Grant Number:	1R01CA149045-01 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:	2010

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.




An empiric approach to identifying physician peer groups from claims data: An example from breast cancer care.
Authors: Herrin J. , Soulos P.R. , Xu X. , Gross C.P. , Pollack C.E. .
Source: Health Services Research, 2018-11-28 00:00:00.0; , .
EPub date: 2018-11-28 00:00:00.0.
PMID: 30488484
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Quality Of Breast Cancer Care In The US Territories: Insights From Medicare.
Authors: Layne T.M. , Aminawung J.A. , Soulos P.R. , Nunez-Smith M. , Nunez M.A. , Jones B.A. , Wang K.H. , Gross C.P. .
Source: Health Affairs (project Hope), 2018 03; 37(3), p. 421-428.
PMID: 29505365
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Regional Medicare Expenditures and Survival Among Older Women With Localized Breast Cancer.
Authors: Tannenbaum S. , Soulos P.R. , Herrin J. , Mougalian S. , Long J.B. , Wang R. , Ma X. , Gross C.P. , Xu X. .
Source: Medical Care, 2017 Dec; 55(12), p. 1030-1038.
PMID: 29068906
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Myelodysplastic Syndromes and Acute Myeloid Leukemia After Radiotherapy for Prostate Cancer: A Population-Based Study.
Authors: Wang R. , Zeidan A.M. , Yu J.B. , Soulos P.R. , Davidoff A.J. , Gore S.D. , Huntington S.F. , Gross C.P. , Ma X. .
Source: The Prostate, 2017 Apr; 77(5), p. 437-445.
EPub date: 2016-11-21 00:00:00.0.
PMID: 27868212
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The Role of Patient Factors, Cancer Characteristics, and Treatment Patterns in the Cost of Care for Medicare Beneficiaries with Breast Cancer.
Authors: Xu X. , Herrin J. , Soulos P.R. , Saraf A. , Roberts K.B. , Killelea B.K. , Wang S.Y. , Long J.B. , Wang R. , Ma X. , et al. .
Source: Health Services Research, 2016 Feb; 51(1), p. 167-86.
PMID: 26119176
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Physician's peer exposure and the adoption of a new cancer treatment modality.
Authors: Pollack C.E. , Soulos P.R. , Gross C.P. .
Source: Cancer, 2015-08-15 00:00:00.0; 121(16), p. 2799-807.
EPub date: 2015-08-15 00:00:00.0.
PMID: 25903304
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Comparative effectiveness of surgery and radiosurgery for stage I non-small cell lung cancer.
Authors: Yu J.B. , Soulos P.R. , Cramer L.D. , Decker R.H. , Kim A.W. , Gross C.P. .
Source: Cancer, 2015-07-15 00:00:00.0; 121(14), p. 2341-9.
EPub date: 2015-07-15 00:00:00.0.
PMID: 25847699
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Older women with localized breast cancer: costs and survival rates increased across two time periods.
Authors: Feinstein A.J. , Long J. , Soulos P.R. , Ma X. , Herrin J. , Frick K.D. , Chagpar A.B. , Krumholz H.M. , Yu J.B. , Ross J.S. , et al. .
Source: Health Affairs (project Hope), 2015 Apr; 34(4), p. 592-600.
PMID: 25847641
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Adoption of hypofractionated whole-breast irradiation for early-stage breast cancer: a National Cancer Data Base analysis.
Authors: Wang E.H. , Mougalian S.S. , Soulos P.R. , Rutter C.E. , Evans S.B. , Haffty B.G. , Gross C.P. , Yu J.B. .
Source: International Journal Of Radiation Oncology, Biology, Physics, 2014-12-01 00:00:00.0; 90(5), p. 993-1000.
EPub date: 2014-12-01 00:00:00.0.
PMID: 25149661
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Reply to K. Quan et al, S.p. Collins et al, C.R. King et al, S. Arcangeli et Al, D.B. Fuller, and D. Vordermark.
Authors: Yu J.B. , Cramer L.D. , Herrin J. , Soulos P.R. , Potosky A.L. , Gross C.P. .
Source: Journal Of Clinical Oncology : Official Journal Of The American Society Of Clinical Oncology, 2014-10-20 00:00:00.0; 32(30), p. 3456-7.
EPub date: 2014-10-20 00:00:00.0.
PMID: 25185090
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Development and validation of a prognostic index for fracture risk in older men undergoing prostate cancer treatment.
