title: Age disparity in palliative radiation therapy among patients with advanced cancer.
abstract: OBJECTIVE
  Palliative radiation therapy represents an important treatment option among patients with advanced cancer, although research shows decreased use among older patients. This study evaluated age-related patterns of palliative radiation use among an elderly Medicare population.
  
  
  METHODS
  We identified 63,221 patients with metastatic lung, breast, prostate, or colorectal cancer diagnosed between 2000 and 2007 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Receipt of palliative radiation therapy was extracted from Medicare claims. Multivariate Poisson regression analysis determined residual age-related disparity in the receipt of palliative radiation therapy after controlling for confounding covariates including age-related differences in patient and demographic covariates, length of life, and patient preferences for aggressive cancer therapy.
  
  
  RESULTS
  The use of radiation decreased steadily with increasing patient age. Forty-two percent of patients aged 66 to 69 received palliative radiation therapy. Rates of palliative radiation decreased to 38%, 32%, 24%, and 14% among patients aged 70 to 74, 75 to 79, 80 to 84, and over 85, respectively. Multivariate analysis found that confounding covariates attenuated these findings, although the decreased relative rate of palliative radiation therapy among the elderly remained clinically and statistically significant. On multivariate analysis, compared to patients 66 to 69 years old, those aged 70 to 74, 75 to 79, 80 to 84, and over 85 had a 7%, 15%, 25%, and 44% decreased rate of receiving palliative radiation, respectively (all P<.0001).
  
  
  CONCLUSIONS
  Age disparity with palliative radiation therapy exists among older cancer patients. Further research should strive to identify barriers to palliative radiation among the elderly, and extra effort should be made to give older patients the opportunity to receive this quality of life-enhancing treatment at the end of life.
authors.affiliation: University of Hawaii, John A. Burns School of Medicine, Honolulu, Hawaii.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Wong
authors.affiliation: Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California; Moores Cancer Center, University of California San Diego, La Jolla, California.
authors.forename: Beibei
authors.initials: B
authors.lastname: Xu
authors.affiliation: Moores Cancer Center, University of California San Diego, La Jolla, California; Division of Palliative Medicine, Department of Internal Medicine, University of California San Diego, La Jolla, California.
authors.forename: Heidi N
authors.initials: HN
authors.lastname: Yeung
authors.affiliation: Moores Cancer Center, University of California San Diego, La Jolla, California; Division of Palliative Medicine, Department of Internal Medicine, University of California San Diego, La Jolla, California.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Roeland
authors.affiliation: Moores Cancer Center, University of California San Diego, La Jolla, California; Department of Family and Preventive Medicine, University of California San Diego, La Jolla, California.
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Martinez
authors.affiliation: Department of Radiation Oncology, Stanford University, Stanford, California.
authors.forename: Quynh-Thu
authors.initials: QT
authors.lastname: Le
authors.affiliation: Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California; Moores Cancer Center, University of California San Diego, La Jolla, California.
authors.forename: Loren K
authors.initials: LK
authors.lastname: Mell
authors.affiliation: Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California; Moores Cancer Center, University of California San Diego, La Jolla, California. Electronic address: j2murphy@ucsd.edu.
authors.forename: James D
authors.initials: JD
authors.lastname: Murphy
mesh_terms: D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000532:radiotherapy / Q000556:secondary; D001932:Brain Neoplasms / Q000532:radiotherapy / Q000556:secondary; D001943:Breast Neoplasms / Q000532:radiotherapy*; D015179:Colorectal Neoplasms / Q000532:radiotherapy*; D015986:Confounding Factors, Epidemiologic; D005260:Female; D006801:Humans; D008136:Longevity; D008175:Lung Neoplasms / Q000532:radiotherapy*; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D010166:Palliative Care / Q000379:methods / Q000706:statistics & numerical data* / Q000639:trends; D057240:Patient Preference; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011788:Quality of Life; D011878:Radiotherapy / Q000706:statistics & numerical data / Q000639:trends; D012044:Regression Analysis; D018426:SEER Program / Q000706:statistics & numerical data; D014481:United States