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Adjuvant Chemotherapy After Resection in Elderly Medicare and Medicaid Patients With Colon Cancer
Cathy J. Bradley, PhD;
Charles W. Given, PhD;
Bassam Dahman, MS;
Timothy L. Fitzgerald, MD
Arch Intern Med. 2008;168(5):521-529.
Background This study investigated the influence of Medicaid enrollment on the receipt and completion of adjuvant chemotherapy and the likelihood of evaluation by an oncologist for those patients who do not initiate chemotherapy.
Methods Medicaid and Medicare administrative data were merged with the Michigan Tumor Registry to extract a sample of patients who had resection for a first primary colon tumor diagnosed between January 1, 1997, and December 31, 2000 (n = 4765). We used unadjusted and adjusted logistic regression to assess the relationship between Medicaid enrollment and the outcomes of interest.
Results Relative to Medicare patients, Medicaid patients were less likely to initiate chemotherapy (odds ratio, 0.50; 95% confidence interval, 0.39-0.65) or complete chemotherapy (odds ratio, 0.52; 95% confidence interval, 0.31-0.85). When the sample was restricted to patients with TNM-staged disease, Medicaid patients were less likely to initiate chemotherapy. Older patients and patients with comorbidities were also less likely to initiate or, in some cases, to complete chemotherapy.
Conclusion Medicaid enrollment is associated with disparate colon cancer treatment, which likely compromises the long-term survival of these patients.
Author Affiliations: Department of Health Administration and Massey Cancer Center (Dr Bradley) and Division of Quality Health Care, Department of Internal Medicine (Mr Dahman), Virginia Commonwealth University, Richmond; Department of Family Practice, Michigan State University, East Lansing (Dr Given); and Trinity Health System and Richard J. Lacks Cancer Center at Saint Mary's Health Care, Grand Rapids, Michigan (Dr Fitzgerald).
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