Authors: Graham-Steed T.R. , Soulos P.R. , Dearing N. , Concato J. , Tinetti M.E. , Gross C.P. .
Source: Journal Of Geriatric Oncology, 2014-10-01 00:00:00.0; 5(4), p. 343-51.
EPub date: 2014-10-01 00:00:00.0.
PMID: 25240918
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Response.
Authors: Sen S. , Wang S.Y. , Soulos P.R. , Frick K.D. , Long J.B. , Roberts K.B. , Yu J.B. , Evans S.B. , Chagpar A.B. , Gross C.P. .
Source: Journal Of The National Cancer Institute, 2014 Sep; 106(9), .
PMID: 25114276
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Understanding regional variation in Medicare expenditures for initial episodes of prostate cancer care.
Authors: Wang S.Y. , Wang R. , Yu J.B. , Ma X. , Xu X. , Kim S.P. , Soulos P.R. , Saraf A. , Gross C.P. .
Source: Medical Care, 2014 Aug; 52(8), p. 680-7.
PMID: 25023913
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Evolution of breast cancer screening in the Medicare population: clinical and economic implications.
Authors: Killelea B.K. , Long J.B. , Chagpar A.B. , Ma X. , Wang R. , Ross J.S. , Gross C.P. .
Source: Journal Of The National Cancer Institute, 2014 Aug; 106(8), .
PMID: 25031307
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For-profit hospital ownership status and use of brachytherapy after breast-conserving surgery.
Authors: Sen S. , Soulos P.R. , Herrin J. , Roberts K.B. , Yu J.B. , Lesnikoski B.A. , Ross J.S. , Krumholz H.M. , Gross C.P. .
Source: Surgery, 2014 May; 155(5), p. 776-88.
PMID: 24787104
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Stereotactic body radiation therapy versus intensity-modulated radiation therapy for prostate cancer: comparison of toxicity.
Authors: Yu J.B. , Cramer L.D. , Herrin J. , Soulos P.R. , Potosky A.L. , Gross C.P. .
Source: Journal Of Clinical Oncology : Official Journal Of The American Society Of Clinical Oncology, 2014-04-20 00:00:00.0; 32(12), p. 1195-201.
EPub date: 2014-04-20 00:00:00.0.
PMID: 24616315
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Examining the cost-effectiveness of radiation therapy among older women with favorable-risk breast cancer.
Authors: Sen S. , Wang S.Y. , Soulos P.R. , Frick K.D. , Long J.B. , Roberts K.B. , Yu J.B. , Evans S.B. , Chagpar A.B. , Gross C.P. .
Source: Journal Of The National Cancer Institute, 2014 Mar; 106(3), p. dju008.
PMID: 24598714
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The cost implications of prostate cancer screening in the Medicare population.
Authors: Ma X. , Wang R. , Long J.B. , Ross J.S. , Soulos P.R. , Yu J.B. , Makarov D.V. , Gold H.T. , Gross C.P. .
Source: Cancer, 2014-01-01 00:00:00.0; 120(1), p. 96-102.
EPub date: 2014-01-01 00:00:00.0.
PMID: 24122801
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Trends and clinical implications of preoperative breast MRI in Medicare beneficiaries with breast cancer.
Authors: Killelea B.K. , Long J.B. , Chagpar A.B. , Ma X. , Soulos P.R. , Ross J.S. , Gross C.P. .
Source: Breast Cancer Research And Treatment, 2013 Aug; 141(1), p. 155-63.
PMID: 23942872
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Reply to L.W. Cuttino et al.
Authors: Presley C.J. , Soulos P.R. , Herrin J. , Roberts K.B. , Yu J.B. , Gross C.P. .
Source: Journal Of Clinical Oncology : Official Journal Of The American Society Of Clinical Oncology, 2013-06-10 00:00:00.0; 31(17), p. 2227-9.
PMID: 23901421
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Variation in receipt of radiation therapy after breast-conserving surgery: assessing the impact of physicians and geographic regions.
Authors: Feinstein A.J. , Soulos P.R. , Long J.B. , Herrin J. , Roberts K.B. , Yu J.B. , Gross C.P. .
Source: Medical Care, 2013 Apr; 51(4), p. 330-8.
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The adoption of new adjuvant radiation therapy modalities among Medicare beneficiaries with breast cancer: clinical correlates and cost implications.
Authors: Roberts K.B. , Soulos P.R. , Herrin J. , Yu J.B. , Long J.B. , Dostaler E. , Gross C.P. .
