Receipt of Appropriate Surgical Care for Medicare Beneficiaries With Cancer

Greenberg, Caprice C.; Lipsitz, Stuart R.; Neville, Bridget A.; In, Haejin; Hevelone, Nathanael D.; Porter, Sam; Weeks, Christine; Jha, Ashish K.; Gawande, Atul A.; Schrag, Deborah; Weeks, Jane C.

doi:10.1001/archsurg.2011.141

Cited by 32 publications

(29 citation statements)

References 15 publications

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“…Previous studies have found that when clinical guideline recommendations are based on expert consensus instead of strong evidence, clinician compliance with guideline-directed management is lower (17,18). Thus, it is not surprising that we found marked variation among physicians regarding prophylactic central lymph node dissections, the role of pretreatment scans before radioactive iodine treatment, the use of a fixed dose of radioactive iodine vs dosimetry for distant metastases, and long-term thyroid cancer management, given that there are no strong guideline recommendations regarding these aspects of thyroid cancer management and/or that data are limited (10).…”

Section: Discussionmentioning

confidence: 99%

Variation in the Management of Thyroid Cancer

Haymart

Banerjee

Yang

et al. 2013

The Journal of Clinical Endocrinology &Amp; Metabolism

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Objective:We sought to identify aspects of thyroid cancer management that have the greatest variation.Design/Setting/Participants: We surveyed 944 physicians involved in thyroid cancer care from 251 hospitals affiliated with the US National Cancer Database. Physicians were asked questions in the following four domains: thyroid surgery, radioactive iodine use, thyroid hormone replacement postsurgery, and long-term thyroid cancer management. We calculated the ratio of observed variation to hypothetical maximum variation under the assumed distribution of the response. Ratios closer to 1 indicate greater variation. Results:We had a 66% response rate. We found variation in multiple aspects of thyroid cancer management, including the role of central lymph node dissections (variation, 0.99; 95% confidence interval [CI], 0.98 -1.00), the role of pretreatment scans before radioactive iodine treatment (variation, 1.00; 95% CI, 0.98 -1.00), and all aspects of long-term thyroid cancer management, including applications of ultrasound (variation, 0.97; 95% CI, 0.93-0.99) and radioactive iodine scans (variation, 0.99; 95% CI, 0.97-1.00). For the management of small thyroid cancers, variation exists in all domains, including optimal extent of surgery (variation, 0.91; 95% CI,) and the role of both radioactive iodine treatment (variation, 0.91; 95% CI,) and suppressive doses of thyroid hormone replacement (variation, 1.00; 95% CI, 0.99 -1.00). Conclusion:We identified areas of variation in thyroid cancer management. To reduce the variation and improve the management of thyroid cancer, there is a need for more research and more research dissemination. (J Clin Endocrinol

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Section: Discussionmentioning

confidence: 99%

Variation in the Management of Thyroid Cancer

Haymart

Banerjee

Yang

et al. 2013

The Journal of Clinical Endocrinology &Amp; Metabolism

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“…A previous study that assessed concordance with cancer treatment guidelines among Medicare beneficiaries indicated that receipt of guideline-concordant cancer care varied depending on patient age, race, cancer type, and geographic region. 3 Accepted practice guidelines for most cancers are regularly updated by the National Comprehensive Cancer Network (NCCN), the National Quality Forum (NQF), and the National Cancer Institute (NCI). In this study, our group, the Collaborative to Improve Native Cancer Outcomes (CINCO) identified 22 nationally endorsed practice guidelines for the 4 most common cancers (breast, colon, prostate, and lung).…”

Section: Introductionmentioning

confidence: 99%

Guideline‐concordant cancer care and survival among American Indian/Alaskan Native patients

