Utilization of surveillance after polypectomy in the Medicare population

Background: Surveillance in patients with previous polypectomy was underused in the Medicare population in 1994. This study investigates whether expansion of Medicare reimbursement for colonoscopy screening in high-risk individuals has reduced the inappropriate use of surveillance. Methods: We used Kaplan-Meier analysis to estimate time to surveillance and polyp recurrence rates for Medicare beneficiaries with a colonoscopy with polypectomy between 1998 and 2003 who were followed through 2008 for receipt of surveillance colonoscopy. Generalized Estimating Equations were used to estimate risk factors for: 1) failing to undergo surveillance and 2)

Improved Survival Associated with Neoadjuvant Chemoradiation in Patients with Clinical Stage IIIA(N2) Non–Small-Cell Lung Cancer

IntroductionOptimal management of clinical stage IIIA-N2 non–small-cell lung cancer (NSCLC) is controversial. This study examines whether neoadjuvant chemoradiation plus surgery improves survival rates when compared with other recommended treatment strategies.MethodsAdult patients from the National Cancer Database, with clinical stage IIIA-N2 disease definitively treated between 1998 and 2004 at American College of Surgeons Commission on Cancer accredited facilities, were included in the study. Treatment was defined as neoadjuvant chemoradiation plus either lobectomy (NeoCRT+L) or pneumonectomy (NeoCRT+P), lobectomy plus adjuvant therapy (L+AT), pneumonectomy plus adjuvant therapy (P+AT), and concurrent chemoradiation (CRT). Median follow-up and overall survival (OS) were defined from date of diagnosis to last contact. Five-year OS was estimated using Kaplan–Meier methods. Cox proportional hazard regression was used to estimate hazard ratios and 95% confidence intervals (CIs), adjusting for sociodemographic, clinical, and facility characteristics.ResultsMedian follow-up was 11.8 months for 11,242 eligible patients. Five-year OS was 33.5%, 20.7%, 20.3%, 13.35%, and 10.9% for NeoCRT+L, NeoCRT+P, L+AT, P+AT, and CRT, respectively (p < 0.0001). On multivariable analysis, the estimated hazard ratio was 0.51 (CI: 0.45–0.58) for NeoCRT+L; 0.77 (0.63–0.95) for NeoCRT+P; 0.66 (0.59–0.75) for L+AT; 0.69 (0.54–0.88) for P+AT; and 1.0 (reference) for the CRT group. Comorbidity did not attenuate the relationship between treatment and survival.ConclusionThis large study demonstrates that patients with clinical stage IIIA-N2 NSCLC, who underwent neoadjuvant chemoradiation followed by lobectomy, were associated with an improved survival

Long-Term Clinical Outcomes of Care Management for Chronically Depressed Primary Care Patients: A Report From the Depression in Primary Care Project

PURPOSE Recent studies examining depression disease management report improvements in short-term outcomes, but less is known about whether improvements are sustainable over time. This study evaluated the sustained clinical effectiveness of low-intensity depression disease management in chronically depressed patients

Kaplan-Meier estimates of probability of first surveillance event, stratified by cohort based on date of baseline colonoscopy with polypectomy.

<p>Kaplan-Meier estimates of probability of first surveillance event, stratified by cohort based on date of baseline colonoscopy with polypectomy.</p

Odds ratio for failing to undergo a subsequent surveillance within 5 years after baseline colonoscopy among Medicare beneficiaries with a colonoscopy with polypectomy between 1998 and 2003.

¥<p>Statistically significant (p<0.01).</p><p>Odds ratio for failing to undergo a subsequent surveillance within 5 years after baseline colonoscopy among Medicare beneficiaries with a colonoscopy with polypectomy between 1998 and 2003.</p

Probability of first surveillance event and first polypectomy event within 5 years after baseline colonoscopy with polypectomy among Medicare beneficiaries, stratified by cohort based on date of baseline colonoscopy with polypectomy – results of sensitivity analyses (estimated using the Kaplan-Meier method).

<p>*Results in the table refer to the following analyses: 1) original analysis; 2) Inclusion of patients with polyps detected and removed at (procto-) sigmoidoscopy; 3) Single inclusion of individuals in the cohort of their first colonoscopy with polypectomy between 1998 and 2003; 4) Limiting the definition of a surveillance event to a colonoscopy; 5) Including people from the SEER-Medicare data with a cancer diagnosis.</p><p>Probability of first surveillance event and first polypectomy event within 5 years after baseline colonoscopy with polypectomy among Medicare beneficiaries, stratified by cohort based on date of baseline colonoscopy with polypectomy – results of sensitivity analyses (estimated using the Kaplan-Meier method).</p

Odds ratio for polyp recurrence as indicated by surveillance polypectomy among Medicare beneficiaries with a baseline colonoscopy with polypectomy between 1998 and 2003 and a surveillance event within 5 years of that baseline colonoscopy.

¥<p>Statistically significant (p<0.01).</p><p>* Statistically significant (p<0.05).</p><p>Odds ratio for polyp recurrence as indicated by surveillance polypectomy among Medicare beneficiaries with a baseline colonoscopy with polypectomy between 1998 and 2003 and a surveillance event within 5 years of that baseline colonoscopy.</p

Kaplan-Meier estimates of polyp recurrence as indicated by surveillance polypectomy, stratified by cohort based on date of baseline colonoscopy with polypectomy.

<p>Kaplan-Meier estimates of polyp recurrence as indicated by surveillance polypectomy, stratified by cohort based on date of baseline colonoscopy with polypectomy.</p

Geographic access to lung cancer screening among eligible adults living in rural and urban environments in the United States

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/172070/1/cncr33996.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/172070/2/cncr33996_am.pd