Source: International Journal Of Radiation Oncology, Biology, Physics, 2013-04-01 00:00:00.0; 85(5), p. 1186-92.
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The cost of breast cancer screening in the Medicare population.
Authors: Gross C.P. , Long J.B. , Ross J.S. , Abu-Khalaf M.M. , Wang R. , Killelea B.K. , Gold H.T. , Chagpar A.B. , Ma X. .
Source: Jama Internal Medicine, 2013-02-11 00:00:00.0; 173(3), p. 220-6.
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Use of new treatment modalities for non-small cell lung cancer care in the Medicare population.
Authors: Vest M.T. , Herrin J. , Soulos P.R. , Decker R.H. , Tanoue L. , Michaud G. , Kim A.W. , Detterbeck F. , Morgensztern D. , Gross C.P. .
Source: Chest, 2013-02-01 00:00:00.0; 143(2), p. 429-35.
PMID: 23187634
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Proton versus intensity-modulated radiotherapy for prostate cancer: patterns of care and early toxicity.
Authors: Yu J.B. , Soulos P.R. , Herrin J. , Cramer L.D. , Potosky A.L. , Roberts K.B. , Gross C.P. .
Source: Journal Of The National Cancer Institute, 2013-01-02 00:00:00.0; 105(1), p. 25-32.
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The relation between age and androgen deprivation therapy use among men in the Medicare population receiving radiation therapy for prostate cancer.
Authors: Quon J.L. , Yu J.B. , Soulos P.R. , Gross C.P. .
Source: Journal Of Geriatric Oncology, 2013 Jan; 4(1), p. 9-18.
PMID: 23482846
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A new approach to understanding racial disparities in prostate cancer treatment.
Authors: Presley C.J. , Raldow A.C. , Cramer L.D. , Soulos P.R. , Long J.B. , Yu J.B. , Makarov D.V. , Gross C.P. .
Source: Journal Of Geriatric Oncology, 2013 Jan; 4(1), p. 1-8.
PMID: 23828723
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Patterns of use and short-term complications of breast brachytherapy in the national medicare population from 2008-2009.
Authors: Presley C.J. , Soulos P.R. , Herrin J. , Roberts K.B. , Yu J.B. , Killelea B. , Lesnikoski B.A. , Long J.B. , Gross C.P. .
Source: Journal Of Clinical Oncology : Official Journal Of The American Society Of Clinical Oncology, 2012-12-10 00:00:00.0; 30(35), p. 4302-7.
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Impact of the 2008 US Preventive Services Task Force recommendation to discontinue prostate cancer screening among male Medicare beneficiaries.
Authors: Ross J.S. , Wang R. , Long J.B. , Gross C.P. , Ma X. .
Source: Archives Of Internal Medicine, 2012-11-12 00:00:00.0; 172(20), p. 1601-3.
PMID: 22987029
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Characteristics associated with the use of nonanatomic resections among Medicare patients undergoing resections of early-stage lung cancer.
Authors: Kim A.W. , Detterbeck F.C. , Boffa D.J. , Decker R.H. , Soulos P.R. , Cramer L.D. , Gross C.P. .
Source: The Annals Of Thoracic Surgery, 2012 Sep; 94(3), p. 895-901.
PMID: 22835558
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Assessing the impact of a cooperative group trial on breast cancer care in the medicare population.
Authors: Soulos P.R. , Yu J.B. , Roberts K.B. , Raldow A.C. , Herrin J. , Long J.B. , Gross C.P. .
Source: Journal Of Clinical Oncology : Official Journal Of The American Society Of Clinical Oncology, 2012-05-10 00:00:00.0; 30(14), p. 1601-7.
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The relationship between clinical benefit and receipt of curative therapy for prostate cancer.
Authors: Raldow A.C. , Presley C.J. , Yu J.B. , Sharma R. , Cramer L.D. , Soulos P.R. , Long J.B. , Makarov D.V. , Gross C.P. .
Source: Archives Of Internal Medicine, 2012-02-27 00:00:00.0; 172(4), p. 362-3.
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Thoroughness of mediastinal staging in stage IIIA non-small cell lung cancer.
Authors: Vest M.T. , Tanoue L. , Soulos P.R. , Kim A.W. , Detterbeck F. , Morgensztern D. , Gross C.P. .
Source: Journal Of Thoracic Oncology : Official Publication Of The International Association For The Study Of Lung Cancer, 2012 Jan; 7(1), p. 188-95.
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