Semester

Spring

Date of Graduation

2013

Document Type

Dissertation

Degree Type

PhD

College

School of Pharmacy

Department

Pharmaceutical Systems and Policy

Committee Chair

S Suresh Madhavan

Committee Co-Chair

Mohammed Almubarak

Committee Member

Michael Hendryx

Committee Member

Usha Sambamoorthi

Committee Member

Cindy Tworek.

Abstract

The elderly carry a disproportionate burden of lung cancer in the US. Although significant improvements have been made during the past decade in cancer treatment, substantial disparities still exist in guideline-based lung cancer care and outcomes. Such variation in lung cancer care is a cause for major concern in rural areas like West Virginia (WV). The purpose of this study was to do a comprehensive evaluation of variations in lung cancer care and associated health outcomes in the elderly. This retrospective study was conducted using SEER-Medicare and WVCR--Medicare linked data files for the years 2002-2007. As part of the project, three studies were conducted. In the first study, we compared geographic variations in clinical guideline-based lung cancer care and associated health outcomes among elderly Medicare Fee-for-service (FFS) beneficiaries. The study found disparities in receipt of minimally appropriate care in both the WV and US populations. Receipt of minimally appropriate care was found to be associated with longer survival times. In the second study, we compared geographic variations in timeliness of lung cancer care and found significant variation in delays in diagnosis and treatment in both the WV and US populations. However, non-timely care was not associated with poorer prognosis. The third study determined the patterns of receipt of tobacco-use cessation counseling services and found such services to be received by more than half of all beneficiaries. Overall, the findings highlight the critical need to address disparities in receipt of guideline-based appropriate and timely lung cancer care among Medicare FFS beneficiaries. The findings also reveals the urgent need for future cancer prevention efforts directed towards promoting smoking cessation in the rural WV population. In the long run, such cancer prevention efforts can help to reduce lung cancer incidence, which in turn can help to reduce the geographic disparities in lung cancer mortality.

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