title: Real-world treatment patterns and costs in a US Medicare population with metastatic squamous non-small cell lung cancer.
abstract: OBJECTIVE
  Despite advances in the treatment of nonsquamous non-small cell lung cancer (NSCLC), therapeutic choices and overall disease course for squamous NSCLC have remained relatively unchanged over the past several years. We provide a detailed account of current treatment patterns, healthcare use, and survival in real-world clinical settings for metastatic squamous NSCLC.
  
  
  METHODS
  Patients aged ≥65 years with metastatic squamous NSCLC diagnosed 2001-2009 were identified and followed through 2010 using the Surveillance, Epidemiology and End Results-Medicare database. Treatment patterns were descriptively analyzed. Multivariate logistic regressions were estimated to identify predictors of treatment pattern events; generalized linear models were estimated for total all-cause and NSCLC-related costs to assess cost drivers.
  
  
  RESULTS
  Of 17,133 patients, 72% received cancer-directed therapy (surgery, radiation, chemotherapy, or biologic therapy), whereas 28% received only supportive care. Median survival was significantly longer in patients receiving cancer-directed therapy (8 months) than in patients receiving supportive care only (2 months) (P<0.0001). An agent-specific first-line chemotherapy regimen was identified for 91% of the 7700 patients who received chemotherapy. Among these, the most common first-line regimen was carboplatin-paclitaxel combination therapy (46%). Common second-line regimens were gemcitabine monotherapy (16%) and pemetrexed monotherapy (11%). Factors associated with decreased odds of receiving cancer-directed treatment were black versus white race (OR, 0.72; 95% CI, 0.64-0.82), residence in the West versus South (OR, 0.73; 95% CI, 0.66-0.81), and metastatic disease at initial diagnosis versus progression to metastatic disease (OR, 0.77; 95% CI, 0.70-0.84).
  
  
  CONCLUSIONS
  Our study shows that prognosis remains poor for patients with metastatic squamous NSCLC, even among those receiving treatment, but particularly for patients limited to supportive care only, highlighting the continuing unmet medical need in this population. Additionally, our analysis indicates that selections for second-line and third-line chemotherapies are not necessarily consistent with National Comprehensive Cancer Network guidelines.
authors.affiliation: RTI Health Solutions, 300 Park Offices Drive, Research Triangle Park, NC, USA. Electronic address: kldavis@rti.org.
authors.forename: Keith L
authors.initials: KL
authors.lastname: Davis
authors.affiliation: RTI Health Solutions, 300 Park Offices Drive, Research Triangle Park, NC, USA. Electronic address: rgoyal@rit.org.
authors.forename: Ravi K
authors.initials: RK
authors.lastname: Goyal
authors.affiliation: Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA. Electronic address: able_stephen_l@lilly.com.
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Able
authors.affiliation: Eli Lilly and Company, Sunninghill Road, Windlesham, Surrey, UK. Electronic address: jackie.brown@lilly.com.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Brown
authors.affiliation: Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA. Electronic address: li_li_x1@lilly.com.
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.affiliation: RTI Health Solutions, 300 Park Offices Drive, Research Triangle Park, NC, USA. Electronic address: jkaye@rti.org.
authors.forename: James A
authors.initials: JA
authors.lastname: Kaye
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D008297:Male; D006278:Medicare; D009367:Neoplasm Staging; D010342:Patient Acceptance of Health Care; D011159:Population Surveillance; D010818:Practice Patterns, Physicians'; D018426:SEER Program; D047368:Tumor Burden; D014481:United States / Q000453:epidemiology
keywords: Costs; Medicare; Resource utilization; Squamous non-small cell lung cancer; Survival; Treatment patterns