title: Treatment and survival differences in older Medicare patients with lung cancer as compared with those who are dually eligible for Medicare and Medicaid.
abstract: OBJECTIVE
  This study compares non-small-cell lung cancer (NSCLC) treatments provided to older patients (age > or = 66 years) who are dually eligible for Medicare and Medicaid with treatments provided to similar patients who are insured by Medicare. We extend the analysis to include a comparison of survival rates between Medicare and dually eligible patients. Dual eligibility is associated with low socioeconomic status. However, Medicaid coverage in addition to Medicare removes many financial barriers to care.
  
  
  METHODS
  The sample included 2,626 older patients with local and regional stage NSCLC diagnosed between 1997 and 2000. Four outcomes were studied: the likelihood of receiving resection, chemotherapy, radiation therapy, and survival (perioperative and longer-term). Logistic regression was used to predict the likelihood of treatment, and stratified and multivariate analyses were used to evaluate differences in survival.
  
  
  RESULTS
  Dually eligible patients were half as likely to undergo resection as Medicare patients (P < .001) and were more likely to receive radiation than Medicare patients. Stratified and multivariate analyses showed that surgically treated dually eligible patients had slightly inferior survival as compared with that of Medicare patients. Survival was equivalent among patients who did not undergo resection, regardless of insurance coverage.
  
  
  CONCLUSIONS
  Older dually eligible patients with NSCLC had a lower likelihood of undergoing resection despite controls for socioeconomic factors and comorbidities. However, if such patients were surgically treated, survival improved substantially, but it remained inferior to the survival of Medicare patients. Additional research is needed to understand why resection rates were substantially lower among dually eligible patients.
authors.affiliation: Department of Health Administration and Massey Cancer Center, Virginia Commonwealth University, Grant House, Richmond, VA 23298-0203, USA. cjbradley@vcu.edu
authors.forename: Cathy J
authors.initials: CJ
authors.lastname: Bradley
authors.forename: Bassam
authors.initials: B
authors.lastname: Dahman
authors.forename: Charles W
authors.initials: CW
authors.lastname: Given
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000208:ethnology / Q000401:mortality / Q000628:therapy; D004608:Eligibility Determination / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D016015:Logistic Models; D008175:Lung Neoplasms / Q000208:ethnology / Q000401:mortality / Q000628:therapy; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D008824:Michigan / Q000453:epidemiology; D011013:Pneumonectomy / Q000706:statistics & numerical data; D011878:Radiotherapy / Q000706:statistics & numerical data; D012042:Registries; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data
chemical_list: D000970:Antineoplastic Agents
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