Estimating Chemotherapy Use Among Patients With a Prior Primary Cancer Diagnosis Using SEER-Medicare Data

Workforce Caring for Cancer Survivors in the United States: Estimates and Projections of Utilization

BACKGROUND

This study aims to quantify the extent and diversity of the cancer care workforce, beyond medical oncologists, to inform future demand, as the number of cancer survivors is expected to grow in the US.

METHODS

SEER-Medicare data was used to evaluate healthcare utilization of cancer survivors diagnosed between 2000-2014 and enrolled in fee-for-service Medicare Parts A and B and 65 years or older in 2008-2015. We calculated percentage of cancer survivors who saw each clinician specialty and their average annual number of visits in each phase of care. We projected the national number of individuals receiving care and number of annual visits by clinician specialty and phase of care through 2040.

RESULTS

Cancer survivors had higher care utilization in the first year after diagnosis and last year of life phases. During the initial year after cancer diagnosis, most survivors were seen for cancer-related care by a medical oncologist (59.1%), primary care provider (55.9%) and/or other cancer-treating physicians (42.2%). The percentage of survivors with cancer-related visits to each specialty declined after the first year after diagnosis, plateauing after year 6-7. However, at 10 or more years after diagnosis, about 20% of cancer survivors had visits to medical oncologists and an average of 4 visits a year.

CONCLUSIONS

Cancer survivors had higher care utilization in the first year after diagnosis and last year of life. High levels of care utilization across specialty in all phases of care has important implications for models of survivorship care coordination and workforce planning.

Cancer Treatment Data in Central Cancer Registries: When Are Supplemental Data Needed?

Background:

We evaluated treatment concordance between the Colorado All Payer Claims Database (APCD) and the Colorado Central Cancer Registry (CCCR) to explore whether APCDs can augment registry data. We compare treatment concordance for breast cancer, an extensively studied site with an inpatient reporting source and select leukemias that are often diagnosed outpatient.

Methods:

We analyzed concordance by cancer type and treatment, patient demographics, reporting source, and health insurance, calculating the sensitivity, specificity, positive predictive values (PPV) and Kappa statistics. We estimated an adjusted logistic regression model to assess whether the APCD statistically significantly reports additional cancer-directed treatments.

Results:

Among women with breast cancer, 14% had chemotherapy treatments that were absent from the CCCR. Missing treatments were more common among women younger than age 50 (15%) and patients aged 75 and older (19%), rural residents (17%), and when the reporting source was outpatient (22%). Similar and more pronounced patterns for people with leukemia were observed. Concordance for oral treatments was lower for each cancer. Sensitivity and PPVs were high, with moderate Kappa statistics. The APCD was 5.3 percentage points less likely to identify additional treatments for breast cancer patients and 10 percentage points more likely to identify additional treatments when the reporting source was an outpatient facility.

Conclusion:

A robust data infrastructure is needed to investigate research questions that require population-level analyses, particularly for questions seeking to reduce health inequity and comparisons across payers, including Medicare Advantage and fee-for-service. APCD data are a step toward creating an infrastructure for cancer, particularly for patients who reside in rural areas and/or receive care from outpatient centers.