Treatment and survival differences in older Medicare patients with lung cancer as compared with those who are dually eligible for Medicare and Medicaid

Abstract

Purpose: This study compares non-small-cell lung cancer (NSCLC) treatments provided to older patients (age > or = 66 years) who are dually eligible for Medicare and Medicaid with treatments provided to similar patients who are insured by Medicare. We extend the analysis to include a comparison of survival rates between Medicare and dually eligible patients. Dual eligibility is associated with low socioeconomic status. However, Medicaid coverage in addition to Medicare removes many financial barriers to care.

Patients and methods: The sample included 2,626 older patients with local and regional stage NSCLC diagnosed between 1997 and 2000. Four outcomes were studied: the likelihood of receiving resection, chemotherapy, radiation therapy, and survival (perioperative and longer-term). Logistic regression was used to predict the likelihood of treatment, and stratified and multivariate analyses were used to evaluate differences in survival.

Results: Dually eligible patients were half as likely to undergo resection as Medicare patients (P < .001) and were more likely to receive radiation than Medicare patients. Stratified and multivariate analyses showed that surgically treated dually eligible patients had slightly inferior survival as compared with that of Medicare patients. Survival was equivalent among patients who did not undergo resection, regardless of insurance coverage.

Conclusion: Older dually eligible patients with NSCLC had a lower likelihood of undergoing resection despite controls for socioeconomic factors and comorbidities. However, if such patients were surgically treated, survival improved substantially, but it remained inferior to the survival of Medicare patients. Additional research is needed to understand why resection rates were substantially lower among dually eligible patients.

Fig 1.

Survival curves by Medicaid coverage and resection. (A) Overall survival (all-cause mortality) was statistically significantly better for Medicare patients compared with Medicaid patients (P < .05). (B) Overall survival (all-cause mortality) was not significantly different for Medicare and Medicaid patients when the sample was stratified by surgical resection, although statistical significance was approached for patients who underwent resection (P = .08). Survival curves were constructed with the Kaplan-Meier estimation method and compared with the log-rank test. DE, dually eligible.