Chemotherapy is effective in prolonging patient survival and decreasing tumor recurrence for an increasing number of cancers. Almost all chemotherapy agents are associated with toxicity, which is the prime factor limiting their use. Current information on toxicity from different types of chemotherapy usually comes from randomized controlled trials. However, there have been few population-based assessments of toxicities associated with cancer chemotherapy in the community. Our studies on the external and internal validity of Medicare claims for chemotherapy suggest that Medicare claims data provide valid information on cancer chemotherapy. We have also demonstrated the feasibility of using Medicare claims data to assess population-based hospitalizations for serious toxicities associated with breast cancer chemotherapy. We propose to use the updated National Cancer Institute's SEER (Surveillance, Epidemiology, and End Results)-Medicare linked data to address in-depth issues on the postmarketing surveillance of short- and longterm toxicities associated with chemotherapy for several major cancers that are often treated with chemotherapy, including breast, ovarian, colorectal, and lung cancers.
Our specific aims are: 1) to determine the rate of hospitalization for short-term toxicity associated with chemotherapy administration;2) to determine the mortality associated with hospitalization for short-term toxicity from chemotherapy;3) to determine the incidence of long-term or late-stage toxicity associated with chemotherapy use (e.g., cardiac dysfunction, bone marrow failure, second malignancies, and cognitive impairment);4) to determine how hospitalization, mortality and long-term toxicity vary with type of cancer, and type and amount of chemotherapy;and 5) to examine how hospitalization, mortality and long-term toxicity vary by age, gender, ethnicity, co-morbidity, socioeconomic factors, geographical area, hospital and physician characteristics. These analyses will be conducted in a large population-based cohort of over 300,000 patients diagnosed with the above cancers at age 65 or older from 1992 to 2002 in thirteen SEER areas, over 30% of whom receive chemotherapy. Currently, there is no systematic approach for evaluating long-term toxicity of the marketed drugs. The proposed innovative use of the nationwide, population-based computerized Medicare claims data offer a promising and less expensive way of obtaining information on postmarketing drug toxicity in community settings. This database is especially unique for studying cancer chemotherapy and its toxicity because chemotherapy is among the few drugs that are covered by Medicare for past several decades.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Project (R01)
Project #
Application #
Study Section
Health Care Quality and Effectiveness Research (HQER)
Program Officer
Zhan, Chunliu
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Texas Health Science Center Houston
Public Health & Prev Medicine
Schools of Public Health
United States
Zip Code
Hardy, Dale; Chan, Wenyaw; Liu, Chih-Chin et al. (2012) Racial disparities in length of stay in hospice care by tumor stage in a large elderly cohort with non-small cell lung cancer. Palliat Med 26:61-71
Cen, P; Liu, C; Du, X L (2012) Comparison of toxicity profiles of fluorouracil versus oxaliplatin regimens in a large population-based cohort of elderly patients with colorectal cancer. Ann Oncol 23:1503-11
Hu, Chung-Yuan; Chan, Wenyaw; Delclos, George P et al. (2012) Adjuvant chemotherapy and risk of gastrointestinal, hematologic, and cardiac toxicities in elderly patients with stage III colon cancer. Am J Clin Oncol 35:228-36
Sail, Kavita; Franzini, Luisa; Lairson, David et al. (2012) Differences in treatment and survival among African-American and Caucasian women with early stage operable breast cancer. Ethn Health 17:309-23
Liu, Chih-Chin; Xia, Rui; Guadagnolo, Ashleigh et al. (2011) Risk of xerostomia in association with the receipt of radiation therapy in older patients with head and neck cancer. Am J Ther 18:206-15
Gruschkus, Stephen K; Lairson, David; Dunn, J Kay et al. (2011) Cost-effectiveness of white blood cell growth factor use among a large nationwide cohort of elderly non-Hodgkin's lymphoma patients treated with chemotherapy. Value Health 14:253-62
Hu, Chung-Yuan; Delclos, George L; Chan, Wenyaw et al. (2011) Post-treatment surveillance in a large cohort of patients with colon cancer. Am J Manag Care 17:329-36
Nurgalieva, Zhannat; Liu, Chih-Chin; Du, Xianglin L (2011) Chemotherapy use and risk of bone marrow suppression in a large population-based cohort of older women with breast and ovarian cancer. Med Oncol 28:716-25
White, Arica; Vernon, Sally W; Franzini, Luisa et al. (2011) Racial and ethnic disparities in colorectal cancer screening persisted despite expansion of Medicare's screening reimbursement. Cancer Epidemiol Biomarkers Prev 20:811-7
Hardy, D; Liu, C-C; Cormier, J N et al. (2010) Cardiac toxicity in association with chemotherapy and radiation therapy in a large cohort of older patients with non-small-cell lung cancer. Ann Oncol 21:1825-33

Showing the most recent 10 out of 28 publications