Mesothelioma in the United States: a Surveillance, Epidemiology, and End Results (SEER)–Medicare investigation of treatment patterns and overall survival

Figures & data

Table 1 Frequency distributions of patient/tumor/treatment characteristics in SEER–Medicare study of malignant mesothelioma diagnosed 2005–2009

Characteristic	All		No chemo		Chemotherapy		Chemo, no surgery		Chemo and surgery
	n	(%)a	n	(%)a	n	(%)a	n	(%)a	n	(%)a
Total	1,625		898	55.3	727	44.7	478	65.7	249	34.3
Age (years)
66–69	209	12.9	80	8.9	129	17.7	65	13.6	64	25.7
70–74	325	20	116	12.9	209	28.7	127	26.6	82	32.9
75–79	402	24.7	204	22.7	198	27.2	135	28.2	63	25.3
80–84	396	24.4	254	28.3	142	19.5	114	23.8	28	11.2
≥85	293	18	244	27.2	49	6.7	37	7.7	12	4.8
Race
White	1,494	91.9	814	90.6	680	93.5	443	92.7	237	>90
Black	60	3.7	44	4.9	16	2.2	**	**	**	**
Other	71	4.4	40	4.5	31	4.3	**	**	**	**
Sex
Male	1,268	78	696	77.5	572	78.7	381	79.7	191	76.7
Female	357	22.0	202	22.5	155	21.3	97	20.3	58	23.3
SEER region
Midwest	167	10.3	94	10.5	73	10	53	11.1	20	8
Northeast	456	28.1	245	27.3	211	29	128	26.8	83	33.3
South	298	18.3	173	19.3	125	17.2	78	16.3	47	18.9
West	704	43.3	386	43	318	43.7	219	45.8	99	39.8
Year of diagnosis
2005	360	22.2	200	22.3	160	22	108	22.6	52	20.9
2006	302	18.6	169	18.8	133	18.3	83	17.4	50	20.1
2007	340	20.9	190	21.2	150	20.6	100	20.9	50	20.1
2008	339	20.9	183	20.4	156	21.5	98	20.5	58	23.3
2009	284	17.5	156	17.4	128	17.6	89	18.6	39	15.7
Marital status
Married	1,014	62.4	510	56.8	504	69.3	324	67.8	180	72.3
Unmarriede	563	34.6	358	39.9	205	28.2	139	29.1	69*	27.7
Unknown	49	3	30	3.3	19	2.6	15	3.1
<12 Years of educationb
<8.4%	402	24.7	203	22.6	199	27.4	127	26.6	72	28.9
8.4%–<14.1%	395	24.3	199	22.2	196	27	130	27.2	66	26.5
14.1%–<22.6%	394	24.2	235	26.2	159	21.9	102	21.3	57	22.9
≥22.6%	399	24.6	237	26.4	162	22.3	119*	24.9	54*	21.7
Unknown	35	2.2	24	2.7	11	1.5
Income below poverty lineb
<3.9%	407	25	196	21.8	211	29	132	27.6	79	31.7
3.9%–<6.9%	393	24.2	220	24.5	173	23.8	114	23.8	59	23.7
6.9%–<12.3%	394	24.2	217	24.2	177	24.3	114	23.8	63	25.3
≥12.3%	396	24.4	241	26.8	155	21.3	118	24.7	48	19.3
Unknown	35	2.2	24	2.7	11	1.5
Modified Charlson Comorbidity Indexc
0	885	54.5	452	50.3	433	59.6	271	56.7	162	65.1
1	462	28.4	262	29.2	200	27.5	136	28.5	64	25.7
2	173	10.6	111	12.4	62	8.5	45	9.4	23	9.2
≥3	105	6.5	73	8.1	32	4.4	26	5.4
Primary site
Pulmonary	1,531	94.2	849	94.5	682	93.8	456	95.4	226	90.8
Peritoneal and other	94	5.8	49	5.5	45	6.2	22	4.6	23	9.2
Histology
Sarcomatoid	194	11.9	113	12.6	81	11.1	56	11.7	25	10
Epithelioid	497	30.6	229	25.5	268	36.9	162	33.9	106	42.6
Biphasic	81	5	38	4.2	43	5.9	19	4	24	9.6
Malignant mesothelioma – NOS	853	52.5	518	57.7	335	46.1	241	50.4	94	37.8
SEER summary stage
Local/regional	371	22.8	201	22.4	170	23.4	107	22.4	63	25.3
Distantd	1,165	71.7	641	71.4	524	72.1	345	72.2	186*	74.7
Unknown	89	5.5	56	6.2	33	4.5	26	5.4
AJCC stage
Stage I	269	16.6	166	18.5	103	14.2	69	14.4	34	13.7
Stage II	193	11.9	93	10.4	100	13.8	55	11.5	45	18.1
Stage III	223	13.7	98	10.9	125	17.2	70	14.6	55	22.1
Stage IV	473	29.1	247	27.5	226	31.1	165	34.5	61	24.5
Unknown/NA	467	28.7	294	32.7	173	23.8	119	24.9	54	21.7

Notes:

a Percentages may not sum 100%, due to rounding;

b referring to the census tract in which the patient resided at time of diagnosis and the proportion of residents within the tract with less than 12 years of education or household income below the poverty line;

c Modified Charlson Comorbidity Index, determined from Medicare claims within 12 months before diagnosis;

d any patient with pleural effusion;

e included single, separated, divorced, and widowed;

* cells merged to mask small cell size;

** cell size ≤10 suppressed. This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the National Cancer Institute; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database.²⁴

Abbreviations: SEER, Surveillance, Epidemiology, and End Results; NOS, not otherwise specified; AJCC, American Joint Committee on Cancer; NA, not applicable.

