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Absence Of Cancer Diagnosis And Treatment In Elderly Medicaid-Insured Nursing Home Residents

June 09, 2017

UroToday- A study in the January 2008 issue of the Journal of the National Cancer Institute suggests that Medicaid patients in nursing home care receive limited cancer services. While the prevalence of cancer in nursing home patients is 1 in 10, according to Dr. Bradley and coauthors this population has received little attention in outcomes research.

In the U.S, Medicaid is the predominant payer for long-term residential nursing home care. These patients often have low income, frail, and more than 30% of them require assistance to perform 3 or more activities of daily living. It is reported that nursing home staff may not effectively recognize and treat cancer. The researchers used statewide Medicaid and Medicare data merged with the Michigan Tumor Registry to identify a study sample of patients with a first primary cancer diagnosis. Tumor registry patients were matched to the state Medicare Denominator file for the years 1996-2000 and all claims for inpatient, outpatient, physician, and hospice services were identified. Those with at least one year of claims history before the month of diagnosis were selected, as this permitted an estimate of patients' comorbidity burden. The researchers calculated odds ratios for late or invasive but unknown stage of cancer, death within 3 months of diagnosis, receipt of hospice services, and receipt of cancer-directed surgery.

One-third of the patient group was older than age 86; the majority was white, female, and resided in census tracts with household incomes of less than $35,000. They had one or more comorbid conditions and 25% had Alzheimer disease. Cancers diagnosed were breast (14%), colon/rectum (17%), lung (15%), prostate (10%), and bladder (3.6%), among others. Sixty-two percent of the cancers were diagnosed with a stage of distant or invasive but unknown (the latter was 43% of all cancer diagnoses). Eighty-five percent of patients had died by the end of the study period and 48% had died within 3 months of diagnosis. Mean survival following diagnosis was 9 months. Only 7% received chemotherapy or radiation and among patients with breast, colorectal, lung, or prostate cancer 22% received surgery. Most surgery was performed on breast cancer patients (65%) and relative to breast cancer, prostate, lung, and colorectal cancer was more likely to be diagnosed with late or unstaged cancer. Patients with bladder cancer were much less likely to have their cancer diagnosed at late stage than were women with breast cancer. Only 28% of all patients received hospice care.

The report concludes that nursing home patients had a preponderance of late or unstaged disease, high mortality with a few months of diagnosis, low hospice use, and very little cancer-directed treatment, even among patients with early stage cancer where treatment can alleviate symptoms.

Bradley CJ, Clement JP, Lin C

J Natl Cancer Inst. 100(1): 21-31, January 2008

Doi: 10.1093/jnci/djm271

Reported by UroToday Contributing Editor Christopher P. Evans, M.D

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