title: Guideline-concordant lung cancer care and associated health outcomes among elderly patients in the United States.
abstract: OBJECTIVE
  In the United States (US), the elderly carry a disproportionate burden of lung cancer. Although evidence-based guidelines for lung cancer care have been published, lack of high quality care still remains a concern among the elderly. This study comprehensively evaluates the variations in guideline-concordant lung cancer care among elderly in the US.
  
  
  METHODS
  Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database (2002-2007), we identified elderly patients (aged ≥65 years) with lung cancer (n = 42,323) and categorized them by receipt of guideline-concordant care, using evidence-based guidelines from the American College of Chest Physicians. A hierarchical generalized logistic model was constructed to identify variables associated with receipt of guideline-concordant care. Kaplan-Meier analysis and Log Rank test were used for estimation and comparison of the three-year survival. Multivariate Cox proportional hazards model was constructed to estimate lung cancer mortality risk associated with receipt of guideline-discordant care.
  
  
  RESULTS
  Only less than half of all patients (44.7%) received guideline-concordant care in the study population. The likelihood of receiving guideline-concordant care significantly decreased with increasing age, non-white race, higher comorbidity score, and lower income. Three-year median survival time significantly increased (exceeded 487 days) in patients receiving guideline-concordant care. Adjusted lung cancer mortality risk significantly increased by 91% (HR = 1.91, 95% CI: 1.82-2.00) among patients receiving guideline-discordant care.
  
  
  CONCLUSIONS
  This study highlights the critical need to address disparities in receipt of guideline-concordant lung cancer care among elderly. Although lung cancer diagnostic and management services are covered under the Medicare program, underutilization of these services is a concern.
authors.affiliation: Virginia Commonwealth University, School of Pharmacy, Department of Pharmacotherapy & Outcomes Science, Richmond, VA 23298-0533, USA. Electronic address: panadpara@vcu.edu.
authors.forename: Pramit A
authors.initials: PA
authors.lastname: Nadpara
authors.affiliation: West Virginia University, School of Pharmacy, Department of Pharmaceutical Systems & Policy, Morgantown, WV 26506-9500, USA.
authors.forename: S Suresh
authors.initials: SS
authors.lastname: Madhavan
authors.affiliation: West Virginia University, School of Pharmacy, Department of Pharmaceutical Systems & Policy, Morgantown, WV 26506-9500, USA.
authors.forename: Cindy
authors.initials: C
authors.lastname: Tworek
authors.affiliation: West Virginia University, School of Pharmacy, Department of Pharmaceutical Systems & Policy, Morgantown, WV 26506-9500, USA.
authors.forename: Usha
authors.initials: U
authors.lastname: Sambamoorthi
authors.affiliation: Indiana University, School of Public Health, Department of Applied Health Science, Bloomington, IN 47405, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Hendryx
authors.affiliation: West Virginia University, School of Medicine, Morgantown, WV 26506-9600, USA.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Almubarak
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D054625:Healthcare Disparities; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008175:Lung Neoplasms / Q000401:mortality / Q000628:therapy*; D008297:Male; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D016016:Proportional Hazards Models; D018426:SEER Program; D014481:United States
keywords: Cancer; Disparities; Elderly; Guidelines; Lung; Medicare; Treatment