Regional Variation in Spending and Survival for Older Adults With Advanced Cancer
Open accessAbstract
BACKGROUND: Medicare spending varies substantially across the United States. We evaluated the association between mean regional spending and survival in advanced cancer. METHODS: We identified 116 523 subjects with advanced cancer from 2002 to 2007, using Surveillance, Epidemiology and End Results (SEER)-Medicare linked data. Subjects were aged 65 years and older with non-small cell lung, colon, breast, prostate, or pancreas cancer. Of these subjects, 61 083 had incident advanced-stage cancer (incident cohort) and 98 935 had death from cancer (decedent cohort); 37% of subjects were included in both cohorts. Subjects were linked to one of 80 hospital referral regions within SEER areas. We estimated mean regional spending in both cohorts. We assessed the primary outcome, survival, in the incident cohort; the exposure measure was the quintile of regional spending in the decedent cohort. Survival in quintiles 2 through 5 was compared with that in quintile 1 (lowest spending quintile) using Cox regression models. RESULTS: From quintile 1 to 5, mean regional spending increased by 32% and 41% in the incident and decedent cohorts (incident cohort: $28 854 to $37 971; decedent cohort: $27 446 to $38 630). The association between spending and survival varied by cancer site and quintile; hazard ratios ranged from 0.92 (95% confidence interval [CI] = 0.82 to 1.04, pancreas cancer quintile 5) to 1.24 (95% CI = 1.11 to 1.39, breast cancer quintile 3). In most cases, differences in survival between quintile 1 and quintiles 2 through 5 were not statistically significant. CONCLUSION: There is substantial regional variation in Medicare spending for advanced cancer, yet no consistent association between mean regional spending and survival.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The OCM was developed partly to address the rising costs of oncology care and the significant regional variation in quality and costs.
“The model was developed partly to address the rising costs of oncology care [42] and the significant regional variation in quality and costs [43].”
From Translating economic evaluations into financing strategies for implementing evidence-based practices (2021) · cites this paper as [43]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987) · Journal of Chronic Diseases · doi:10.1016/0021-9681(87)90171-8 · Cited by 49,742 · see citing works
Siegel, R., Naishadham, D., & Jemal, A. (2012) · CA: A Cancer Journal for Clinicians · doi:10.3322/caac.20138 · Cited by 10,679 · see citing works
Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases
DEYO, R. (1992) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(92)90133-8 · Cited by 10,452 · see citing works
Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer
Temel, J. S., Greer, J. A., Muzikansky, A., Gallagher, E. R., Admane, S., Jackson, V. A., Dahlin, C. M., Blinderman, C. D., Jacobsen, J., Pirl, W. F., et al. (2010) · New England Journal of Medicine · doi:10.1056/nejmoa1000678 · Cited by 7,482 · see citing works
Paclitaxel–Carboplatin Alone or with Bevacizumab for Non–Small-Cell Lung Cancer
Sandler, A., Gray, R., Perry, M. C., Brahmer, J., Schiller, J. H., Dowlati, A., Lilenbaum, R., & Johnson, D. H. (2006) · New England Journal of Medicine · doi:10.1056/nejmoa061884 · Cited by 5,761 · see citing works
Sipuleucel-T Immunotherapy for Castration-Resistant Prostate Cancer
Kantoff, P. W., Higano, C. S., Shore, N. D., Berger, E. R., Small, E. J., Penson, D. F., Redfern, C. H., Ferrari, A. C., Dreicer, R., Sims, R. B., et al. (2010) · New England Journal of Medicine · doi:10.1056/nejmoa1001294 · Cited by 5,572 · see citing works
Projections of the cost of cancer care in the United States: 2010–2020
Mariotto, A. B., Robin Yabroff, K., Shao, Y., Feuer, E. J., & Brown, M. L. (2011) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djq495 · Cited by 2,657 · see citing works
Development of a comorbidity index using physician claims data
Klabunde, C. N., Potosky, A. L., Legler, J. M., & Warren, J. L. (2000) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(00)00256-0 · Cited by 1,846 · see citing works
Fisher, E. S., Wennberg, D. E., Stukel, T. A., Gottlieb, D. J., Lucas, F. L., & Pinder, É. L. (2003) · Annals of Internal Medicine · doi:10.7326/0003-4819-138-4-200302180-00006 · Cited by 1,537 · see citing works
Fisher, E. S., Wennberg, D. E., Stukel, T. A., Gottlieb, D. J., Lucas, F. L., & Pinder, É. L. (2003) · Annals of Internal Medicine · doi:10.7326/0003-4819-138-4-200302180-00007 · Cited by 1,341 · see citing works
Aggressiveness of Cancer Care Near the End of Life: Is It a Quality-of-Care Issue?
