Patient Demographic and Socioeconomic Characteristics in the SEER-Medicare Database

Bach, Peter B.; Guadagnoli, Edward; Schrag, Deborah; Schussler, Nicola; Warren, Joan L.

doi:10.1097/00005650-200208001-00003

Cited by 219 publications

(194 citation statements)

References 14 publications

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“…The primary study outcome, postoperative survival, was calculated using Medicare data that stay current as of the date of linkage with the SEER registry (17). Patients alive as of December 31, 2009 were censored at the date of the last follow-up.…”

Section: Study Populationmentioning

confidence: 99%

Adjuvant Treatment for Elderly Patients with Early-Stage Lung Cancer Treated with Limited Resection

Mhango

Bonomi²,

Neugut

et al. 2013

Annals ATS

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Objectives: Limited resection is commonly used for treating older patients with early-stage non-small cell lung cancer (NSCLC) who cannot tolerate lobectomy. However, parenchymal-sparing procedures leave patients at increased risk of recurrence. The role of postoperative radiotherapy (PORT) and chemotherapy after limited resection is not established. Methods:We identified 1,929 patients with stage I-II (<5 cm in size) NSCLC who underwent limited resection (wedge or segmentectomy) from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Using propensity score methods, we compared toxicity and survival of patients treated with limited resection alone, PORT, adjuvant chemotherapy, or PORT and chemotherapy. We conducted secondary analysis stratifying the sample by size (.2-5 cm), stage (IA vs. IB/IIA), and type of limited resection (wedge resection vs. segmentectomy).Measurements and Main Results: Overall, 1,656 (85.8%), 159 (8.3%), 74 (3.8%), and 40 (2.1%) patients were treated with limited resection alone, PORT, adjuvant chemotherapy, or PORT and chemotherapy, respectively. Adjusted analysis using inverse probability weighting showed that PORT (hazard ratio [HR], 1.57; 95% confidence interval [CI], 1.45-1.69), adjuvant chemotherapy (HR, 1.48; 95% CI, 1.36-1.61), and PORT and chemotherapy (HR, 1.73; 95% CI, 1.61-1.86) were associated with worse survival compared with limited resection alone. Similar results were obtained in secondary analyses. Compared with limited resection alone, the adjusted odds ratios for toxicity were 1.97 (95% CI, 1.6-2.4), 3.15 (95% CI, 2.58-3.85), 2.59 (95% CI, 2.0-3.4) for PORT, chemotherapy, and PORT and chemotherapy, respectively.Conclusions: PORT and adjuvant chemotherapy are not beneficial and appear to be associated with increased toxicity and worse survival after limited resection in elderly patients with early-stage NSCLC. Alternative strategies should be explored to improve local control.

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Section: Study Populationmentioning

confidence: 99%

Adjuvant Treatment for Elderly Patients with Early-Stage Lung Cancer Treated with Limited Resection

Mhango

Bonomi²,

Neugut

et al. 2013

Annals ATS

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“…14 We assigned median Census-tract income and Censustract percentage of nonhigh school graduates as patient-level measures of income and education, respectively. 25 We measured pre-existing comorbidity by using a modification of the Charlson Index 26 to identify comorbid conditions (including diabetes, renal insufficiency, and cardiovascular disease) from inpatient and physician claims that were submitted during the 12 months before the index admission for kidney cancer surgery. 27 We also noted the presence or absence of hypertension, urolithiasis, and/or renovascular disease, given their relevance to surgical decision-making among patients with kidney cancer.…”

