K. Bikov

Health disparities in staging of SEER-Medicare prostate cancer patients in the United States

OBJECTIVES To examine whether race or age disparities affected the odds of being staged among prostate cancer (PC) patients. Accurate staging is critical for determining treatment for PC. METHODS Multivariable logistic regression models examined race and age disparities with respect to the odds of being staged among PC patients using Surveillance, Epidemiology, and End Results-Medicare data. Similar analyses were performed to estimate the adjusted odds of being staged with distant metastatic vs in situ or local/regional disease. RESULTS The proportion of patients without staging ranged between 3% and 16% by age and between 6% and 8% by race. Adjusted results demonstrated statistically significant lower odds ratios (P <.05) for 70-74, 75-79, and 80+-year-olds of 0.76, 0.52, and 0.23, respectively, relative to PC patients aged 65-69. The odds of being staged for African Americans are 0.78 times that of non-Hispanic Whites (95% confidence interval = 0.72-0.86). The adjusted probability of distant metastatic disease at initial diagnosis is higher for African Americans (odds ratio = 1.61; 95% confidence interval = 1.47-1.76) and older men with odds ratios of 1.25, 1.85, and 4.33 for ages 70-74, 75-79, and 80+, respectively, compared with 65-69-year-olds (all P <.05). CONCLUSIONS Even though the overall odds of being staged increased over time, race and age disparities persisted. When staging did occur, the probability of distant metastatic disease was high for African Americans, and there were increasing odds of metastatic disease for all men with advanced age.

792 Hospital Center Effect for Laparoscopic Colectomy Among Elderly Stage I-III Colon Cancer Patients

associated with distal versus proximal acid reflux. Methods: We reviewed the records of all patients that had dual probe pH testing from January 1999 to November 2012. Only patients with complete foregut evaluation including endoscopy, video esophagram, and motility were included. Increased esophageal acid exposure was defined as a DeMeester composite score of .14.76 in the distal probe and .16.4 in the proximal probe. Dual probe pH catheters with sensors spaced 10, 15 or 18 cm apart were selected such that the proximal probe would be as close as possible to the upper esophageal sphincter in each patient. Results: From 425 total patients 256 (60%) had increased esophageal acid exposure on dual probe pH testing. Presenting symptoms in these patients were heartburn (73%), regurgitation (60%), cough (54%), hoarseness (50%), or asthma (24%). The location of abnormal reflux was at the distal probe only in 133 patients (31%), at the proximal probe only in 11 patients (3%) and at both probes in 112 patients (26%). There was no significant difference in the prevalence of cough, hoarseness or asthma based on location of the abnormal acid exposure. Abnormal acid exposure at both the proximal and distal probes was most likely to occur in patients with a hiatal hernia larger than 3 cm in size [Table]. Conclusions: Patients with increased esophageal acid exposure at both the proximal and distal probes tended to have more severe reflux disease with hernias larger than 3 cm in size, erosive esophagitis and Barretts esophagus. Isolated abnormal proximal acid exposure was uncommon, and was not associated with different symptoms. These findings suggest that dual probe pHmonitoring does not significantly improve the ability to detect patients with reflux disease that might be related to respiratory symptoms compared to standard pH monitoring in the distal esophagus. Consequently, there is little added benefit to monitor patients with a dual probe pH system.

Benefits Improvement and Protection Act's impact on transplantation rates among elderly MEDICARE beneficiaries with end-stage renal disease.

Background The Benefits Improvement and Protection Act (BIPA) expanded Medicare coverage for posttransplantation immunosuppresants for elderly patients and others eligible for Medicare beyond their end-stage renal disease (ESRD) status yet retained the 3-year limit for patients eligible solely because of ESRD status. Our objective was to determine BIPA’s impact on renal transplantation among elderly patients (age ≥65 years) affected by BIPA. Methods Medicare claims and the U.S. Renal Data System Standard Analysis Files were used to analyze the likelihood of transplantation among elderly patients, all of whom were affected by BIPA, versus the nonelderly, many of whom were unaffected by BIPA. A difference-in-differences approach and generalized logistic regressions were used to estimate BIPA’s impact. Results Analysis of data for 632,904 ESRD Medicare beneficiaries who met inclusion/exclusion criteria suggests that BIPA made elderly patients more likely (relative likelihood, 1.36; 95% confidence interval, 1.32–1.41) to have a transplant. The likelihood for nonelderly patients decreased following BIPA (relative likelihood, 0.93; 95% confidence interval, 0.92–0.94). Conclusion Transplantation rates increased among those elderly patients, all of whom were affected by BIPA by extending immunosuppressant coverage under BIPA. These results suggest that removing financial barriers to posttransplantation care may positively impact transplantation rates yet raise questions regarding whether the law shifted transplants from younger to older patients.

Algorithm for identifying various second- and third-line chemotherapy regimens in elderly U.S. Medicare patients with metastatic colon cancer.

553 Background: Patients with metastatic colon cancer (mCC) often receive multiple lines of chemotherapy treatment (TX) in response to disease progression or toxicities. A claims-based algorithm that identifies TX lines can provide information on “real world” clinical practice patterns that may not be captured by clinical trials. Methods: Our claims-based algorithm was applied to SEER-Medicare data of elderly mCC patients diagnosed in ‘03-‘07 and followed through ‘09. The algorithm included 17 clinical rules for identifying the beginning and end TX lines. The face validity of the algorithm was assessed by 1) examining the output against a TX map for a random sample of patients; 2) evaluating the overall results; and 3) conducting a sensitivity analysis, which evaluated the variability in the number of detected TX lines as a function of key algorithm parameters. Results: Of 7,951 mCC patients, 3,266 (41%) received TX; 1,440 (18% of all, 44% of TX) and 274 (3% of all, 8% of TX) received 2nd and 3rd line TX,...

Comparative analysis of second and subsequent chemotherapy lines on short- and long-term survival of elderly Medicare metastatic colon cancer patients.

455 Background: Metastatic colon cancer (mCC) patients often receive multiple lines of chemotherapy as treatment (TX) to improve survival or quality of life, yet the “real world” benefits and risks of multiple TX lines have not been fully examined. Methods: Elderly (65+) SEER-Medicare patients diagnosed with mCC in 2003-2007 were followed until death or 12/31/09 to examine the survival benefits for different chemotherapy lines. The median time between diagnosis date and the starting date of 2nd line was 352 days. Therefore, we restricted comparative analysis of 2nd and subsequent chemotherapy TX lines to patients who survived at least 1 year after mCC diagnosis date. We used Cox regression framework and adjusted for patients’ TX and censoring histories by using inverse probability weighting method. Separate analyses were conducted for short (2 years) and long-term (5 years) survival to examine different benefits of 2nd and subsequent chemotherapy lines. Results: Of 2,600 elderly Medicare mCC patients diag...