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Eaglehouse YL, Shriver CD, Lin J, Bytnar JA, Darmon S, McGlynn KA, Zhu K. MilCanEpi: Increased Capability for Cancer Care Research in the Department of Defense. JCO Clin Cancer Inform 2023; 7:e2300035. [PMID: 37582239 PMCID: PMC10569781 DOI: 10.1200/cci.23.00035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/23/2023] [Accepted: 06/29/2023] [Indexed: 08/17/2023] Open
Abstract
The Military Health System (MHS) of the US Department of Defense (DoD) provides comprehensive medical care to over nine million beneficiaries, including active-duty members, reservists, activated National Guard, military retirees, and their family members. The MHS generates an extensive database containing administrative claims and medical encounter data, while the DoD also maintains a cancer registry that collects information about the occurrence of cancer among its beneficiaries who receive care at military treatment facilities. Collating data from the two sources diminishes the limitations of using registry or medical claims data alone for cancer research and extends their usage. To facilitate cancer research using the unique military health resources, a computer interface linking the two databases has been developed, called Military Cancer Epidemiology, or MilCanEpi. The intent of this article is to provide an overview of the MilCanEpi data system, describing its components, structure, potential uses, and limitations.
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Affiliation(s)
- Yvonne L. Eaglehouse
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Craig D. Shriver
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD
| | - Jie Lin
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
- Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Julie A. Bytnar
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Sarah Darmon
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Katherine A. McGlynn
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
| | - Kangmin Zhu
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
- Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
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Eaglehouse YL, Park AB, Georg MW, Brown DW, Lin J, Shao S, Bytnar JA, Shriver CD, Zhu K. Consolidation of Cancer Registry and Administrative Claims Data on Cancer Diagnosis and Treatment in the US Military Health System. JCO Clin Cancer Inform 2020; 4:906-917. [PMID: 33074744 DOI: 10.1200/cci.20.00043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Linked cancer registry and medical claims data have increased the capacity for cancer research. However, few efforts have described methods to select information between data sources, which may affect data use. We developed a systematic process to evaluate and consolidate cancer diagnosis and treatment information between the linked Department of Defense Central Cancer Registry (CCR) and Military Health System Data Repository (MDR) administrative claims database, called Military Cancer Epidemiology Data System (MilCanEpi). METHODS MilCanEpi contains information on cancer diagnosis and treatment of patients receiving care from 1998 to 2014. We used an iterative process guided by knowledge of data features, current literature, and logical comparisons between the CCR and MDR data to evaluate and consolidate cancer diagnosis and treatment received (yes or no) and their dates. We applied the processes to breast cancer data as an example. Agreement between diagnosis and treatment dates in the two data sources was evaluated using Cohen's κ with 95% CIs. RESULTS In MilCanEpi, we identified 15,965 patients with a breast cancer diagnosis and 15,145 patients who underwent breast cancer surgery; 97.9% and 84.1% of patients had records in both CCR and MDR for diagnosis and surgery, respectively. Exact agreement was 13.7% for diagnosis dates (Cohen's κ = 0.14; 95% CI, 0.13 to 0.14) and 68.9% for surgery dates (Cohen's κ = 0.69; 95% CI, 0.68 to 0.70) between the two data sources. After applying systematic processes, 98.1% of patients with a breast cancer diagnosis and 99.7% of patients with surgery had information selected for analytic data sets. CONCLUSION The developed processes resulted in high consolidation rates of breast cancer data in MilCanEpi and may serve as a data selection template for other tumor sites and linked data sources.
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Affiliation(s)
- Yvonne L Eaglehouse
- Murtha Cancer Center/Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Amie B Park
- Murtha Cancer Center/Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Matthew W Georg
- Murtha Cancer Center/Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Derek W Brown
- Murtha Cancer Center/Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD.,Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Jie Lin
- Murtha Cancer Center/Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Stephanie Shao
- Murtha Cancer Center/Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD.,General Dynamics Information Technology Federal Health, Rockville, MD
| | - Julie A Bytnar
- Murtha Cancer Center/Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Craig D Shriver
- Murtha Cancer Center/Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD.,Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Kangmin Zhu
- Murtha Cancer Center/Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD.,Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
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Pakuła J, Stępień T, Kuzdak K. Metastatic breast cancer in regrowth of thyroid lobe after subtotal thyroidectomy - case report. POLISH JOURNAL OF SURGERY 2020; 92:1-3. [PMID: 32945782 DOI: 10.5604/01.3001.0013.5723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Breast cancer is the most common malignant neoplasm among women. Metastases to the thyroid are relatively rare. Those lesions annunciate neoplasm dissemination in most cases. Metastatic breast cancer of thyroid lobe regrowth hasn't been described yet. In the article the authors present a case of a 66-year old women with isolated, metachronous breast cancer metastasis in regrowth of the right thyroid lobe. Resection of the right lobe with metastatic tumor was performed with a purpose of total recovery. Despite surgery, multiple bone metastases were detected a few months after. In conclusion, regrowth of the thyroid is a potential site of recurrence and metastasis. Therefore, the thyroid bed cannot be omitted in routine examination during and after oncological treatment.
