Am J Manag Care

OBJECTIVESTo determine whether a treating oncologist\u2019s characteristics are associated with variation in use of chemotherapy for patients with advanced non\u2013small cell lung cancer (aNSCLC) at the end of life.STUDY DESIGNRetrospective cohort.METHODSUsing the 2009 Surveillance, Epidemiology, and End Results\u2013Medicare database, we studied chemotherapy receipt within 30 days of death among Medicare enrollees who were diagnosed with aNSCLC between 1999 and 2006, received chemotherapy, and died within 3 years of diagnosis. A multilevel model was constructed to assess the contribution of patient and physician characteristics and geography to receiving chemotherapy within 30 days of death.RESULTSAmong 21,894 patients meeting eligibility criteria, 43.1% received chemotherapy within 30 days of death. In unadjusted bivariate analyses, female sex, Asian or black race, older age, and a greater number of comorbid diagnoses predicted lower likelihood of receiving chemotherapy at the end of life (P 64.038 for all comparisons). Adjusting for patient and physician characteristics, physicians in small independent practices were substantially more likely than those employed in other practice models, particularly academic practices or nongovernment hospitals, to order chemotherapy for a patient in the last 30 days of life (P <.001 for all comparisons); female physicians were less likely than males to prescribe such treatment (P = .04).CONCLUSIONSPatients receiving care for aNSCLC in small independent oncology practices are more likely to receive chemotherapy in the last 30 days of life.20172018-04-01T00:00:00ZHHSN261201000035C/PC,CA/None/NoneHHSN261201000140C/CA/NCI NIH HHS/United StatesP20 MD000182/MD/NIMHD NIH HHS/United StatesHHSN261201000035I/CA/NCI NIH HHS/United StatesHHSN261201000034C/CA/NCI NIH HHS/United StatesU58 DP003862/DP/NCCDPHP CDC HHS/United States28554208PMC5762116855