A COMPARISON OF PATTERNS OF CARE OF NONSMALL CELL LUNG-CARCINOMA PATIENTS IN A YOUNGER AND MEDIGAP COMMERCIALLY INSURED COHORT

BACKGROUND, The objective of this study was to examine and compare lif etime treatment patterns and hospitalization of incident nonsmall cell lung carcinoma (NSCLC) between pre-Medicare eligible (age < 65 years) and supplemental Medi-gap (age < 65 years) enrollees in a commerciall y insured cohort using insurance claims. METHODS. Claims from Virginia Blue Cross and Blue Shield beneficiaries with NSCLC submitted between 1989-1991 were merged with records from the Virginia Cancer Registry (VCR). Data from the VCR identified incident cases, disease stage, and type of tumor. Initial treatment categories were stratified using Phy sicians' Current Procedural Terminology codes. RESULTS, There were 170 6 incident NSCLC patients; 349 were age less than or equal to 64 years (''younger'') and 1212 were age greater than or equal to 65 years ('' elderly''). Having commercial insurance was not associated with any su rvival advantage compared with national averages at 2 years. In compar ison with elderly patients, younger patients more often were treated w ith surgery for local disease (80.2% vs. 54.8%) and surgery alone or i n combination with radiation for regional disease (51.9% vs. 32.0%). R adiation was used more often in elderly patients compared with younger patients with local disease (30.5% vs. 14.0%) but less often in patie nts with distant disease (76.2% vs. 54.9%). Compared with elderly pati ents, younger patients presenting with distant disease received more c hemotherapy (18.8% vs. 5.1%; P < 0.001); late palliative use of chemot herapy or radiation occurred in only 4-8% of younger patients. Compare d with elderly patients, younger patients with regional or distant dis ease spent more days in the hospital (compared with national averages at 2 years: regional disease, 30.0 vs. 23.9 days; distant disease, 33. 0 vs. 21.4 days; P < 0.0001). CONCLUSIONS. The results of this study s how that more comprehensive health insurance is not associated with be tter outcomes in patients with NSCLC. Age specific trends for greater use of surgery, radiation, and total hospitalization in younger patien ts is consistent with other reports. Commercial health care claims sup plemented by clinical staging from cancer registries can address long term practice patterns in patients with cancer. Cancer 1998;83:1930-7. (C) 1998 American Cancer Society.