This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Du, X. Articles by Goodwin, J. S. Search for Related Content PubMed PubMed Citation Articles by Du, X. Articles by Goodwin, J. S. Social Bookmarking                            What's this?

Patterns of Use of Chemotherapy for Breast Cancer in Older Women: Findings From Medicare Claims Data

From the Department of Internal Medicine, Department of Preventive Medicine and Community Health, and Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX.

Address reprint requests to Xianglin Du, MD, PhD, Department of Internal Medicine, 3.134 Jennie Sealy Hospital, University of Texas Medical Branch, Galveston, TX 77555-0460; email: xdu{at}utmb.edu

PURPOSE: There is little population-based information available on the use of chemotherapy in women with breast cancer. This study describes the use of chemotherapy through analysis of Medicare claims and determines the correlates of chemotherapy use.

PATIENTS AND METHODS: We used the merged Surveillance, Epidemiology, and End Results–Medicare database and identified women 65 years of age diagnosed with breast cancer in 1991 and 1992. Chemotherapy was ascertained from Medicare claims through procedure codes for chemotherapy made within 24 months of the diagnosis.

RESULTS: In women with stages I, II, III, and IV breast cancer, the percentage receiving chemotherapy within 24 months of diagnosis was 5.1%, 19.5%, 33.9%, and 35.2%, respectively. Most women receiving chemotherapy had two to 12 claims; the median number was eight. Use of chemotherapy decreased significantly with age across all tumor stages; eg, in women with stage III cancer, the use of chemotherapy declined from 49% in those aged 65 to 69 years to 10% in those 80 years old. In a multivariate analysis, there was little variation by ethnicity. Chemotherapy use was highest (70%) in women aged 65 to 69 years with node-positive and estrogen receptor–negative tumors and lowest (5%) in those with node-negative and estrogen receptor–positive tumors. Compared with those without comorbid diseases, patients with a comorbidity score of 2 had significantly lower use of chemotherapy.

CONCLUSION: Medicare claims data seem to provide valuable information on the use of chemotherapy for breast cancer in older women. However, external validation of the accuracy and completeness of these data is required before any firm conclusion can be drawn.

This study used the Linked SEER-Medicare Database. The interpretation and reporting of these data are the sole responsibilities of the authors.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				M. J. Hassett, M. E. Hughes, J. C. Niland, S. B. Edge, R. L. Theriault, Y.-N. Wong, J. Wilson, W. B. Carter, D. W. Blayney, and J. C. Weeks Chemotherapy Use for Hormone Receptor-Positive, Lymph Node-Negative Breast Cancer J. Clin. Oncol., December 1, 2008; 26(34): 5553 - 5560. [Abstract] [Full Text] [PDF]

				I. Boncz, A. Sebestyen, I. Pinter, J. Betlehem, I. Kriszbacher, T. Csere, L. Mangel, and J. Bodis Age Group Specific Gap Between Treatment Cost of and Mortality Due to Breast and Colorectal Cancer J. Clin. Oncol., October 1, 2007; 25(28): 4501 - 4502. [Full Text] [PDF]

				M. C. Pinder, Z. Duan, J. S. Goodwin, G. N. Hortobagyi, and S. H. Giordano Congestive Heart Failure in Older Women Treated With Adjuvant Anthracycline Chemotherapy for Breast Cancer J. Clin. Oncol., September 1, 2007; 25(25): 3808 - 3815. [Abstract] [Full Text] [PDF]

				C. Bouchardy, E. Rapiti, S. Blagojevic, A.-T. Vlastos, and G. Vlastos Older Female Cancer Patients: Importance, Causes, and Consequences of Undertreatment J. Clin. Oncol., May 10, 2007; 25(14): 1858 - 1869. [Abstract] [Full Text] [PDF]

				D. Crivellari, M. Aapro, R. Leonard, G. von Minckwitz, E. Brain, A. Goldhirsch, A. Veronesi, and H. Muss Breast Cancer in the Elderly J. Clin. Oncol., May 10, 2007; 25(14): 1882 - 1890. [Abstract] [Full Text] [PDF]

				A Surbone, M Kagawa-Singer, C Terret, L Baider, and On behalf of the SIOG Task Force on Cultural Compe The illness trajectory of elderly cancer patients across cultures: SIOG position paper Ann. Onc., April 1, 2007; 18(4): 633 - 638. [Abstract] [Full Text] [PDF]