Javid

Varghese

Morris

et al. 2014

Cancer

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BACKGROUND American Indians/Alaskan Natives (AI/ANs) have the worst 5-year cancer survival of all racial/ethnic groups in the United States. Causes for this disparity are unknown. The authors of this report examined the receipt of cancer treatment among AI/AN patients compared with white patients. METHODS This was a retrospective cohort study of 338,204 patients who were diagnosed at age ≥65 years with breast, colon, lung, or prostate cancer between 1996 and 2005 in the Surveillance, Epidemiology, and End Results-Medicare database. Nationally accepted guidelines for surgical and adjuvant therapy and surveillance were selected as metrics of optimal, guideline-concordant care. Treatment analyses compared AI/ANs with matched whites. RESULTS Across cancer types, AI/ANs were less likely to receive optimal cancer treatment and were less likely to undergo surgery (P ≤ .025 for all cancers). Adjuvant therapy rates were significantly lower for AI/AN patients with breast cancer (P <.001) and colon cancer (P = .001). Rates of post-treatment surveillance also were lower among AI/ANs and were statistically significantly lower for AI/AN patients with breast cancer (P = .002) and prostate cancer (P <.001). Nonreceipt of optimal cancer treatment was associated with significantly worse survival across cancer types. Disease-specific survival for those who did not undergo surgery was significantly lower for patients with breast cancer (hazard ratio [HR], 0.62), colon cancer (HR, 0.74), prostate cancer (HR, 0.52), and lung cancer (HR, 0.36). Survival rates also were significantly lower for those patients who did not receive adjuvant therapy for breast cancer (HR, 0.56), colon cancer (HR, 0.59), or prostate cancer (HR, 0.81; all 95% confidence intervals were <1.0). CONCLUSIONS Fewer AI/AN patients than white patients received guideline-concordant cancer treatment across the 4 most common cancers. Efforts to explain these differences are critical to improving cancer care and survival for AI/AN patients.

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“…Although previous studies have suggested that blacks are substantially less likely to undergo surgery for some cancer types, this issue has not been carefully studied among patients with poor prognosis cancers. 3,4,9-13 Moreover, there is little understanding of the extent to which lower surgery rates in blacks may reflect the fact that blacks receive care at different hospitals, which may have lower overall rates of surgery. 14,15 Finally, there have been no comprehensive studies assessing the extent to which the comparative underuse of surgery by race explains differences in survival.…”

Section: Introductionmentioning

confidence: 99%

Racial Disparities in Surgical Resection and Survival among Elderly Patients with Poor Prognosis Cancer

Revels

Banerjee

Yin

et al. 2013

Journal of the American College of Surgeons

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Background Reports indicate that blacks have lower survival following the diagnosis of a poor prognosis cancer, compared with whites. We explored the extent to which this disparity is attributable to the underuse of surgery. Study Design Using the SEER-Medicare database we identified 57,364 patients, ages ≥65, with a new diagnosis of non-metastatic liver, lung, pancreatic and esophageal cancer, from 2000-2005. We evaluated racial differences in resection rates after adjustment for patient, tumor and hospital characteristics, using hierarchical logistic regression. Cox proportional hazards regression was used to assess racial differences in survival, after adjusting for patient, tumor and hospital characteristics, and receipt of surgery. Results Compared with whites, blacks were less likely to undergo surgery for liver (adjusted OR [aOR], 0.49, 95%CI 0.29-0.83), lung (aOR 0.62 95%CI 0.56-0.69), pancreas (aOR 0.53, 95%CI 0.41-0.70) and esophagus cancers (aOR 0.64, 95%CI 0.42-0.99). Hospitals varied in their surgery rates among patients with potentially resectable disease. However, resection rates were consistently lower for blacks, regardless of the resection rate of the treating hospital. Although there were no racial differences in overall survival with liver and esophageal cancer, blacks experienced poorer survival for lung (adjusted HR [aHR]1.05, 95%CI 1.00-1.10) and pancreas cancer (aHR 1.15, 95%CI 1.03-1.30). In both instances, there were no residual racial disparities in overall survival after further adjusting for use of surgery. Conclusions Blacks are less likely to undergo surgery following the diagnosis of a poor prognosis cancer. Our findings suggest that surgery is an important predictor of overall mortality, and that efforts to reduce racial disparities will require stakeholders to gain a better understanding of why elderly blacks are less likely to get to the operating room.

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Receipt of Appropriate Surgical Care for Medicare Beneficiaries With Cancer

Cited by 32 publications

References 15 publications

Variation in the Management of Thyroid Cancer

Variation in the Management of Thyroid Cancer

Guideline‐concordant cancer care and survival among American Indian/Alaskan Native patients

Racial Disparities in Surgical Resection and Survival among Elderly Patients with Poor Prognosis Cancer

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