title: Receipt of chemotherapy among medicare patients with cancer by type of supplemental insurance.
abstract: OBJECTIVE
  Medicare beneficiaries with cancer bear a greater portion of their health care costs, because cancer treatment costs have increased. Beneficiaries have supplemental insurance to reduce out-of-pocket costs; those without supplemental insurance may face barriers to care. This study examines the association between type of supplemental insurance coverage and receipt of chemotherapy among Medicare patients with cancer who, per National Comprehensive Cancer Network treatment guidelines, should generally receive chemotherapy.
  
  
  METHODS
  This retrospective, observational study included 1,200 Medicare patients diagnosed with incident cancer of the breast (stage IIB to III), colon (stage III), rectum (stage II to III), lung (stage II to IV), or ovary (stage II to IV) from 2000 to 2005. Using the National Cancer Institute Patterns of Care Studies and linked SEER-Medicare data, we determined each Medicare patient's supplemental insurance status (private insurance, dual eligible [ie, Medicare with Medicaid], or no supplemental insurance), consultation with an oncologist, and receipt of chemotherapy. Using adjusted logistic regression, we evaluated the association of type of supplemental insurance with oncologist consultation and receipt of chemotherapy.
  
  
  RESULTS
  Dual-eligible patients were significantly less likely to receive chemotherapy than were Medicare patients with private insurance. Patients with Medicare only who saw an oncologist had comparable rates of chemotherapy compared with Medicare patients with private insurance.
  
  
  CONCLUSIONS
  Dual-eligible Medicare beneficiaries received recommended cancer chemotherapy less frequently than other Medicare beneficiaries. With the increasing number of Medicaid patients under the Affordable Care Act, there will be a need for patient navigators and sufficient physician reimbursement so that low-income patients with cancer will have access to oncologists and needed treatment.
authors.affiliation: Joan L. Warren, Anne-Michelle Noone, and Linda C. Harlan, National Cancer Institute, Bethesda; Jennifer Stevens, Information Management Services, Beltsville, MD; Eboneé N. Butler, University of North Carolina, Chapel Hill, NC; Christopher S. Lathan, Dana-Farber Cancer Institute, Boston, MA; and Kevin Ward, Emory University, Atlanta, GA. joan_warren@nih.gov.
authors.forename: Joan L
authors.initials: JL
authors.lastname: Warren
authors.affiliation: Joan L. Warren, Anne-Michelle Noone, and Linda C. Harlan, National Cancer Institute, Bethesda; Jennifer Stevens, Information Management Services, Beltsville, MD; Eboneé N. Butler, University of North Carolina, Chapel Hill, NC; Christopher S. Lathan, Dana-Farber Cancer Institute, Boston, MA; and Kevin Ward, Emory University, Atlanta, GA.
authors.forename: Eboneé N
authors.initials: EN
authors.lastname: Butler
authors.affiliation: Joan L. Warren, Anne-Michelle Noone, and Linda C. Harlan, National Cancer Institute, Bethesda; Jennifer Stevens, Information Management Services, Beltsville, MD; Eboneé N. Butler, University of North Carolina, Chapel Hill, NC; Christopher S. Lathan, Dana-Farber Cancer Institute, Boston, MA; and Kevin Ward, Emory University, Atlanta, GA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Stevens
authors.affiliation: Joan L. Warren, Anne-Michelle Noone, and Linda C. Harlan, National Cancer Institute, Bethesda; Jennifer Stevens, Information Management Services, Beltsville, MD; Eboneé N. Butler, University of North Carolina, Chapel Hill, NC; Christopher S. Lathan, Dana-Farber Cancer Institute, Boston, MA; and Kevin Ward, Emory University, Atlanta, GA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Lathan
authors.affiliation: Joan L. Warren, Anne-Michelle Noone, and Linda C. Harlan, National Cancer Institute, Bethesda; Jennifer Stevens, Information Management Services, Beltsville, MD; Eboneé N. Butler, University of North Carolina, Chapel Hill, NC; Christopher S. Lathan, Dana-Farber Cancer Institute, Boston, MA; and Kevin Ward, Emory University, Atlanta, GA.
authors.forename: Anne-Michelle
authors.initials: AM
authors.lastname: Noone
authors.affiliation: Joan L. Warren, Anne-Michelle Noone, and Linda C. Harlan, National Cancer Institute, Bethesda; Jennifer Stevens, Information Management Services, Beltsville, MD; Eboneé N. Butler, University of North Carolina, Chapel Hill, NC; Christopher S. Lathan, Dana-Farber Cancer Institute, Boston, MA; and Kevin Ward, Emory University, Atlanta, GA.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Ward
authors.affiliation: Joan L. Warren, Anne-Michelle Noone, and Linda C. Harlan, National Cancer Institute, Bethesda; Jennifer Stevens, Information Management Services, Beltsville, MD; Eboneé N. Butler, University of North Carolina, Chapel Hill, NC; Christopher S. Lathan, Dana-Farber Cancer Institute, Boston, MA; and Kevin Ward, Emory University, Atlanta, GA.
authors.forename: Linda C
authors.initials: LC
authors.lastname: Harlan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000191:economics*; D016015:Logistic Models; D008297:Male; D008484:Medicaid / Q000191:economics; D006278:Medicare / Q000191:economics*; D016345:Medicare Part B / Q000191:economics*; D015999:Multivariate Analysis; D009369:Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*; D012017:Referral and Consultation / Q000191:economics; D012189:Retrospective Studies; D018426:SEER Program / Q000706:statistics & numerical data; D014481:United States