				E. P. McCarthy, L. H. Ngo, R. G. Roetzheim, T. N. Chirikos, D. Li, R. E. Drews, and L. I. Iezzoni Disparities in breast cancer treatment and survival for women with disabilities. Ann Intern Med, November 7, 2006; 145(9): 637 - 645. [Abstract] [Full Text] [PDF]

				R. Luo, S. H. Giordano, J. L. Freeman, D. Zhang, and J. S. Goodwin Referral to Medical Oncology: A Crucial Step in the Treatment of Older Patients with Stage III Colon Cancer Oncologist, October 1, 2006; 11(9): 1025 - 1033. [Abstract] [Full Text] [PDF]

				J. Mandelblatt Treating Breast Cancer: The Age Old Dilemma of Old Age J. Clin. Oncol., September 20, 2006; 24(27): 4369 - 4370. [Full Text] [PDF]

				G. Kimmick, F. Camacho, K. L. Foley, E. A. Levine, R. Balkrishnan, and R. Anderson Racial Differences in Patterns of Care Among Medicaid-Enrolled Patients With Breast Cancer J. Oncol. Pract, September 1, 2006; 2(5): 205 - 213. [Abstract] [Full Text] [PDF]

				S. H. Giordano, Z. Duan, Y.-F. Kuo, G. N. Hortobagyi, and J. S. Goodwin Use and Outcomes of Adjuvant Chemotherapy in Older Women With Breast Cancer J. Clin. Oncol., June 20, 2006; 24(18): 2750 - 2756. [Abstract] [Full Text] [PDF]

				E. B. Elkin, A. Hurria, N. Mitra, D. Schrag, and K. S. Panageas Adjuvant Chemotherapy and Survival in Older Women With Hormone Receptor-Negative Breast Cancer: Assessing Outcome in a Population-Based, Observational Cohort J. Clin. Oncol., June 20, 2006; 24(18): 2757 - 2764. [Abstract] [Full Text] [PDF]

				E. L. Trimble and M. C. Christian Cancer treatment and the older patient. Clin. Cancer Res., April 1, 2006; 12(7): 1956 - 1957. [Full Text] [PDF]

				L. C. Richardson, L. Tian, L. Voti, A. G. Hartzema, I. Reis, L. E. Fleming, and J. MacKinnon The Roles of Teaching Hospitals, Insurance Status, and Race/Ethnicity in Receipt of Adjuvant Therapy for Regional-Stage Breast Cancer in Florida Am J Public Health, January 1, 2006; 96(1): 160 - 166. [Abstract] [Full Text] [PDF]

				S. L.B. Miller, L. E. Jones, and C. P. Carney Psychiatric Sequelae Following Breast Cancer Chemotherapy: A Pilot Study Using Claims Data Psychosomatics, December 1, 2005; 46(6): 517 - 522. [Abstract] [Full Text] [PDF]

				J. J. Doyle, A. I. Neugut, J. S. Jacobson, V. R. Grann, and D. L. Hershman Chemotherapy and Cardiotoxicity in Older Breast Cancer Patients: A Population-Based Study J. Clin. Oncol., December 1, 2005; 23(34): 8597 - 8605. [Abstract] [Full Text] [PDF]

				X. L. Du, D. R. Lairson, C. E. Begley, and S. Fang Temporal and Geographic Variation in the Use of Hematopoietic Growth Factors in Older Women Receiving Breast Cancer Chemotherapy: Findings From a Large Population-Based Cohort J. Clin. Oncol., December 1, 2005; 23(34): 8620 - 8628. [Abstract] [Full Text] [PDF]

				J. N. Cormier, Y. Xing, M. Ding, J. E. Lee, P. F. Mansfield, J. E. Gershenwald, M. I. Ross, and X. L. Du Population-Based Assessment of Surgical Treatment Trends for Patients With Melanoma in the Era of Sentinel Lymph Node Biopsy J. Clin. Oncol., September 1, 2005; 23(25): 6054 - 6062. [Abstract] [Full Text] [PDF]

				X. L. Du, D. V. Jones, and D. Zhang Effectiveness of Adjuvant Chemotherapy for Node-Positive Operable Breast Cancer in Older Women J. Gerontol. A Biol. Sci. Med. Sci., September 1, 2005; 60(9): 1137 - 1144. [Abstract] [Full Text] [PDF]