Table 2 Frequency distributions of chemotherapy lines and regimens in SEER–Medicare study of malignant mesothelioma diagnosed 2005–2009 (n=1,625)

	Total (n=1,625)		No surgery (n=1,136)		Surgery (n =486)
	n	(%)	n	(%)	n	(%)
Chemotherapy
Yes	727	(44.7)	478	(65.7)	249	(34.3)
No	898	(55.3)	661	(73.6)	237	(26.4)

Among patients who had chemotherapy		Totala		No surgery		Surgery ≤9 months after diagnosis
		n	(%)	n	(%)	n	(%)
One chemotherapy line onlyb		478		326	(68.2)	147	(30.8)
Cisplatin/carboplatin with pemetrexed (Ca/Ci+Pe)c		322	(67.4)	223	(68.4)	95	(64.6)
Pemetrexed (Pe)		106	(22.2)	70	(21.5)	36	(24.5)
All other chemotherapy regimens		50	(10.5)	33	(10.1)	16	(10.9)
Two chemotherapy lines		173		105	(60.7)	67	(38.7)
First line	Second lined
Ca/Ci+Pe	Any second line	114	(65.9)	63	(60)	50	(74.6)
Ca/Ci+Pe	Ca/Ci+Pe	32	(28.1)	18	(28.6)	14	(28)
Ca/Ci+Pe	Gemcitabine (Ge)	34	(29.8)	18	(28.6)	16	(32)
Ca/Ci+Pe	All other chemotherapy regimens	47	(41.2)	27	(42.9)	20	(40)
All other chemotherapy regimens		59	(34.1)	42	(40)	17	(25.4)
More than two chemotherapy linese		76	(10.5)	47	(61.8)	27	(35.5)
Three chemotherapy linesf		41	(5.6)
Four chemotherapy linesf		26	(3.6)

Notes: Percentages may not sum to 100%, due to rounding.

a Includes all patients who had chemotherapy while surgery vs no surgery groups, excludes patients with surgery more than 9 months after diagnosis;

b chemotherapy lines administered for 1 month only combined with subsequent or previous chemotherapy line(s) (with common agent) of multiple-month duration;

c pemetrexed, when administered within 3 months of the combination cisplatin/carboplatin+pemetrexed, not considered a new line, but combined with cisplatin/carboplatin+pemetrexed;

d any chemotherapy with ≥3-month gap considered a new line;

e includes third-line, fourth-line, fifth-line, and additional lines of therapy.

f Data is not presented for “No surgery” and “Surgery” to preserve patient anonymity. This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the National Cancer Institute; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database.²⁴

Abbreviation: SEER, Surveillance, Epidemiology, and End Results.

Table 3 Overall survival statistics of patients in SEER–Medicare study of malignant mesothelioma diagnosed 2005–2009

Chemotherapy group	Surgery	Patients, n	Median survival, months (range)	Proportion surviving 1 year (95% CI)
All patients		1,625	8 (1–69)	0.31 (0.29–0.33)
	No	1,139	7 (1–69)	0.27 (0.24–0.3)
	Yes	486	10 (1–69)	0.41 (0.37–0.45)
No chemotherapy		898	4 (1–69)	0.17 (0.15–0.2)
	No	661	4 (1–69)	0.16 (0.14–0.19)
	Yes	237	5 (1–47)	0.2 (0.15–0.26)
Chemotherapy		727	12 (1–69)	0.48 (0.45–0.52)
	No	478	10 (1–68)	0.42 (0.37–0.46)
	Yes	249	14 (1–69)	0.61 (0.55–0.67)
One linea,b		473	9 (1–69)	0.35 (0.31–0.39)
	No	326	8 (1–68)	0.29 (0.24–0.34)
	Yes	147	12 (2–69)	0.48 (0.4–0.56)
Two linesa,c		172	15 (2–56)	0.64 (0.56–0.71)
	No	105	14 (2–55)	0.59 (0.49–0.68)
	Yes	67	16 (4–56)	0.72 (0.59–0.81)
One lineb,d		473	7 (1–68)	0.2 (0.15–0.26)
	No	326	6 (1–58)	0.2 (0.16–0.25)
	Yes	147	8 (1–68)	0.35 (0.27–0.43)
Two linesc,d		172	5 (1–33)	0.17 (0.12–0.23)
	No	105	5 (1–33)	0.17 (0.10–0.25)
	Yes	67	5 (1–25)	0.17 (0.09–0.27)

Notes:

a Survival months calculated from date of diagnosis for each patient;

b excluded 5 patients with surgery later than 9 months after diagnosis;

c excluded 1 patient with surgery later than 9 months after diagnosis;

d survival months calculated from date of administration of chemotherapy agent (second line for two lines). This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the National Cancer Institute; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database.²⁴

Abbreviations: SEER, Surveillance, Epidemiology, and End Results; CI, confidence interval.

Healthcaredeliverycancergov/[database on the Internet]Rockville, MDNational National Cancer Institute, Division of Cancer Control and Population Sciences Available from: http://healthcaredelivery.cancer.gov/seermedicare/obtain/use.htmlAccessed June 16, 2016

 Google Scholar