Earle, C. C., Landrum, M. B., Souza, J. M., Neville, B. A., Weeks, J. C., & Ayanian, J. Z. (2008) · Journal of Clinical Oncology · doi:10.1200/jco.2007.15.8253 · Cited by 950 · see citing works
Self-citationThe Dartmouth Atlas of Health Care
Kirby, R. S. (1998) · Cartographic Perspectives · doi:10.14714/cp29.675 · Cited by 846 · see citing works
Brumley, R., Enguidanos, S., Jamison, P., Seitz, R., Morgenstern, N., Saito, S., McIlwane, J., Hillary, K., & Gonzalez, J. (2007) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2007.01234.x · Cited by 845 · see citing works
Cost of Care for Elderly Cancer Patients in the United States
Yabroff, K. R., Lamont, E. B., Mariotto, A. B., Warren, J. L., Topor, M. A., Meekins, A., & Brown, M. L. (2008) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djn103 · Cited by 700 · see citing works
Self-citationSchnipper, L. E., Smith, T. J., Raghavan, D., Blayney, D. W., Ganz, P. A., Mulvey, T. M., & Wollins, D. S. (2012) · Journal of Clinical Oncology · doi:10.1200/jco.2012.42.8375 · Cited by 650 · see citing works
Estimating Health Care Costs Related to Cancer Treatment From SEER-Medicare Data
Brown, M. L., Riley, G. F., Schussler, N., et al. (2002) · Medical Care · doi:10.1097/00005650-200208001-00014 · Cited by 613 · see citing works
Impact of an Inpatient Palliative Care Team: A Randomized Controlled Trial
Gade, G., Venohr, I., Conner, D., McGrady, K., Beane, J., Richardson, R. H., Williams, M. P., Liberson, M., Blum, M., & Penna, R. D. (2008) · Journal of Palliative Medicine · doi:10.1089/jpm.2007.0055 · Cited by 564 · see citing works
Palliative Care Consultation Teams Cut Hospital Costs For Medicaid Beneficiaries
Morrison, R. S., Dietrich, J., Ladwig, S., Quill, T. E., Sacco, J., Tangeman, J. C., & Meier, D. E. (2011) · Health Affairs · doi:10.1377/hlthaff.2010.0929 · Cited by 469 · see citing works
Regional Variations in Diagnostic Practices
Song, X., Skinner, J., Bynum, J., Sutherland, J. M., Wennberg, J. E., & Fisher, E. S. (2010) · New England Journal of Medicine · doi:10.1056/nejmsa0910881 · Cited by 440 · see citing works
Are Regional Variations in End-of-Life Care Intensity Explained by Patient Preferences?
Barnato, A. E., Herndon, M. B., Anthony, D. L., Gallagher, P. M., Skinner, J., Bynum, J., & Fisher, E. S. (2007) · Medical Care · doi:10.1097/01.mlr.0000255248.79308.41 · Cited by 411 · see citing works
Bending the Cost Curve in Cancer Care
Smith, T. J., & Hillner, B. E. (2011) · New England Journal of Medicine · doi:10.1056/nejmsb1013826 · Cited by 397 · see citing works
Racial and Ethnic Differences in Preferences for End-of-Life Treatment
Barnato, A. E., Anthony, D. L., Skinner, J., Gallagher, P. M., & Fisher, E. S. (2009) · Journal of General Internal Medicine · doi:10.1007/s11606-009-0952-6 · Cited by 358 · see citing works
Medicare Payments from Diagnosis to Death for Elderly Cancer Patients by Stage at Diagnosis
Riley, G. F., Potosky, A. L., Lubitz, J. D., & Kessler, L. G. (1995) · Medical Care · doi:10.1097/00005650-199508000-00007 · Cited by 332 · see citing works
Resurrecting Treatment Histories of Dead Patients
Bach, P. B., Schrag, D., & Begg, C. B. (2004) · JAMA · doi:10.1001/jama.292.22.2765 · Cited by 256 · see citing works
Self-citationDeclining Death Rates Reflect Progress against Cancer
Jemal, A., Ward, E., & Thun, M. J. (2010) · PLoS ONE · doi:10.1371/journal.pone.0009584 · Cited by 229 · see citing works
Clarifying Sources of Geographic Differences in Medicare Spending
Zuckerman, S., Waidmann, T., Berenson, R. A., & Hadley, J. (2010) · New England Journal of Medicine · doi:10.1056/nejmsa0909253 · Cited by 194 · see citing works
Is Technological Change In Medicine Always Worth It? The Case Of Acute Myocardial Infarction
Skinner, J., Staiger, D. O., & Fisher, E. S. (2006) · Health Affairs · doi:10.1377/hlthaff.25.w34 · Cited by 185 · see citing works
Elkin, E. B., & Bach, P. B. (2010) · JAMA · doi:10.1001/jama.2010.283 · Cited by 155 · see citing works
Association of Hospital Spending Intensity With Mortality and Readmission Rates in Ontario Hospitals
Stukel, T. A., Fisher, E. S., Alter, D. A., Guttmann, A., Ko, D. T., Fung, K., Wodchis, W. P., Baxter, N. N., Earle, C. C., & Lee, D. S. (2012) · JAMA · doi:10.1001/jama.2012.265 · Cited by 141 · see citing works
NÉMETH, F., Koval, S., Zavázalová, H., et al. (2007) · PubMed · Cited by 122 · see citing works
Hospice Care and Survival among Elderly Patients with Lung Cancer
Saito, A. M., Landrum, M. B., Neville, B. A., Ayanian, J. Z., Weeks, J. C., & Earle, C. C. (2011) · Journal of Palliative Medicine · doi:10.1089/jpm.2010.0522 · Cited by 111 · see citing works
Self-citationIs Survival Better at Hospitals With Higher “End-of-Life” Treatment Intensity?
