1. Printing: This poster is 48” wide by 36” high. It’s designed to be printed on a large-format printer. Customizing the Content: The placeholders in this poster are formatted for you. Type in the placeholders to add text, or click an icon to add a table, chart, SmartArt graphic, picture or multimedia file. To add or remove bullet points from text, just click the Bullets button on the Home tab. If you need more placeholders for titles, content or body text, just make a copy of what you need and drag it into place. PowerPoint’s Smart Guides will help you align it with everything else. Want to use your own pictures instead of ours? No problem! Just right-click a picture and choose Change Picture. Maintain the proportion of pictures as you resize by dragging a corner. A Medicare-Associated Impact on Cancer Survival at Age 65 in U.S., 2004-2013 Yueqing Wang, MPH 1 ; Francis P. Boscoe, PhD 1,2 1. Department of Biostatistics and Epidemiology, School of Public Health, University of Albany 2. NYS Cancer Registry, New York State Department of Health BACKGROUND Turning 65 has an important impact on the health of many U.S. residents, as it represents the age when nearly all become eligible for healthcare coverage through Medicare. This age boundary has a profound effect on health and healthcare utilization, as patients can receive medical screening tests and treatment at low expense. Previous research has shown a spike in screen-detected cancer diagnosis among 65-year olds, suggesting that uninsured or underinsured cancer patients were more likely to postpone medical encounters until being enrolled in Medicare. Here we attempted to measure whether 65-year old patients also tend to have better cancer outcomes than those slightly younger. We focused on lung cancer and liver cancer, as these two cancer have relatively low 5- year survival (lower than 20%), and are not influenced by screening behavior. METHODS We generated 5-year relative survival of first primary lung cancer and liver cancer by single year of age at diagnosis from the New York State Cancer Registry. We derived data from those age 55 through 75 diagnosed with malignant tumors between 2004 and 2013. We generated Kaplan-Meier curves to ascertain whether there was any meaningful difference in overall survival for each age, especially for 64-year olds and 65-year olds. We also calculated the percentage of patients receiving surgery for cancer by single year of age to assess the possibility of postponed cancer treatment. Owing to the distinct and diverse population residing in New York City, we conducted the analysis separately for New York City and New York State exclusive of New York City (Rest of State). RESULTS *Figure2A and B represent 5-year survival difference of lung cancer in New York City and Upstate, respectively; *Figure2C and D represent 5-year survival difference of liver cancer in New York City and Upstate, respectively; KEY FINDINGS FURTHER ANALYSIS Based on these findings, we intend to construct regression models to find if the survival disparity was modified by other factors besides age, and to obtain adjusted hazard ratios to measure the benefits of Medicare coverage on cancer patients’ survival. Table 1 summarizes demographic and tumor characteristics for lung cancer and liver cancer patients. Patients in New York City and Rest of State appeared to be significantly different on nearly all selected indicators. Patients in New York City had a more diverse ethnicity/race, with higher proportion of patients who are Black and Asian/Pacific Islander. The stage distribution at diagnosis was similar between New York City and Rest of State, although the large sample size meant that these small differences were statistically significant. Patients outside of New York City were much more likely to have poorly differentiated tumor grade at the time of diagnosis Figure2. Kaplan-Meier Survival Plots for Lung Cancer and Liver Cancer for those Aged 64-65, 2004-2013 Figure1. Proportion of Patients Ever Receiving Surgery for those Aged 64 and 65, 2004-2013 Patients at age 65 were more likely to receive surgery than those at age 64 Generally, patients at age 65 had better 5-year cancer survival than those at age 64 5-year lung cancer survival was significantly higher among age 65 than age 64 in New York City In summary, there is evidence to suggest being diagnosed with lung cancer or liver cancer at age 64 results in less treatment and poorer survival than at age 65. This may be driven by underinsured and uninsured patients deferring treatment until reaching the age for Medicare eligibility, with the effect more pronounced among New York City residents. Table1. Demographic Characteristic of Patient Diagnosed with Primary Lung Cancer and Liver Cancer, New York State, U.S., 2004-2013 As shown in Figure 1, patients at age 65 were more likely to receive surgery than those at age 64. A significant difference was observed among lung cancer patients in New York City, where 5% more patients received surgery when diagnosed at age 65 compared to their 64-year old counterparts (36% vs. 31%, p=0.02). From the PROC LIFETEST results presented in Figure 2, the 5-year lung cancer survival was found to be significantly higher among those diagnosed at age 65 than at age 64 in New York City (p=0.0106). A similar though not significant pattern was also observed in the rest of the state and for liver cancer. Notably, in all of the plots, the lines eventually intersect after 3-5 years, suggesting that any Medicare advantage is only temporary. A B C D