Factors associated with immunotherapy use among newly diagnosed cancer patients

CONTEXT: Immunotherapy represents a newer modality for cancer treatment with substantial health benefits. However, the high costs of immunotherapy may create access barriers. OBJECTIVE: To examine factors associated with the utilization of immunotherapy among newly diagnosed cancer patients. DESIGN AND SETTING: Analysis of a large national cancer registry data, the National Cancer Data Base, that represents approximately 75% of newly diagnosed cancer patients in the US. PATIENTS: Patient diagnosed with non-Hodgkin lymphoma (NHL), metastatic breast cancer (MBC), or metastatic colorectal cancer (MCRC). MAIN OUTCOME MEASURES: Factors associated with utilization of immunotherapy in NHL, MBC, or MCRC. RESULTS: The study included 207,581 and 42,804 patients diagnosed with NHL and MBC between 1998 and 2004, respectively (based on approval of rituximab in 1997 and trastuzumab in 1998); and 16,027 patients diagnosed with MCRC in 2004 (based on approval of cetuximab and bevacizumab in 2004). Immunotherapy use varied significantly by age, race, insurance status, year of diagnosis, and type of treatment facilities, with largest effects observed in years of diagnosis, followed by insurance status. Among young cancer patients, we found that compared with uninsured patients, the odds of receiving immunotherapy were 1.61, and 2.13 for privately insured MBC, and MCRC patients, respectively, and were in the range of 1.13 to 19.23 for privately insured NHL patients. For elderly NHL patients, those with secondary insurance in addition to Medicare were 1.26 to 8.24 times more likely to receive immunotherapy than those with Medicare alone. CONCLUSIONS: The disparities observed in this study suggest that additional efforts are required to ensure that all cancer patients receive timely and appropriate treatment.