title: Use of new treatment modalities for non-small cell lung cancer care in the Medicare population.
abstract: BACKGROUND
  Many older patients with early stage non-small cell lung cancer (NSCLC) do not receive curative therapy. New surgical techniques and radiation therapy modalities, such as video-assisted thoracoscopic surgery (VATS), potentially allow more patients to receive treatment. The adoption of these techniques and their impact on access to cancer care among Medicare beneficiaries with stage I NSCLC are unknown.
  
  
  METHODS
  We used the Surveillance, Epidemiology and End Results-Medicare database to identify patients with stage I NSCLC diagnosed between 1998 and 2007. We assessed temporal trends and created hierarchical generalized linear models of the relationship between patient, clinical, and regional factors and type of treatment.
  
  
  RESULTS
  The sample comprised 13,458 patients with a mean age of 75.7 years. The proportion of patients not receiving any local treatment increased from 14.6% in 1998 to 18.3% in 2007. The overall use of surgical resection declined from 75.2% to 67.3% ( P , .001), although the proportion of patients undergoing VATS increased from 11.3% to 32.0%. Similarly, although the use of new radiation modalities increased from 0% to 5.2%, the overall use of radiation remained stable. The oldest patients were less likely to receive surgical vs no treatment (OR, 0.12; 95% CI, 0.09-0.16) and more likely to receive radiation vs surgery (OR, 13.61; 95% CI, 9.75-19.0).
  
  
  CONCLUSIONS
  From 1998 to 2007, the overall proportion of older patients with stage I NSCLC receiving curative local therapy decreased, despite the dissemination of newer, less-invasive forms of surgery and radiation.
authors.affiliation: Department of Internal Medicine, Section of Pulmonary and Critical Care Medicine, New Haven, CT.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Vest
authors.affiliation: Department of Internal Medicine, Section of Cardiology, New Haven, CT; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT; Health Research and Educational Trust, Chicago, IL.
authors.forename: Jeph
authors.initials: J
authors.lastname: Herrin
authors.affiliation: Department of Internal Medicine, Section of General Internal Medicine, New Haven, CT; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT.
authors.forename: Pamela R
authors.initials: PR
authors.lastname: Soulos
authors.affiliation: Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT; Department of Therapeutic Radiology, New Haven, CT.
authors.forename: Roy H
authors.initials: RH
authors.lastname: Decker
authors.affiliation: Department of Internal Medicine, Section of Pulmonary and Critical Care Medicine, New Haven, CT.
authors.forename: Lynn
authors.initials: L
authors.lastname: Tanoue
authors.affiliation: Department of Internal Medicine, Section of Pulmonary and Critical Care Medicine, New Haven, CT.
authors.forename: Gaetane
authors.initials: G
authors.lastname: Michaud
authors.affiliation: Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT; Department of Surgery, Section of Thoracic Surgery, New Haven, CT.
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Kim
authors.affiliation: Department of Surgery, Section of Thoracic Surgery, New Haven, CT.
authors.forename: Frank
authors.initials: F
authors.lastname: Detterbeck
authors.affiliation: Department of Internal Medicine, Section of Medical Oncology, New Haven, CT; Yale Cancer Center, Yale School of Medicine, New Haven, CT.
authors.forename: Daniel
authors.initials: D
authors.lastname: Morgensztern
authors.affiliation: Department of Internal Medicine, Section of General Internal Medicine, New Haven, CT; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT. Electronic address: cary.gross@yale.edu.
authors.forename: Cary P
authors.initials: CP
authors.lastname: Gross
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D016014:Linear Models; D008175:Lung Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D006278:Medicare; D009367:Neoplasm Staging; D016634:Radiosurgery / Q000706:statistics & numerical data*; D050397:Radiotherapy, Intensity-Modulated / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018426:SEER Program; D020775:Thoracic Surgery, Video-Assisted / Q000706:statistics & numerical data*; D014481:United States