Barnato, A. E., Chang, C.-C. H., Farrell, M. H., Lave, J. R., Roberts, M. S., & Angus, D. C. (2010) · Medical Care · doi:10.1097/mlr.0b013e3181c161e4 · Cited by 105 · see citing works
Hospital Spending and Inpatient Mortality: Evidence From California
Romley, J. A., Jena, A. B., & Goldman, D. P. (2011) · Annals of Internal Medicine · doi:10.7326/0003-4819-154-3-201102010-00005 · Cited by 92 · see citing works
Aggressive Treatment Style and Surgical Outcomes
Silber, J. H., Kaestner, R. J., Even‐Shoshan, O., Wang, Y., & Bressler, L. J. (2010) · Health Services Research · doi:10.1111/j.1475-6773.2010.01180.x · Cited by 83 · see citing works
Landrum, M. B., Meara, E. R., Chandra, A., et al. (2008) · Health Affairs · doi:10.1377/hlthaff.27.1.159 · Cited by 64 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- Federal Register: Daily Journal of the United States Government. https:// www.federalregister.gov/articles/search?conditions[term]=wage+index. Accessed February 11, 2013.
Cited by
Sorted by citations
Cheville, A. L., Moynihan, T., Herrin, J., Loprinzi, C., & Kroenke, K. (2019) · JAMA Oncology · doi:10.1001/jamaoncol.2019.0011 · Cited by 143 · see citing works
Kline, R. M., Bazell, C., Smith, E., Schumacher, H., Rajkumar, R., & Conway, P. H. (2015) · Journal of Oncology Practice · doi:10.1200/jop.2014.002337 · Cited by 110 · see citing works
Translating economic evaluations into financing strategies for implementing evidence-based practices
Dopp, A. R., Kerns, S. E. U., Panattoni, L., Ringel, J. S., Eisenberg, D., Powell, B. J., Low, R., & Raghavan, R. (2021) · Implementation Science · doi:10.1186/s13012-021-01137-9 · Cited by 52 · see citing works
Human-Machine Collaboration in Cancer and Beyond: The Centaur Care Model
Goldstein, I. M., Lawrence, J., & Miner, A. S. (2017) · JAMA Oncology · doi:10.1001/jamaoncol.2016.6413 · Cited by 27 · see citing works
- Authors
- Brooks, G. A., Li, L., Sharma, D. B., Weeks, J. C., Hassett, M. J., Yabroff, K. R., & Schrag, D.
- Affiliations
- National Institutes of Health (US)
- Venue
- JNCI: Journal of the National Cancer Institute
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-03-12
- Volume
- 105
- Issue
- 9
- Pages
- 634-642
- ISSN
- 0027-8874 (ISSN-L)
- 1460-2105
- PMC
- PMC3691948
- OpenAlex
- W2150275080
- Cited by
- 98
- References
- 35
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 3 · 2023: 4 · 2022: 3 · 2021: 10 · 2020: 4 · 2019: 8 · 2018: 10 · 2017: 19 · 2016: 11 · 2015: 9 · 2014: 11 · 2013: 2
- FWCI
- 25.74
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JNCI Journal of the National Cancer Institute (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- National Institutes of Health (5r01ca131847-05)
- National Cancer Institute (L30 CA179613, R01-CA131847, 5R01CA131847, T32CA009172)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Financial Impacts of Cancer
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Keywords
- Medicare spending, regional variation, advanced cancer, cancer survival, older adults, hospital referral regions, health care costs, cancer site differences, SEER-Medicare linkage
- MeSH terms
- Aged, Aged, 80 and over, Breast Neoplasms, Carcinoma, Non-Small-Cell Lung, Health Expenditures, Female, Medicare, Hospitalization, Humans, Lung Neoplasms, Male, Medical Record Linkage, Neoplasm Staging, Neoplasms, Palliative Care, Pancreatic Neoplasms, Prostatic Neoplasms, United States, Proportional Hazards Models, SEER Program, Patient-Centered Care, Kaplan-Meier Estimate
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
