This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (7)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Aging/ Geriatrics  • Health Policy  • Randomized Controlled Trial  • Alert me on articles by topic  Social Bookmarking   What's this?

Cary P. Gross, MD; Natalie Wong, MPH; Joel A. Dubin, PhD; Susan T. Mayne, PhD; Harlan M. Krumholz, MD

Arch Intern Med. 2005;165:1514-1520.

Background  The Medicare program was revised in 2000 to authorize payment of routine care costs for patients in clinical trials. This study evaluates the impact of the Medicare reimbursement policy change on enrollment of older patients into cancer trials.

Methods  We conducted a longitudinal analysis of the enrollment of older patients in National Cancer Institute–sponsored lung, colorectal, breast, and prostate cancer trials from January 1996 through June 2003. Our primary analysis was restricted to 23 trials that were actively accruing before and after the Medicare change, enrolled more than 100 patients, and had at least 5% of participants older than 65 years. We used multivariate logistic regression to determine whether the proportion of participants who were elderly increased after the policy change.

Results  The primary study sample consisted of 16 135 patients in 23 trials. After adjusting for cancer type, trial exclusion criteria, and patient sociodemographic characteristics in multivariate analysis, no significant change occurred in the representation of older patients after the policy change (adjusted odds of participants being elderly after vs before policy change, 1.13; 95% confidence interval, 0.96-1.32; P = .14). In a secondary analysis of patients who had enrolled in any trial during the study period, no significant change occurred in enrollment of older persons after the policy change among phase 3 or phase 1 and 2 trial participants (P = .84 and P = .07 in adjusted analyses, respectively).

Conclusion  The Medicare trial reimbursement policy was not associated with a significant increase in the enrollment of older patients in cancer trials.

Author Affiliations: Sections of General Internal Medicine (Dr Gross) and Cardiovascular Medicine (Dr Krumholz), Department of Medicine, Robert Wood Johnson Clinical Scholars Program (Drs Gross and Krumholz), and Department of Epidemiology and Public Health (Ms Wong and Drs Dubin, Mayne, and Krumholz), Yale University School of Medicine, New Haven, Conn.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Five Strategies for Accelerating the War on Cancer in an Era of Budget Deficits
Doroshow et al.
The Oncologist 2009;14:110-116.
ABSTRACT | FULL TEXT