Adjuvant Chemotherapy After Resection in Elderly Medicare and Medicaid Patients With Colon Cancer

Department of Health Administration and Massey Cancer Center, Virginia Commonwealth University, Richmond, VA 23298-0203, USA.
Archives of Internal Medicine (Impact Factor: 17.33). 04/2008; 168(5):521-9. DOI: 10.1001/archinternmed.2007.82
Source: PubMed


This study investigated the influence of Medicaid enrollment on the receipt and completion of adjuvant chemotherapy and the likelihood of evaluation by an oncologist for those patients who do not initiate chemotherapy.
Medicaid and Medicare administrative data were merged with the Michigan Tumor Registry to extract a sample of patients who had resection for a first primary colon tumor diagnosed between January 1, 1997, and December 31, 2000 (n = 4765). We used unadjusted and adjusted logistic regression to assess the relationship between Medicaid enrollment and the outcomes of interest.
Relative to Medicare patients, Medicaid patients were less likely to initiate chemotherapy (odds ratio, 0.50; 95% confidence interval, 0.39-0.65) or complete chemotherapy (odds ratio, 0.52; 95% confidence interval, 0.31-0.85). When the sample was restricted to patients with TNM-staged disease, Medicaid patients were less likely to initiate chemotherapy. Older patients and patients with comorbidities were also less likely to initiate or, in some cases, to complete chemotherapy.
Medicaid enrollment is associated with disparate colon cancer treatment, which likely compromises the long-term survival of these patients.

Download full-text


Available from: Bassam A Dahman, Sep 01, 2015
  • Source
    • "Colorectal cancer is a common malignancy and its incidence is increasing in industrialized countries [1]. While there are several studies on new drugs for colorectal cancer [2-4], fewer studies have been conducted to assess the appropriateness and equity of care provided to colorectal cancer patients at a population level [5-7]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: The present study focuses on the analysis of social, clinical and hospital characteristics that can lead to disparities in the management and outcome of care. To that end, indicators of the quality of initial treatment delivered to newly-diagnosed colorectal cancer patients in a North-Western Region of Italy, were investigated using administrative data. Methods: The cohort includes all incident colorectal cancer patients (N = 24,187) selected by a validated algorithm from the Piedmont Hospital Discharge Record system over an 8-year period (2000-2007).Three indicators of quality of care in this population-based cohort were evaluated: the proportion of preoperative radiotherapy (RT) and of abdominoperineal (AP) resection in rectal cancer patients, and the proportion of postoperative in-hospital mortality in colorectal cancer patients. Results: Among rectal cancers, older patients were less likely to have preoperative RT, and more likely to receive an AP resection compared to younger patients. The probability of undergoing preoperative RT and AP resection was reduced in females compared to males (odds ratio (OR) 0.77, 95% confidence interval (CI) 0.64-0.93 and OR 0.78, 95%CI 0.69-0.89, respectively). However, there was a trend of increasing RT over time (p for trend <0.01). The probability of undergoing AP resection was increased in less-educated patients and in hospitals with a low caseload.A higher risk of postoperative in-hospital mortality was found among colorectal cancer patients who were older, male, (female versus male OR 0.71, 95%CI 0.60-0.84), unmarried (OR 1.32, 95%CI 1.09-1.59) or with unknown marital status. Conclusions: The study provides evidence of the importance of social, clinical and hospital characteristics on the equity and quality of care in a Southern European country with an open-access public health care system.
    Full-text · Article · Sep 2012 · BMC Public Health
  • [Show abstract] [Hide abstract]
    ABSTRACT: Cancer is a disease of aging; approximately 60% of all cancers and 70% of cancer mortality occur in persons aged 65 years and over. Aging is a highly individualized process, characterized by physiologic and psychosocial changes that can affect tolerance to treatment. Older patients are a highly heterogeneous group, with varying levels of risk for functional or physical decline and mortality. Historically, clinical trials have not reflected the general population of older cancer patients due to the low numbers of older patients included and the strict inclusion criteria for healthy, “fit” older adults [1]. Therefore, the majority of patients aged 65 years and older with cancer are treated based on data derived from clinical trials that often describe the effects of treatment on the median-age population enrolled in the studies or on the elderly with good performance status.
    No preview · Chapter · Jan 1970
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Recent work has shown how the support vector machine (SVM) framework can be used for blind equalization of constant modulus (CM) signals. The basic idea consists of exploiting the CM property of the input signals to reformulate the blind equalization problem as a regression problem. We extend this idea to encompass the problem of separating and estimating multiple CM signals mixed through an unknown matrix (i.e., blind beamforming). The quadratic inequalities derived from the CM property are transformed into linear ones, thus yielding a quadratic programming (QP) problem. Then an iterative reweighted procedure is proposed to blindly restore the CM property. Once a signal is recovered, its contribution to the original observations is removed and the iterative procedure can be applied again to extract another CM signal. Simulation results show that this SVM-based algorithm offers better performance than the algebraic constant modulus algorithm (ACMA), mainly when only a small number of snapshots is available.
    Preview · Conference Paper · Aug 2004
Show more