Section: Patient-level Covariatesmentioning

confidence: 99%

Diffusion of surgical innovation among patients with kidney cancer

Miller

Saigal

Banerjee

et al. 2008

Cancer

107

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BACKGROUNDDespite their potential benefits to patients with kidney cancer, the adoption of partial nephrectomy and laparoscopy has been gradual and asymmetric. To clarify whether this trend reflects differences in kidney cancer patients or differences in surgeon practice styles, the authors compared the magnitude of surgeon‐attributable variance in the use of partial nephrectomy and laparoscopic radical nephrectomy with that attributable to patient and tumor characteristics.METHODSBy using linked Surveillance, Epidemiology, and End Results‐Medicare data, the authors identified a cohort of 5483 Medicare beneficiaries who underwent surgery for kidney cancer between 1997 and 2002. Two primary outcomes were defined: 1) the use of partial nephrectomy and (2) the use of laparoscopy among patients undergoing radical nephrectomy. By using multilevel models, surgeon‐ and patient‐level contributions to observed variations in the use of partial nephrectomy and laparoscopic radical nephrectomy were estimated.RESULTSOf the 5483 cases identified, 611 (11.1%) underwent partial nephrectomy (43 performed laparoscopically), and 4872 (88.9%) underwent radical nephrectomy (515 performed laparoscopically). After adjusting for patient demographics, comorbidity, tumor size, and surgeon volume, the surgeon‐attributable variance was 18.1% for partial nephrectomy and 37.4% for laparoscopy. For both outcomes, the percentage of total variance attributable to surgeon factors was consistently higher than that attributable to patient characteristics.CONCLUSIONSFor many patients with kidney cancer, the surgery provided depends more on their surgeon's practice style than on the characteristics of the patient and his or her disease. Consequently, dismantling barriers to surgeon adoption of partial nephrectomy and laparoscopy is an important step toward improving the quality of care for patients with early‐stage kidney cancer. Cancer 2008. © 2008 American Cancer Society.

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“…Although race/ethnicity categories may have involved a certain degree of misclassification, 2 categories (African American and Caucasian) in this study are likely to have a minimal misclassification bias, if any. 40 …”

Section: Other Characteristicsmentioning

confidence: 99%

Ethnic variations in diagnosis, treatment, socioeconomic status, and survival in a large population‐based cohort of elderly patients with non‐Hodgkin lymphoma

Wang

Burau

Fang

et al. 2008

Cancer

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BACKGROUND.There is a lack of research on ethnic disparities in survival among patients with non‐Hodgkin lymphoma (NHL), although these disparities have been documented for patients with many other tumors.METHODS.A retrospective cohort of 13,321 patients diagnosed with incident NHL at age ≥65 years from 1992 to 1999 were identified from the Surveillance, Epidemiology, and End Results (SEER)‐Medicare linked database with 11 years of follow‐up. Of these patients, 11,868 were Caucasians, 533 were African Americans, and 920 were other ethnicities. A time‐to‐event Cox regression model was used to examine the relative risk of all‐cause and disease‐specific mortality.RESULTS.A larger proportion (72.2%) of African Americans were in the poorest quartile of socioeconomic status as measured by the poverty level compared with 21.8% of Caucasians, and 43.2% of African Americans received chemotherapy compared with 52.4% of Caucasians (P < .01). Hazard ratio of all‐cause and NHL‐specific mortality increased significantly with age, advanced stage, higher comorbidity scores, and poorer socioeconomic status. Patients receiving either chemotherapy or radiotherapy or both were significantly less likely to die. After taking into account differences in treatment, comorbidity, and socioeconomic status, there was no statistically significant difference in the risk of all‐cause (hazard ratio, 0.97; 95% confidence interval, 0.88‐1.08) and disease‐specific mortality (hazard ratio, 1.07; 95% confidence interval, 0.92‐1.25) between African Americans and Caucasians.CONCLUSIONS.The risk of mortality in patients with NHL was associated with socioeconomic status and was reduced in patients receiving chemotherapy. No significant differences in the risk of mortality were observed between African Americans and Caucasians after controlling for factors such as treatment and socioeconomic status. Cancer 2008. © 2008 American Cancer Society.

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Patient Demographic and Socioeconomic Characteristics in the SEER-Medicare Database

Cited by 219 publications

References 14 publications

Adjuvant Treatment for Elderly Patients with Early-Stage Lung Cancer Treated with Limited Resection

Adjuvant Treatment for Elderly Patients with Early-Stage Lung Cancer Treated with Limited Resection

Diffusion of surgical innovation among patients with kidney cancer

Ethnic variations in diagnosis, treatment, socioeconomic status, and survival in a large population‐based cohort of elderly patients with non‐Hodgkin lymphoma

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