Journal of the National Cancer Institute Advance Access originally published online on September 23, 2008
JNCI Journal of the National Cancer Institute 2008 100(19):1413-1414; doi:10.1093/jnci/djn289
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Published by Oxford University Press 2008.
CORRESPONDENCE |
Response: Re: Cost of Care for the Elderly Cancer Patients in the United States
Affiliations of authors: Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (KRY, JLW, MLB); Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA (EBL)
Correspondence to: K. Robin Yabroff, PhD, MBA, Health Services and Economics Branch/Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Executive Plaza North, Rm 4005, 6130 Executive Blvd, MSC 7344, Bethesda, MD 20892-7344 (e-mail: yabroffr{at}mail.nih.gov).
We agree with the points raised by Balducci et al. in their correspondence and also by Balducci (1) that measures of physiological age, rather than just chronological age, are important in treatment decision-making and outcomes in elderly cancer patients. Our population-based estimates of the average cost of cancer care in the elderly in the United States reflecting the underlying diversity in the population, although we did not report costs separately for subgroups of patients on the basis of factors relevant to physiological age, such as functional status and comorbidity (2). We believe that future work estimating the costs of cancer care that considers such factors, including functional status, comorbidity, social support, patient preferences, and quality of life, will be an important part of a geriatric oncology research agenda. Implementation of this research agenda may be difficult, however, because such patient data are not routinely collected or measured in a single large data source. Few observational databases, including the linked Surveillance, Epidemiology, and End Results (SEER)–Medicare data used in our study (2), include all of these important measures and all types of health care costs. These measures and costs are not routinely collected in clinical trials either.
Routine inclusion of health services resource use and cost of care information in clinical trials of treatment efficacy, particularly those that are conducted in the elderly and include comprehensive geriatric assessments, will be an important next step. Understanding the effectiveness and cost- effectiveness of such therapies in the general population of elderly treated outside of clinical trials will require the addition of more detailed health and quality of life assessment data in medical records and in tumor registry programs. Cost of care measures will also need to be added directly or with data linkages. The resulting high-quality observational data may also be used to provide information that could be used in clinical care for elderly populations when trials are not ongoing or planned and to evaluate the delivery of guideline-consistent cancer care (3).
Currently, the SEER registry areas represent approximately 26% of the US population (4), and the linked SEER–Medicare data do not include information on the care received by patients covered by managed care. Additional efforts in data linkages, such the Cancer Research Network, which links medical care for cancer patients in managed care organizations with tumor registry data (5), will also be necessary. The National Cancer Institute has supported ongoing work in the use of existing data from claims and medical records to measure comorbidity (6) and in efforts to improve and standardize patient-reported outcomes in the context of clinical trials (7).
Finally, we agree with Balducci et al. that the challenges to the Medicare program to provide optimal care for cancer patients within budgetary constraints will only increase with increasing cancer prevalence in the elderly. We encourage them, and others, to test their hypotheses about the efficacy, effectiveness, and cost-effectiveness of comprehensive geriatric assessment and individualized care in cancer care delivery for the elderly in large community-based health-care delivery settings and in clinical trials. Such findings should improve the quality of care for an important and growing population.
REFERENCES
1. Balducci L. Aging, frailty, and chemotherapy. Cancer Control (2007) 14((1)):7–12.[Medline]
2. Yabroff KR, Lamont EB, Mariotto A, et al. Cost of care for elderly cancer patients in the United States. J Natl Cancer Inst (2008) 100((9)):630–641.
3. Owusu C, Buist DS, Field TS, et al. Predictors of tamoxifen discontinuation among older women with estrogen receptor-positive breast cancer. J Clin Oncol (2008) 26((4)):549–555.
4. Ries LAG, Harkins D, Krapcho M, et al. SEER Cancer Statistics Review, 1975–2005 (2008) Bethesda, MD: National Cancer Institute.
5. Ritzwoller DP, Goodman MJ, Maciosek MV, et al. Creating standard cost measures across integrated health care delivery systems. J Natl Cancer Inst Monogr (2005) (35):80–87.
6. Klabunde CN, Harlan LC, Warren JL. Data sources for measuring comorbidity: a comparison of hospital records and Medicare claims for cancer patients. Med Care (2006) 44((10)):921–928.[CrossRef][Web of Science][Medline]
7. Clauser SB, Ganz PA, Lipscomb J, Reeve BB. Patient-reported outcomes assessment in clinical trials: evaluating and enhancing the payoff to decision making. J Clin Oncol (2007) 25((32)):5049–5050.
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J Natl Cancer Inst 2008 100: 1413.
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