Skip Navigation
Grant Details

Grant Number: 5R01CA149045-03 Interpret this number
Primary Investigator: Gross, Cary
Organization: Yale University
Project Title: Use and Outcomes of Radiation Therapy for Medicare Patients with Common Cancers
Fiscal Year: 2012
Back to top


Abstract

DESCRIPTION (provided by applicant): For patients with localized breast, lung, and prostate cancer, several new treatment options have been developed in recent years. As care options expand, clinicians, patients, and policy-makers encounter difficult decisions. Despite the hope of superior efficacy against cancer, decreased side effects, or both generated by newer radiation modalities, it is unclear whether these new, expensive therapies will have an impact on patient health that is commensurate with their cost. A new approach is needed for evaluating diffusion of treatments while evidence of efficacy is still in development: evaluating utilization and costs according to likelihood of benefit. Some older patients with a higher burden of comorbidity will receive less benefit, and perhaps greater risk with more aggressive therapy. We propose a population based study of older persons with breast, lung, or prostate cancer enrolled in the Medicare fee-for-service program, in order to address the following aims with a particular emphasis on complex patients: Aim 1: To identify, as a function of clinical factors among patients diagnosed in 1996-2005, changes in the proportion of patients treated with newer radiation modalities as well as in over-all treatment approaches. We will also examine whether the use of new treatment modalities is associated with increases in the percentage of patients receiving cancer therapy; Aim 2: To identify factors associated with adoption of new radiation modalities including provider, health system, and non-clinical patient factors; Aim 3: To determine the total costs to the Medicare fee for service program for initial care of breast, lung, and prostate cancer in 2006-08 and the proportion of these costs that are associated with radiation modalities; Aim 4: To compare the effectiveness of radiation treatment modalities. This retrospective, longitudinal study will use population-based data obtained from the Center for Medicare and Medicaid Services (CMS) and the National Cancer Institute. This SEER-Medicare database will be used to delineate changes in cancer therapy according to cancer and comorbidity strata for patients diagnosed through 2005. We will also obtain a 100% sample of Medicare fee-for-service beneficiaries with breast, lung, or prostate cancer during 2006-2008, providing a comprehensive and timely assessment of cancer care, costs, and comparative outcomes. An experienced study team will conduct a methodologically rigorous analysis that includes multilevel, hierarchical modeling to account for clustering of patients at the physician and geographic level. Prior assessments of cancer care have not incorporated both cancer and comorbidity status into a comprehensive assessment of likelihood of benefit of cancer therapy. Addressing these knowledge gaps is critical for understanding the patient and health-system factors that affect the adoption of these technologies, as well as the implications for costs and outcomes - providing potential targets for intervention to improve the effectiveness and efficiency of treatment strategies. PUBLIC HEALTH RELEVANCE: New and expensive radiation therapies are frequently being used to treat older persons with cancers of the lung, prostate or breast. However, little is known about the risks and benefits of these therapies, their costs, or factors associated with their use. The proposed study, using data from both National Cancer Institute as well as Center for Medicare and Medicaid Services, will examine new radiation therapy modalities among Medicare beneficiaries as a function of health status, in an effort to improve decision making about cancer treatments.

Back to top


Publications

For-profit hospital ownership status and use of brachytherapy after breast-conserving surgery.
Authors: Sen S, Soulos PR, Herrin J, Roberts KB, Yu JB, Lesnikoski BA, Ross JS, Krumholz HM, Gross CP
Source: Surgery, 2014 May;155(5), p. 776-88.
EPub date: 2013 Dec 15.
PMID: 24787104
Related Citations

Back to top


Stereotactic body radiation therapy versus intensity-modulated radiation therapy for prostate cancer: comparison of toxicity.
Authors: Yu JB, Cramer LD, Herrin J, Soulos PR, Potosky AL, Gross CP
Source: J Clin Oncol, 2014 Apr 20;32(12), p. 1195-201.
EPub date: 2014 Mar 10.
PMID: 24616315
Related Citations

Back to top


Examining the cost-effectiveness of radiation therapy among older women with favorable-risk breast cancer.
Authors: Sen S, Wang SY, Soulos PR, Frick KD, Long JB, Roberts KB, Yu JB, Evans SB, Chagpar AB, Gross CP
Source: J Natl Cancer Inst, 2014 Mar;106(3), p. dju008.
EPub date: 2014 Mar 5.
PMID: 24598714
Related Citations

Back to top


The cost implications of prostate cancer screening in the Medicare population.
Authors: Ma X, Wang R, Long JB, Ross JS, Soulos PR, Yu JB, Makarov DV, Gold HT, Gross CP
Source: Cancer, 2014 Jan 1;120(1), p. 96-102.
EPub date: 2013 Oct 4.
PMID: 24122801
Related Citations

Back to top


Trends and clinical implications of preoperative breast MRI in Medicare beneficiaries with breast cancer.
Authors: Killelea BK, Long JB, Chagpar AB, Ma X, Soulos PR, Ross JS, Gross CP
Source: Breast Cancer Res Treat, 2013 Aug;141(1), p. 155-63.
EPub date: 2013 Aug 14.
PMID: 23942872
Related Citations

