Comparison of Medicare claims-based proxy measures of poor function and associations with treatment receipt and mortality in older colon cancer patients.

Details

• Alternative Title:
  Med Care
• Personal Author:
  Mayer, Sophie E. ; Tan, Hung-Jui ; Hinton, Sharon Peacock ; Sanoff, Hanna K. ; Stürmer, Til ; Hester, Laura L. ; Faurot, Keturah R. ; Funk, Michele Jonsson ; Lund, Jennifer L.
• Description:
  Background:
  
  Multiple claims-based proxy measures of poor function have been developed to address confounding in observational studies of drug effects in older adults. We evaluated agreement between these measures and their associations with treatment receipt and mortality in a cohort of older colon cancer patients.
  
  Methods:
  
  Medicare beneficiaries age 66+ diagnosed with stage II-III colon cancer were identified in the Surveillance, Epidemiology, and End Results-Medicare database (2004–2011). Poor function was operationalized by: (1) summing the total poor function indicators for each model and (2) estimating predicted probabilities of poor function at diagnosis. Agreement was evaluated using Fleiss’ kappa and Spearman’s correlation. Associations between proxy measures and (1) laparoscopic vs. open surgery, (2) chemotherapy vs. none, (3) 5-fluorouracil (5FU)+oxaliplatin (FOLFOX) vs. 5FU monotherapy, and (4) one-year mortality were estimated using log-binomial regression, controlling for age, sex, stage, and comorbidity. Survival estimates were stratified by functional group, age, and comorbidity.
  
  Results:
  
  Among 29,687 eligible colon cancer patients, 67% were 75+ years and 45% had stage III disease. Concordance across the poor function indicator counts was moderate (κ: 0.64) and correlation of predicted probability measures varied (ρ: 0.21–0.74). Worse function was associated with lower chemotherapy and FOLFOX receipt, and higher one-year mortality. Within age and comorbidity strata, poor function remained associated with mortality.
  
  Conclusions:
  
  While agreement varied across the claims-based proxy measures, each demonstrated anticipated associations with treatment receipt and mortality independent of comorbidity. Claims-based comparative effectiveness studies in older populations should consider applying one of these models to improve confounding control.
  
  
• Subjects:
  Administrative Claims Aged Aged, 80 And Over Algorithm Antineoplastic Combined Chemotherapy Protocols Article Chemotherapy, Adjuvant Colon Cancer Colonic Neoplasms Comorbidity Female Fluorouracil Frailty Humans Insurance Claim Review Male Medicare Oxaliplatin Poor Function SEER Program Treatment Outcome United States

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• Source:
  Med Care. 57(4):286-294
• Pubmed ID:
  30789540
• Pubmed Central ID:
  PMC6417959
• Document Type:
  Journal Article
• Funding:
  K12 CA120780/CA/NCI NIH HHS/United States ; UL1 TR001111/TR/NCATS NIH HHS/United States ; HHSN261201000140C/CA/NCI NIH HHS/United States ; HHSN261201000035C/CA/NCI NIH HHS/United States ; UL1 TR002489/TR/NCATS NIH HHS/United States ; HHSN261201000035I/CA/NCI NIH HHS/United States ; HHSN261201000034C/CA/NCI NIH HHS/United States ; U58 DP003862/DP/NCCDPHP CDC HHS/United States ; R01 AG056479/AG/NIA NIH HHS/United States
• Volume:
  57
• Issue:
  4
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:3e272ec2017fa9e6b581380a98bc0f0478bb24cd18116430acea29979d1fe2ce
• Download URL:
  https://stacks.cdc.gov/view/cdc/76942/cdc_76942_DS1.pdf
• File Type:
  [PDF - 558.22 KB ]