Racial and geographic disparities in the patterns of care and costs at the end of life for patients with lung cancer in 2007-2010 after the 2006 introduction of bevacizumab

Lung Cancer. 2015 Dec;90(3):442-50. doi: 10.1016/j.lungcan.2015.09.017. Epub 2015 Sep 21.


Objectives: To examine racial/ethnic and geographical disparities in cancer care and costs during the last 6 months of life for lung cancer decedents after the Food and Drug Administration's approval of expensive bevacizumab in October 2006.

Methods: We identified 37,393 cases from the Surveillance, Epidemiology and End Results (SEER) cancer registries and Medicare linked databases who were diagnosed with non-small cell lung cancer of all stages in 1991-2009 and died between July 2007 and December 2010.

Results: Overall, the proportion of patients receiving chemotherapy/targeted therapy (31.0%), bevacizumab (4.6%), growth factors (16.0%), surgery (2.8%), and hospice care (60.9) in the last 6 months of life was higher in whites than in other ethnic populations. Hospitalization rate was higher in blacks (83.2%) than in whites (76.0%) and others (78.0%). Those from metro areas had slightly higher percentages of receiving chemotherapy/targeted therapy, bevacizumab, growth factors, and hospice care, but had a higher hospitalization rate and lower emergency care visit. Mean total health care cost was $42,749 for the last 6 months of life in patients with lung cancer. Adjusted mean health care cost in the last 6 months of life was significantly higher in blacks or other ethnic population as compared to whites.

Conclusion: There were substantial racial/ethnic and geographic disparities in the types of cancer care and costs in the last 6 months of life among lung cancer decedents, regardless of the length of survival times and hospice care status. A clinical guideline may help the appropriate use of costly treatment modalities and minimize racial/geographic disparities.

Keywords: Cost; Disparities; End of life care; Lung cancer; Treatment.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angiogenesis Inhibitors / therapeutic use
  • Bevacizumab / therapeutic use
  • Combined Modality Therapy / economics
  • Combined Modality Therapy / methods
  • Ethnicity*
  • Female
  • Health Care Costs*
  • Healthcare Disparities*
  • Humans
  • Lung Neoplasms / epidemiology*
  • Lung Neoplasms / pathology
  • Lung Neoplasms / therapy*
  • Male
  • Neoplasm Staging
  • Odds Ratio
  • SEER Program
  • Terminal Care* / methods


  • Angiogenesis Inhibitors
  • Bevacizumab