Trends in treatment of XXXX in the Medicare population.

@entity1 @entity43 @entity5
OBJECTIVE: Optimal care for most @entity1 with advanced @entity43 generally includes both surgery and chemotherapy. Little is known about the proportion of @entity1 in the US who receive combination care or the sequence in which this care is delivered. This study evaluated patterns of care, frequency of completion of recommended therapy and factors associated with sequencing of therapy. METHODS: Using the Surveillance, Epidemiology and End-Results data we identified a cohort of 8211 @entity1 aged 65 and above with stage III/IV epithelial @entity43 diagnosed between 1995 and 2005. Receipt of chemotherapy or surgery was identified using Medicare claims. Logistic regression was used to evaluate factors associated with sequencing of treatment and the receipt of surgery. RESULTS: 3241 (39.1%) had surgery and at least 6 cycles of chemotherapy in either order. Surgery was performed initially in 4827 (58.8%) @entity1 and 3658/4827 (75.8%) had subsequent chemotherapy. 2017 (24.6%) had primary chemotherapy and 649/2017 (32.2%) of these @entity1 had subsequent surgery. Advanced age, African American race, stage IV disease, non-married status and increasing medical comorbidity were all associated with the failure to receive both surgery and at least 6 cycles of chemotherapy (all p<0.01). CONCLUSIONS: The majority of @entity1 with advanced @entity43 in the Medicare population do not receive both combination therapy with surgery and at least 6 cycles of chemotherapy. A large proportion of @entity1 are receiving chemotherapy as primary treatment for advanced @entity43 , and the majority of these @entity1 do not have @entity5 -directed surgery.
