We found substantial variation in Medicare payments for these six cancer procedures. Cost was strongly associated with postoperative complications and primarily driven by differences in the cost of the index hospitalization. Efforts to prevent and cost-effectively manage complications are more likely to reduce costs than volume-based referral of cancer surgery alone.
Purpose
Men are diagnosed with bladder cancer at three times the rate of women. However, women present with advanced disease and have poorer survival, suggesting delays in bladder cancer diagnosis. Hematuria is the presenting symptom in a majority of cases. Our objective was to assess gender differences in hematuria evaluation in older adults with bladder cancer.
Materials and Methods
Using the Surveillance, Epidemiology and End Results cancer registry linked with Medicare claims, we identified Medicare beneficiaries aged 66 years or older diagnosed with bladder cancer between 2000 and 2007 with a claim for hematuria in the year prior to diagnosis. We examined the impact of gender and demographic and clinical factors on time from initial hematuria claim to urology visit; and time from initial hematuria claim to hematuria evaluation including cystoscopy, upper urinary tract imaging, and urine cytology.
Results
Of 35,646 patients with a hematuria claim in the year preceding bladder cancer diagnosis, 97% had a urology visit claim. The mean time to urology visit was 27 days (range 0-377), and the time to urology visit was longer for women than for men (adjusted hazard ratio 0.9, 95% CI 0.87-0.92). Women were more likely to undergo delayed (after > 30 days) hematuria evaluation (adjusted odds ratio 1.13, 95% CI 1.07-1.21).
Conclusion
We observed longer time to a urology visit for women than for men presenting with hematuria. These findings may explain stage differences in bladder cancer diagnosis and inform efforts to reduce gender disparities in bladder cancer stage and outcomes.
In this population based cohort of older men with prostate cancer only 6% underwent an incontinence procedure after prostatectomy. This low rate may reflect the underuse of potentially beneficial procedures.
Background
Despite advantages in terms of cancer control and organ preservation, the benefits of chemoradiation (CTRT) may be offset by potentially severe, treatment-related toxicities particularly in older patients. Our objectives were to assess the type and frequency of toxicities in older adults with locally or regionally advanced, head and neck squamous cell carcinoma of the (HNSCC) receiving either primary CTRT or RT alone.
Methods
Using SEER cancer registry data linked with Medicare claims, we identified patients aged 66 years or older with locally advanced HNSCC, diagnosed 2001–2009, who received CTRT or RT alone. We examined differences in the frequency of toxicity-related hospital admissions and emergency room (ER) visits as well as feeding tube use and estimated the impact of chemotherapy on the likelihood of toxicity, controlling for demographic and disease characteristics.
Results
Of patients who received CTRT (N=1,502), 62% had a treatment-related toxicity, compared with 46% of patients who received RT alone (N=775). Controlling for demographic and disease characteristics, CTRT patients were twice as likely to experience an acute toxicity compared with their RT only peers. Fifty-five percent of CTRT patients had a feeding tube placed during or after treatment compared with 28% of the RT-only group.
Conclusions
In this population-based cohort of older adults with HNSCC, the rate of acute toxicities and feeding tube use in patients receiving CTRT was considerable. It is possible that for certain older patients, the potential benefit of adding CT to RT does not outweigh the harms of this combined modality therapy.
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