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

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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.

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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

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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).

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Authors and Affiliations

  1. Department of Population and Quantitative Health Sciences, Center for Clinical Investigation, Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Mustafa S. Ascha

  2. Case Western Reserve University, Cleveland, OH, USA

    Kaitlyn Funk

  3. Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    Andrew E. Sloan

  4. Central Brain Tumor Registry of the United States, Hinsdale, IL, USA

    Carol Kruchko

  5. Department of Population and Quantitative Health Sciences, Case Comprehensive Cancer Center, Institute for Computational Biology, Case Western Reserve University School of Medicine, 2-526 Wolstein Research Bldg, 2103 Cornell Rd, Cleveland, OH, 44106-7295, USA

    Jill S. Barnholtz-Sloan

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  1. Mustafa S. Ascha
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  2. Kaitlyn Funk
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  5. Jill S. Barnholtz-Sloan
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Correspondence to Jill S. Barnholtz-Sloan.

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Ascha, M.S., Funk, K., Sloan, A.E. et al. Disparities in the use of stereotactic radiosurgery for the treatment of lung cancer brain metastases: a SEER-Medicare study. Clin Exp Metastasis 37, 85–93 (2020). https://doi.org/10.1007/s10585-019-10005-2

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  • DOI: https://doi.org/10.1007/s10585-019-10005-2

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