Originally published as JCO Early Release 10.1200/JCO.2008.16.3071 on September 15 2008

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Treatment and Survival Differences in Older Medicare Patients With Lung Cancer as Compared With Those Who Are Dually Eligible for Medicare and Medicaid

Cathy J. Bradley, Bassam Dahman, Charles W. Given

From the Departments of Health Administration and Internal Medicine, Division of Quality Health Care, and Massey Cancer Center, Virginia Commonwealth University, Richmond, VA; and the Department of Family Medicine, Michigan State University, East Lansing, MI

Corresponding author: Cathy J. Bradley, PhD, Department of Health Administration and Massey Cancer Center, Virginia Commonwealth University, Grant House, 1008 Clay St, PO Box 980203, Richmond, VA 23298-0203; e-mail: cjbradley{at}vcu.edu

Purpose This study compares non–small-cell lung cancer (NSCLC) treatments provided to older patients (age 66 years) who are dually eligible for Medicare and Medicaid with treatments provided to similar patients who are insured by Medicare. We extend the analysis to include a comparison of survival rates between Medicare and dually eligible patients. Dual eligibility is associated with low socioeconomic status. However, Medicaid coverage in addition to Medicare removes many financial barriers to care.

Patients and Methods The sample included 2,626 older patients with local and regional stage NSCLC diagnosed between 1997 and 2000. Four outcomes were studied: the likelihood of receiving resection, chemotherapy, radiation therapy, and survival (perioperative and longer-term). Logistic regression was used to predict the likelihood of treatment, and stratified and multivariate analyses were used to evaluate differences in survival.

Results Dually eligible patients were half as likely to undergo resection as Medicare patients (P < .001) and were more likely to receive radiation than Medicare patients. Stratified and multivariate analyses showed that surgically treated dually eligible patients had slightly inferior survival as compared with that of Medicare patients. Survival was equivalent among patients who did not undergo resection, regardless of insurance coverage.

Conclusion Older dually eligible patients with NSCLC had a lower likelihood of undergoing resection despite controls for socioeconomic factors and comorbidities. However, if such patients were surgically treated, survival improved substantially, but it remained inferior to the survival of Medicare patients. Additional research is needed to understand why resection rates were substantially lower among dually eligible patients.

published online ahead of print at www.jco.org on September 15, 2008

Supported by National Cancer Institute Grant No. R01-CA101835-01, In-Depth Examination of Disparities in Cancer Outcomes (C.J.B., principal investigator).

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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