Advertisement

Disparities in the use of stereotactic radiosurgery for the treatment of lung cancer brain metastases: a SEER-Medicare study

  • Mustafa S. Ascha
  • Kaitlyn Funk
  • Andrew E. Sloan
  • Carol Kruchko
  • Jill S. Barnholtz-SloanEmail author
Research Paper
  • 11 Downloads

Abstract

Stereotactic radiosurgery (SRS) is a costly procedure used to irradiate disease tissue while sparing healthy tissue, ideally limiting the side effects of treatment. SRS is frequently used in the setting of lung cancer, which is associated with greater rates of BM, though its cost may lead to potentially inequitable use across patient populations. This study investigates potential disparities in the use of SRS to treat Medicare patients. Surveillance, Epidemiology, and End-Results cancer registry data for patients diagnosed between the years 2010 and 2012 were examined to identify lung cancer patients diagnosed with BM at the same time as their primary cancer (SBM). Medicare claims for SRS were identified; the odds of having SRS claims and hazards of mortality associated with those odds were examined with respect to various clinical and demographic characteristics. Of 74,142 Medicare-enrolled patients diagnosed with lung cancer, 9192 were diagnosed with SBM and 3259 of those patients received SRS. Adjusting for clinical and demographic characteristics, males with SBM had 0.85 times the odds of SRS compared to females with SBM. Black patients and those of other race had significantly lower odds of evidence of SRS compared to WNH patients. SRS may not be delivered equitably among Medicare patients. Males and minority patients may have decreased odds of SRS and worse survival compared to female and WNH patients, respectively.

Keywords

Lung cancer brain metastases Stereotactic radiosurgery SEER-Medicare Observational study Real-world evidence 

Abbreviations

AI

American Indian

AJCC

American Joint Committee on Cancer

ALK

Anaplastic lymphoma kinase

API

Asian/Pacific Islander

BM

Brain metastases

CBTRUS

Central Brain Tumor Registry of the United States

CDC

Centers for Disease Control and Prevention

CMS

Centers for Medicare and Medicaid Services

EGFR

Epidermal growth factor receptor

IMS

Information Management Services Inc

NCDB

National Cancer Database

NCI

National Cancer Institute

NHIA

National Home Infusion Association

NSCLC

Non-small cell lung cancer

SBM

Synchronous brain metastases

SCLC

Small cell lung cancer

SEER

Surveillance, Epidemiology, and End Results Program

SRS

Stereotactic radiosurgery

WNH

White Non-Hispanic

Notes

Acknowledgements

Funding for the Central Brain Tumor Registry of the United States (CBTRUS) has been provided by the Centers for Disease Control and Prevention (CDC) under Contract No. 2016-M-9030, the American Brain Tumor Association, The Sontag Foundation, Novocure, AbbVie, the Musella Foundation, National Brain Tumor Society, the National Cancer Institute (NCI) under Contract No. HHSN261201800176P, the Zelda Dorin Tetenbaum Memorial Fund, the Uncle Kory Foundation, and from private and in kind donations. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC or NCI. This work made use of the High Performance Computing Resource in the Core Facility for Advanced Research Computing at Case Western Reserve University. This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the National Cancer Institute; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database. Funding was provided by Foundation for the National Institutes of Health (Grant No. CA217956).

