Quality of treatment selection for medicare beneficiaries with cancer Journal Article


Authors: Mitchell, A. P.; Persaud, S.; Mishra Meza, A.; Fuchs, H. E.; De, P.; Tabatabai, S.; Chakraborty, N.; Dey, P.; Trivedi, N. U.; Mailankody, S.; Blinder, V.; Green, A.; Epstein, A. S.; Daly, B.; Roeker, L.; Bach, P. B.; Gönen, M.
Article Title: Quality of treatment selection for medicare beneficiaries with cancer
Abstract: PURPOSEThe Medicare part D Low-Income Subsidy (LIS) improves access to oral cancer drugs, but provides no assistance for clinician-administered/part B drugs. This analysis assessed the association between LIS participation and receipt of optimal cancer treatment.METHODSWe investigated initial systemic therapy using SEER-Medicare data (2015-2017) and National Comprehensive Cancer Network (NCCN) Evidence Blocks (EB) as the standard for treatment recommendations. We included cancer clinical scenarios wherein (1) ≥one treatment was optimal (higher efficacy and safety scores) versus other treatments; (2) identifiable in SEER-Medicare (eg, not defined by clinical data unavailable in registry data or claims); and (3) both EB and ASCO Value Framework agreed regarding optimal treatment. We fit logistic regression models to assess the association between receipt of systemic therapy (v no therapy) and patient and provider characteristics. Contingent on receipt of treatment, we modeled the likelihood of receiving a treatment ranked (by EB scores) within the highest or lowest quartile for that cancer type.RESULTSNine thousand two hundred and ninety patients were included across 11 clinical scenarios. Fifty-seven percent (5,336) of patients received any systemic therapy and 43% (3,954) received no systemic therapy. Compared with non-LIS participants, LIS participants were less likely to receive any systemic therapy versus no systemic therapy (odds ratio, 0.64 [95% CI, 0.57 to 0.72]). Contingent on receiving systemic therapy, LIS participants received treatment ranked within the worst quartile 24.8% of the time, compared with 21.9% of non-LIS patients (adjusted prevalence difference, 4.3% [95% CI, 0.5 to 8.2]).CONCLUSIONLIS participants were less likely to receive systemic therapy at all and were more likely to receive treatments that receive low NCCN EB scores. © American Society of Clinical Oncology.
Keywords: cancer chemotherapy; aged; aged, 80 and over; major clinical study; systemic therapy; united states; cancer patient; pancreas cancer; cancer staging; antineoplastic agent; neoplasm; neoplasms; melanoma; metastasis; cohort analysis; cancer therapy; health care quality; drug cost; medicare; lung adenocarcinoma; comorbidity; cancer registry; seer program; stomach cancer; drug therapy; chronic lymphatic leukemia; logistic regression analysis; univariate analysis; therapy; myeloma; caucasian; billing and claims; non small cell lung cancer; metastatic melanoma; clinical outcome; very elderly; humans; human; male; female; article; malignant neoplasm; medicare part d
Journal Title: Journal of Clinical Oncology
Volume: 43
Issue: 5
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2025-02-10
Start Page: 524
End Page: 535
Language: English
DOI: 10.1200/jco.24.00459
PUBMED: 39393041
PROVIDER: scopus
PMCID: PMC12178663
DOI/URL:
Notes: The MSK Cancer Center Support Grant (P30 CA008748) is acknowledge in the PDF -- Corresponding authors is MSK author: Aaron P. Mitchell -- Source: Scopus
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MSK Authors
  1. Mithat Gonen
    1029 Gonen
  2. Victoria Susana Blinder
    111 Blinder
  3. Andrew Saul Epstein
    157 Epstein
  4. Robert M Daly
    78 Daly
  5. Angela Kellen Green
    42 Green
  6. Lindsey Elizabeth Roeker
    132 Roeker
  7. Akriti Mishra
    25 Mishra
  8. Hannah Fuchs
    7 Fuchs
  9. Sonia Persaud
    21 Persaud