Back to top


Reply to L.W. Cuttino et al.
Authors: Presley CJ, Soulos PR, Herrin J, Roberts KB, Yu JB, Gross CP
Source: J Clin Oncol, 2013 Jun 10;31(17), p. 2227-9.
PMID: 23901421
Related Citations

Back to top


A new approach to understanding racial disparities in prostate cancer treatment.
Authors: Presley CJ, Raldow AC, Cramer LD, Soulos PR, Long JB, Yu JB, Makarov DV, Gross CP
Source: J Geriatr Oncol, 2013 Jan;4(1), p. 1-8.
PMID: 23828723
Related Citations

Back to top


The relation between age and androgen deprivation therapy use among men in the Medicare population receiving radiation therapy for prostate cancer.
Authors: Quon JL, Yu JB, Soulos PR, Gross CP
Source: J Geriatr Oncol, 2013 Jan;4(1), p. 9-18.
PMID: 23482846
Related Citations

Back to top


The cost of breast cancer screening in the Medicare population.
Authors: Gross CP, Long JB, Ross JS, Abu-Khalaf MM, Wang R, Killelea BK, Gold HT, Chagpar AB, Ma X
Source: JAMA Intern Med, 2013 Feb 11;173(3), p. 220-6.
PMID: 23303200
Related Citations

Back to top


Proton versus intensity-modulated radiotherapy for prostate cancer: patterns of care and early toxicity.
Authors: Yu JB, Soulos PR, Herrin J, Cramer LD, Potosky AL, Roberts KB, Gross CP
Source: J Natl Cancer Inst, 2013 Jan 2;105(1), p. 25-32.
EPub date: 2012 Dec 14.
PMID: 23243199
Related Citations

Back to top


Use of new treatment modalities for non-small cell lung cancer care in the Medicare population.
Authors: Vest MT, Herrin J, Soulos PR, Decker RH, Tanoue L, Michaud G, Kim AW, Detterbeck F, Morgensztern D, Gross CP
Source: Chest, 2013 Feb 1;143(2), p. 429-35.
PMID: 23187634
Related Citations

Back to top


The adoption of new adjuvant radiation therapy modalities among Medicare beneficiaries with breast cancer: clinical correlates and cost implications.
Authors: Roberts KB, Soulos PR, Herrin J, Yu JB, Long JB, Dostaler E, Gross CP
Source: Int J Radiat Oncol Biol Phys, 2013 Apr 1;85(5), p. 1186-92.
EPub date: 2012 Nov 20.
PMID: 23182396
Related Citations

Back to top


Variation in receipt of radiation therapy after breast-conserving surgery: assessing the impact of physicians and geographic regions.
Authors: Feinstein AJ, Soulos PR, Long JB, Herrin J, Roberts KB, Yu JB, Gross CP
Source: Med Care, 2013 Apr;51(4), p. 330-8.
PMID: 23151590
Related Citations

Back to top


Patterns of use and short-term complications of breast brachytherapy in the national medicare population from 2008-2009.
Authors: Presley CJ, Soulos PR, Herrin J, Roberts KB, Yu JB, Killelea B, Lesnikoski BA, Long JB, Gross CP
Source: J Clin Oncol, 2012 Dec 10;30(35), p. 4302-7.
EPub date: 2012 Oct 22.
PMID: 23091103
Related Citations

Back to top


Impact of the 2008 US Preventive Services Task Force recommendation to discontinue prostate cancer screening among male Medicare beneficiaries.
Authors: Ross JS, Wang R, Long JB, Gross CP, Ma X
Source: Arch Intern Med, 2012 Nov 12;172(20), p. 1601-3.
PMID: 22987029
Related Citations

Back to top


Characteristics associated with the use of nonanatomic resections among Medicare patients undergoing resections of early-stage lung cancer.
Authors: Kim AW, Detterbeck FC, Boffa DJ, Decker RH, Soulos PR, Cramer LD, Gross CP
Source: Ann Thorac Surg, 2012 Sep;94(3), p. 895-901.
EPub date: 2012 Jul 25.
PMID: 22835558
Related Citations

Back to top


Assessing the impact of a cooperative group trial on breast cancer care in the medicare population.
Authors: Soulos PR, Yu JB, Roberts KB, Raldow AC, Herrin J, Long JB, Gross CP
Source: J Clin Oncol, 2012 May 10;30(14), p. 1601-7.
EPub date: 2012 Mar 5.
PMID: 22393088
Related Citations

Back to top


The relationship between clinical benefit and receipt of curative therapy for prostate cancer.
Authors: Raldow AC, Presley CJ, Yu JB, Sharma R, Cramer LD, Soulos PR, Long JB, Makarov DV, Gross CP
Source: Arch Intern Med, 2012 Feb 27;172(4), p. 362-3.
PMID: 22371925
Related Citations

Back to top


Thoroughness of mediastinal staging in stage IIIA non-small cell lung cancer.
Authors: Vest MT, Tanoue L, Soulos PR, Kim AW, Detterbeck F, Morgensztern D, Gross CP
Source: J Thorac Oncol, 2012 Jan;7(1), p. 188-95.
PMID: 22134069
Related Citations

Back to top