References

  1. 1.
    Schuette W (2004) Treatment of brain metastases from lung cancer: chemotherapy. Lung Cancer 45:253–257.  https://doi.org/10.1016/j.lungcan.2004.07.967 CrossRefGoogle Scholar
  2. 2.
    Johung KL, Yeh N, Desai NB, Williams TM, Lautenschlaeger T, Arvold ND, Ning MS, Attia A, Lovly CM, Goldberg S, Beal K, Yu JB, Kavanagh BD, Ghiang VL, Camidge DR, Contessa JN (2016) Extended survival and prognostic factors for patients with ALK-rearranged non-small-cell lung cancer and brain metastasis. J Clin Oncol 34:123–129.  https://doi.org/10.1200/JCO.2015.62.0138 CrossRefPubMedGoogle Scholar
  3. 3.
    Shin DY, Na II, Kim CH, Park S, Baek H, Yang SH (2014) EGFR mutation and brain metastasis in pulmonary adenocarcinomas. J Thorac Oncol 9:195–199.  https://doi.org/10.1097/JTO.0000000000000069 CrossRefPubMedGoogle Scholar
  4. 4.
    Haque W, Verma V, Butler EB, Teh BS (2018) Utilization of stereotactic radiosurgery for renal cell carcinoma brain metastases. Clin Genitourin Cancer 16:935–943.  https://doi.org/10.1016/j.clgc.2018.03.015 CrossRefGoogle Scholar
  5. 5.
    Kann BH, Park HS, Johnson SB, Chiang VL, Yu JB (2017) Radiosurgery for brain metastases: changing practice patterns and disparities in the United States. J Natl Compr Cancer Netw 15:1494–1502.  https://doi.org/10.6004/jnccn.2017.7003 CrossRefGoogle Scholar
  6. 6.
    Trifiletti DM, Sheehan JP, Grover S, Dutta SW, Rusthoven CG, Kavanagh BD, Sahgal A, Showalter TN (2017) National trends in radiotherapy for brain metastases at time of diagnosis of non-small cell lung cancer. J Clin Neurosci 45:48–53.  https://doi.org/10.1016/j.jocn.2017.08.028 CrossRefPubMedGoogle Scholar
  7. 7.
    Friedman J, Hastie T, Tibshirani R (2010) Regularization paths for generalized linear models via coordinate descent. J Stat Softw 33(1): 1–22. http://www.jstatsoft.org/v33/i01/
  8. 8.
    Simon N, Friedman J, Hastie T, Tibshirani R (2011) Regularization paths for Cox’s proportional hazards model via coordinate descent. J Stat Softw 39(5): 1–13. http://www.jstatsoft.org/v39/i05/
  9. 9.
    Ascha MS (2019) 0.0.9000 mustafaascha/srs-disparities: repository init. June 10, 2019. DOI: TBDGoogle Scholar
  10. 10.
    Siegel RL (2017) Cancer statistics. CA Cancer J Clin 67:7–30.  https://doi.org/10.3322/caac.21387 CrossRefGoogle Scholar
  11. 11.
    Tabatabai MA, Kengwoung-Keumo JJ, Oates GR, Guemmegne JT, Akinlawon A, Ekadi G, Fouad MN, Singh KP (2016) Racial and gender disparities in incidence of lung and bronchus cancer in the United States: a longitudinal analysis. PLoS ONE 11:1–19.  https://doi.org/10.1371/journal.pone.0162949 CrossRefGoogle Scholar
  12. 12.
    Robin TP, Jones BL, Amini A, Koshy M, Gaspar LE, Liu AK, Nath SK, Kavanagh BD, Camidge DR, Rusthoven CG (2018) Radiosurgery alone is associated with favorable outcomes for brain metastases from small-cell lung cancer. Lung Cancer 120:88–90.  https://doi.org/10.1016/j.lungcan.2018.03.027 CrossRefPubMedGoogle Scholar
  13. 13.
    Greenspoon JN, Ellis PM, Pond G, Caetano S, Broomfield J, Swaminath A (2017) Comparative survival in patients with brain metastases from non-small-cell lung cancer treated before and after implementation of radiosurgery. Curr Oncol 24:146–151.  https://doi.org/10.3747/co.24.3420 CrossRefGoogle Scholar
  14. 14.
    Sheehan JP, Grills I, Chiang VL, Dong H, Berg A, Warnick RE, Kondziolka D, Kavanagh B (2018) Quality of life outcomes for brain metastasis patients treated with stereotactic radiosurgery: pre-procedural predictive factors from a prospective national registry. J Neurosurg 21:1–7.  https://doi.org/10.3171/2018.8.JNS181599 CrossRefGoogle Scholar
  15. 15.
    Meza R, Meernik C, Jeon J, Cote ML (2015) Lung cancer incidence trends by gender, race and histology in the United States, 1973–2010. PLoS ONE 10(3):e0121323CrossRefGoogle Scholar
  16. 16.
    Kromer C, Xu J, Ostrom QT, Gittleman H, Kruchko C, Sawaya R, Barnholtz-Sloan JS (2017) Estimating the annual frequency of synchronous brain metastasis in the United States 2010–2013: a population-based study. J Neurooncol 134(1):55–64CrossRefGoogle Scholar
  17. 17.
    McClelland S 3rd, Page BR, Jaboin JJ, Chapman CH, Deville C Jr, Thomas CR Jr (2017) The pervasive crisis of diminishing radiation therapy access for vulnerable populations in the United States, part 1: African-American patients. Adv Radiat Oncol 2:523–531.  https://doi.org/10.1016/j.adro.2017.07.002 CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Torre LA, Sauer AM, Chen MS Jr, Kagawa-Singer M, Jemal A, Siegel RL (2016) Cancer statistics for Asian Americans, Native Hawaiians, and Pacific Islanders, 2016: converging incidence in males and females. CA Cancer J Clin 66:182–202.  https://doi.org/10.3322/caac.21335 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Thompson CA, Gomex SL, Hastings KG, Kapphahn K, Yu P, Sharrif-Marco S, Bhatt AS, Wakelee HA, Patel MI, Cullen MR, Palaniappan LP (2016) The burden of cancer in Asian Americans: a report of national mortality trends by Asian ethnicity. Cancer Epidemiol Biomarkers Prev 25:1371–1382.  https://doi.org/10.1158/1055-9965.EPI-16-0167 CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Halasz LM, Uno H, Hughes M, D’Amico T, Dexter EU, Edge SB, Hayman A, Niland JC, Otterson GA, Pisters KM, Theriault R, Weeks JC, Punglia RS (2016) Comparative effectiveness of stereotactic radiosurgery versus whole-brain radiation therapy for patients with brain metastases from breast or non-small-cell lung cancer. Cancer 112:2091–2100.  https://doi.org/10.1002/cncr.30009 CrossRefGoogle Scholar
  21. 21.
    Chen L, Shen C, Redmond KJ, Page BR, Kummerlowe M, Mcnutt T, Bettegowda C, Rigamonti D, Lim M, Kleinberg L (2017) Use of stereotactic radiosurgery in elderly and very elderly patients with brain metastases to limit toxicity associated with whole brain radiation therapy. Int J Radioat Oncol Biol Phys 98:939–947.  https://doi.org/10.1016/j.ijrobp.2017.02.031 CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of Population and Quantitative Health Sciences, Center for Clinical InvestigationCase Western Reserve University School of MedicineClevelandUSA
  2. 2.Case Western Reserve UniversityClevelandUSA
  3. 3.Department of NeurosurgeryUniversity Hospitals Cleveland Medical CenterClevelandUSA
  4. 4.Central Brain Tumor Registry of the United StatesHinsdaleUSA
  5. 5.Department of Population and Quantitative Health Sciences, Case Comprehensive Cancer Center, Institute for Computational BiologyCase Western Reserve University School of MedicineClevelandUSA

Personalised recommendations