Access to Cancer Specialist Care and Treatment in Patients With Advanced Stage Lung Cancer |
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Authors: | Apar Kishor Ganti Fred R. Hirsch Murry W. Wynes Arliene Ravelo Suresh S. Ramalingam Raluca Ionescu-Ittu Irina Pivneva Hossein Borghaei |
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Affiliation: | 1. Veteran''s Affairs Nebraska–Western Iowa Health Care System, University of Nebraska Medical Center, Omaha, NE;2. Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO;3. International Association for the Study of Lung Cancer (IASLC), Aurora, CO;4. Genentech Inc, South San Francisco, CA;5. Medical Oncology, Emory University Winship Cancer Institute, Atlanta, GA;6. Analysis Group Inc, Montreal, Quebec, Canada;7. Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA |
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Abstract: | BackgroundAccess to specialty care is critical for patients with advanced stage lung cancer. This study assessed access to cancer specialists and cancer treatment in a broad population of patients with advanced stage lung cancer.Materials and MethodsTwo study samples were extracted from 2 claims databases and analyzed independently: patients aged ≥ 18 years with de novo diagnosis of metastatic lung cancer in the MarketScan database between 2008 and 2014 (commercially insured adult patients; n = 22,268); and patients aged ≥ 65 years in the Surveillance, Epidemiology, and End Results–Medicare database with a diagnosis of advanced non–small-cell lung cancer between 2007 and 2011 (Medicare-insured elderly patients; n = 9651). The study period spanned from 6 weeks before the first lung biopsy tied to the initial lung cancer diagnosis until the end of continuous health insurance enrollment, or data availability, or death.ResultsAmong the commercially insured adults (MarketScan), most patients were seen by a cancer specialist within a month of first lung biopsy (80%), 12% were never seen by a cancer specialist, and 6% did not receive cancer-directed therapy. Among the Medicare-insured elderly patients (SEER–Medicare), the proportions were 79%, 4%, and 10%, respectively. Patients seen by a cancer specialist were more likely to receive cancer-directed therapy (95% vs. 92%, P < .001 and 92% vs. 38%, P < .001, respectively).ConclusionBetween 4% and 12% of patients with advanced stage lung cancer do not have appropriate access to cancer specialist, which appears to negatively affect access to optimal and timely treatment. |
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Keywords: | Access to care Cancer-directed therapy Metastatic lung cancer Non–small-cell lung cancer Referral |
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