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Affiliation(s)
- Joanna Pakuła
- Klinika Chirurgii Endokrynologicznej, Uniwersytet Medyczny w Łodzi
| | - Tomasz Stępień
- Klinika Chirurgii Endokrynologicznej, Uniwersytet Medyczny w Łodzi
| | - Krzysztof Kuzdak
- Klinika Chirurgii Endokrynologicznej, Uniwersytet Medyczny w Łodzi
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Eaglehouse YL, Aljehani M, Georg MW, Castellanos O, Lee JSH, Seabury SA, Shriver CD, Zhu K. Contribution Of Care Source To Cancer Treatment Cost Variation In The US Military Health System. Health Aff (Millwood) 2019; 38:1335-1342. [PMID: 31381409 DOI: 10.1377/hlthaff.2019.00283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The US Military Health System (MHS) provides universal access to health care for more than nine million eligible beneficiaries through direct care in military treatment facilities or purchased care in civilian facilities. Using information from linked cancer registry and administrative databases, we examined how care source contributed to cancer treatment cost variation in the MHS for patients ages 18-64 who were diagnosed with colon, female breast, or prostate cancer in the period 2003-14. After accounting for patient, tumor, and treatment characteristics, we found the independent contribution of care source to total variation in cost to be 8 percent, 12 percent, and 2 percent for colon, breast, and prostate cancer treatment, respectively. About 20-50 percent of the total cost variance remained unexplained and may be related to organizational and administrative factors.
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Affiliation(s)
- Yvonne L Eaglehouse
- Yvonne L. Eaglehouse is a health services researcher in the Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences (USUHS); is an assistant professor in the Department of Surgery at USUHS; and is employed by the Henry M. Jackson Foundation for the Advancement of Military Medicine, all in Bethesda, Maryland
| | - Mayada Aljehani
- Mayada Aljehani is a biostatistician in the Lawrence J. Ellison Institute for Transformative Medicine, University of Southern California (USC), in Los Angeles
| | - Matthew W Georg
- Matthew W. Georg is a research associate in the Murtha Cancer Center Research Program, Department of Surgery, USUHS; and is employed by the Henry M. Jackson Foundation for the Advancement of Military Medicine
| | - Olga Castellanos
- Olga Castellanos is a clinical research program manager in the Lawrence J. Ellison Institute for Transformative Medicine, USC
| | - Jerry S H Lee
- Jerry S. H. Lee is the chief science and innovation officer in the Lawrence J. Ellison Institute for Transformative Medicine, USC; is an associate professor in the Departments of Clinical Medicine and Chemical Engineering, both at USC; and is employed by the Henry M. Jackson Foundation for the Advancement of Military Medicine
| | - Seth A Seabury
- Seth A. Seabury is the director of the Keck-Schaeffer Initiative for Population Health Policy at the Leonard D. Schaeffer Center for Health Policy and Economics and an associate professor in the Department of Pharmaceutical and Health Economics at the School of Pharmacy, both at USC
| | - Craig D Shriver
- Craig D. Shriver is the director of the Murtha Cancer Center Research Program, Department of Surgery, USUHS; director of the Murtha Cancer Center at Walter Reed National Military Medical Center; and a professor in the Department of Surgery at USUHS
| | - Kangmin Zhu
- Kangmin Zhu ( ) is the director of Military Epidemiology and Population Science in the Murtha Cancer Center Research Program, Department of Surgery, USUHS; is a professor in the Department of Preventive Medicine and Biostatistics at USUHS; and is employed by the Henry M. Jackson Foundation for the Advancement of Military Medicine
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