title: Who gets chemotherapy for metastatic lung cancer?
abstract: OBJECTIVE
  To determine the prevalence and factors associated with chemotherapy use in elderly patients presenting with advanced lung cancer.
  
  
  METHODS
  A retrospective cohort study using administrative data.
  
  
  METHODS
  We analyzed the medical bills for the 6,308 Medicare patients > 65 years old with diagnosed stage IV non-small cell lung cancer (NSCLC) in the 11 SEER (survival, epidemiology, and end results) regions between 1991 and 1993. The main outcome measure, chemotherapy administration, was identified by the relevant medical billing codes. Patient sociodemographic and disease characteristics were obtained from the SEER database and census data.
  
  
  RESULTS
  Almost 22% of patients received chemotherapy at some time for their metastatic NSCLC. As expected, younger patients and those with fewer comorbid conditions were more likely to receive chemotherapy. However, several nonmedical factors, such as nonblack race, higher socioeconomic status, treatment in a teaching hospital, and living in the Seattle/Puget Sound or Los Angeles SEER regions, also significantly increased a patient's likelihood of receiving chemotherapy.
  
  
  CONCLUSIONS
  Compared to previous reports, the prevalence of chemotherapy use for advanced NSCLC appears to be increasing. However, despite uniform health insurance coverage, there is wide variation in the utilization of palliative chemotherapy among Medicare patients, and nonmedical factors are strong predictors of whether a patient receives chemotherapy. While it is impossible to know the appropriate rate of usage, nonmedical factors should only influence a patient's likelihood of receiving treatment if they reflect patient treatment preference. Research to further clarify the costs, benefits, and patient preferences for chemotherapy in this patient population is warranted in order to minimize the effect of nonmedical biases on management decisions.
authors.affiliation: Center for Outcomes and Policy Research, Department of Adult Oncology Dana-Farber Cancer Institute, Boston, MA 02115, USA. craig_earle@dfci.harvard.edu
authors.forename: C C
authors.initials: CC
authors.lastname: Earle
authors.forename: L N
authors.initials: LN
authors.lastname: Venditti
authors.forename: P J
authors.initials: PJ
authors.lastname: Neumann
authors.forename: R D
authors.initials: RD
authors.lastname: Gelber
authors.forename: M C
authors.initials: MC
authors.lastname: Weinstein
authors.forename: A L
authors.initials: AL
authors.lastname: Potosky
authors.forename: J C
authors.initials: JC
authors.lastname: Weeks
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D006278:Medicare; D009367:Neoplasm Staging; D018579:Patient Selection; D011287:Prejudice; D012189:Retrospective Studies; D015996:Survival Rate; D014481:United States