				S. H. Giordano, G. N. Hortobagyi, S.-W. C. Kau, R. L. Theriault, and M. L. Bondy Breast Cancer Treatment Guidelines in Older Women J. Clin. Oncol., February 1, 2005; 23(4): 783 - 791. [Abstract] [Full Text] [PDF]

				C. Schairer, P. J. Mink, L. Carroll, and S. S. Devesa Probabilities of Death From Breast Cancer and Other Causes Among Female Breast Cancer Patients J Natl Cancer Inst, September 1, 2004; 96(17): 1311 - 1321. [Abstract] [Full Text] [PDF]

				A. Argiris, Y. Li, B. A. Murphy, C. J. Langer, and A. A. Forastiere Outcome of Elderly Patients With Recurrent or Metastatic Head and Neck Cancer Treated With Cisplatin-Based Chemotherapy J. Clin. Oncol., January 15, 2004; 22(2): 262 - 268. [Abstract] [Full Text] [PDF]

				X. L. Du and C. R. Key Chemotherapy in Women with Breast Cancer Ann Intern Med, November 18, 2003; 139(10): 868 - 869. [Full Text] [PDF]

				L. Penberthy, D. McClish, A. Pugh, W. Smith, C. Manning, and S. Retchin Using Hospital Discharge Files to Enhance Cancer Surveillance Am. J. Epidemiol., July 1, 2003; 158(1): 27 - 34. [Abstract] [Full Text] [PDF]

				X. L. Du Re: Trends in Use of Adjuvant Multi-Agent Chemotherapy and Tamoxifen for Breast Cancer in the United States: 1975-1999 J Natl Cancer Inst, May 7, 2003; 95(9): 683 - 683. [Full Text] [PDF]

				X. L. Du, C. R. Key, C. Osborne, J. D. Mahnken, and J. S. Goodwin Discrepancy between Consensus Recommendations and Actual Community Use of Adjuvant Chemotherapy in Women with Breast Cancer Ann Intern Med, January 21, 2003; 138(2): 90 - 97. [Abstract] [Full Text] [PDF]

				X. L. Du, C. Osborne, and J. S. Goodwin Population-Based Assessment of Hospitalizations for Toxicity From Chemotherapy in Older Women With Breast Cancer J. Clin. Oncol., December 15, 2002; 20(24): 4636 - 4642. [Abstract] [Full Text] [PDF]

				A. Mariotto, E. J. Feuer, L. C. Harlan, L.-M. Wun, K. A. Johnson, and J. Abrams Trends in Use of Adjuvant Multi-Agent Chemotherapy and Tamoxifen for Breast Cancer in the United States: 1975-1999 J Natl Cancer Inst, November 6, 2002; 94(21): 1626 - 1634. [Abstract] [Full Text] [PDF]

				J. L. Malin, M. A. Schuster, K. A. Kahn, and R. H. Brook Quality of Breast Cancer Care: What Do We Know? J. Clin. Oncol., November 1, 2002; 20(21): 4381 - 4393. [Abstract] [Full Text] [PDF]

				J. L. Malin, K. L. Kahn, J. Adams, L. Kwan, M. Laouri, and P. A. Ganz Validity of Cancer Registry Data for Measuring the Quality of Breast Cancer Care J Natl Cancer Inst, June 5, 2002; 94(11): 835 - 844. [Abstract] [Full Text] [PDF]

				C. J. Bradley, C. W. Given, and C. Roberts Race, Socioeconomic Status, and Breast Cancer Treatment and Survival J Natl Cancer Inst, April 3, 2002; 94(7): 490 - 496. [Abstract] [Full Text] [PDF]

				L. C. Harlan, J. Abrams, J. L. Warren, L. Clegg, J. Stevens, and R. Ballard-Barbash Adjuvant Therapy for Breast Cancer: Practice Patterns of Community Physicians J. Clin. Oncol., April 1, 2002; 20(7): 1809 - 1817. [Abstract] [Full Text] [PDF]

				H. B. Muss Older Age -- Not a Barrier to Cancer Treatment N. Engl. J. Med., October 11, 2001; 345(15): 1128 - 1129. [Full Text] [PDF]