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Physician Variation in Lung Cancer Treatment at the End of Life
Jonas B. Green, MD, MPH, MSHS; Martin F. Shapiro, MD, PhD; Susan L. Ettner, PhD; Jennifer Malin, MD, PhD; Alfonso Ang, PhD; and Mitchell D. Wong, MD, PhD
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Physician Variation in Lung Cancer Treatment at the End of Life

Jonas B. Green, MD, MPH, MSHS; Martin F. Shapiro, MD, PhD; Susan L. Ettner, PhD; Jennifer Malin, MD, PhD; Alfonso Ang, PhD; and Mitchell D. Wong, MD, PhD
Patients receiving care for advanced non—small cell lung cancer in small, independent oncology practices are more likely to receive chemotherapy in the last 30 days of life.
The collection of cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201000140C awarded to the Cancer Prevention Institute of California, contract HHSN261201000035C awarded to the University of Southern California, and contract HHSN261201000034C awarded to the Public Health Institute; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement # U58DP003862-01 awarded to the California Department of Public Health. The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors is not intended nor should be inferred. 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.

Author Affiliations: Cedars-Sinai Medical Care Foundation (JBG), Beverly Hills, CA; Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine (MFS, SLE, JM, AA, MDW), and Department of Health Policy and Management, Fielding School of Public Health (MFS, SLE), University of California, Los Angeles, Los Angeles, CA; West Los Angeles Veterans Administration (JM), Los Angeles, CA.

Source of Funding: None.

Author Disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (JBG, JM, MDW, MFS, SLE); acquisition of data (AA, MDW); analysis and interpretation of data (JBG, JM, AA, MDW, MFS, SLE); drafting of the manuscript (JBG, MDW, MFS); critical revision of the manuscript for important intellectual content (JBG, JM, AA, MDW, MFS, SLE); statistical analysis (JBG, AA, MDW); administrative, technical, or logistic support (JBG, AA, MFS); and supervision (JBG, MDW, MFS).

Address Correspondence to: Jonas B. Green, MD, Cedars-Sinai Medical Care Foundation, Los Angeles, CA. E-mail: 

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