries can address long term practice patterns in patients with cancer.
authors.affiliation: Department of Internal Medicine, Medical College of Virginia and the Massey Cancer Center, Virginia Commonwealth University, Richmond, USA.
authors.forename: B E
authors.initials: BE
authors.lastname: Hillner
authors.forename: M K
authors.initials: MK
authors.lastname: McDonald
authors.forename: C E
authors.initials: CE
authors.lastname: Desch
authors.forename: T J
authors.initials: TJ
authors.lastname: Smith
authors.forename: L T
authors.initials: LT
authors.lastname: Penberthy
authors.forename: S M
authors.initials: SM
authors.lastname: Retchin
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000628:therapy*; D006801:Humans; D007348:Insurance, Health; D017054:Insurance, Medigap; D008175:Lung Neoplasms / Q000628:therapy*; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D014768:Virginia