title: Antineoplastic Treatment of Advanced-Stage Non-Small-Cell Lung Cancer: Treatment, Survival, and Spending (2000 to 2011).
abstract: Purpose Multiple agents for advanced non-small-cell lung cancer (NSCLC) have been approved in the past decade, but little is known about their use and associated spending and survival. Methods We used SEER-Medicare data for elderly patients with a new diagnosis of advanced-stage NSCLC and were treated with antineoplastic agents between 2000 and 2011 (N = 22,163). We estimated the adjusted percentage of patients who received each agent, days while on treatment, survival, and spending in the 12 months after diagnosis. Results During the 12-year study period, a marked shift in treatment occurred along with a rapid adoption of pemetrexed (39.2%), erlotinib (20.3%), and bevacizumab (18.9%) and a decline in paclitaxel (38.7%), gemcitabine (17.0%), and vinorelbine (5.7%; all P < .05). The average total days on therapy increased by 5 days (from 103 to 108 days). Patients who received bevacizumab, erlotinib, or pemetrexed had the longest treatment durations on average (approximately 146 days v 75 days for those who did not receive these agents). Approximately 44% of patients received antineoplastic agents in the last 30 days of life throughout the study period. Acute inpatient spending declined (from $29,376 to $23,731), whereas outpatient spending increased 23% (from $37,931 to $46,642). Median survival gains of 1.5 months were observed. Conclusion Considerable shifts in the treatment of advanced-stage NSCLC occurred along with modest gains in survival and total Medicare spending. More precise outcome information is needed to inform value-based treatment decisions for advanced-stage NSCLC.
authors.affiliation: Cathy J. Bradley, University of Colorado, Aurora, CO; K. Robin Yabroff, Department of Health and Human Services, Washington, DC; Angela B. Mariotto, Quyen Tran, and Joan L. Warren, National Cancer Institute, Bethesda; and Christopher Zeruto, Information Management Service, Beltsville, MD.
authors.forename: Cathy J
authors.initials: CJ
authors.lastname: Bradley
authors.affiliation: Cathy J. Bradley, University of Colorado, Aurora, CO; K. Robin Yabroff, Department of Health and Human Services, Washington, DC; Angela B. Mariotto, Quyen Tran, and Joan L. Warren, National Cancer Institute, Bethesda; and Christopher Zeruto, Information Management Service, Beltsville, MD.
authors.forename: K Robin
authors.initials: KR
authors.lastname: Yabroff
authors.affiliation: Cathy J. Bradley, University of Colorado, Aurora, CO; K. Robin Yabroff, Department of Health and Human Services, Washington, DC; Angela B. Mariotto, Quyen Tran, and Joan L. Warren, National Cancer Institute, Bethesda; and Christopher Zeruto, Information Management Service, Beltsville, MD.
authors.forename: Angela B
authors.initials: AB
authors.lastname: Mariotto
authors.affiliation: Cathy J. Bradley, University of Colorado, Aurora, CO; K. Robin Yabroff, Department of Health and Human Services, Washington, DC; Angela B. Mariotto, Quyen Tran, and Joan L. Warren, National Cancer Institute, Bethesda; and Christopher Zeruto, Information Management Service, Beltsville, MD.
authors.forename: Christopher
authors.initials: C
authors.lastname: Zeruto
authors.affiliation: Cathy J. Bradley, University of Colorado, Aurora, CO; K. Robin Yabroff, Department of Health and Human Services, Washington, DC; Angela B. Mariotto, Quyen Tran, and Joan L. Warren, National Cancer Institute, Bethesda; and Christopher Zeruto, Information Management Service, Beltsville, MD.
authors.forename: Quyen
authors.initials: Q
authors.lastname: Tran
authors.affiliation: Cathy J. Bradley, University of Colorado, Aurora, CO; K. Robin Yabroff, Department of Health and Human Services, Washington, DC; Angela B. Mariotto, Quyen Tran, and Joan L. Warren, National Cancer Institute, Bethesda; and Christopher Zeruto, Information Management Service, Beltsville, MD.
authors.forename: Joan L
authors.initials: JL
authors.lastname: Warren
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology; D004358:Drug Therapy / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D018426:SEER Program / Q000706:statistics & numerical data*; D016019:Survival Analysis; D014481:United States
chemical_list: D000970:Antineoplastic Agents