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Ahmed M, Walton R, Creighton N, Gugusheff J, Saini N, Moritz P, Roder D. Innovative use of Australian cancer registry data for early detection of the effects of epidemics and other mass disruptions on cancer incidence. Cancer Epidemiol 2024; 91:102608. [PMID: 38970918 DOI: 10.1016/j.canep.2024.102608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/26/2024] [Accepted: 06/27/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Predictive modelling using pre-epidemic data have long been used to guide public health responses to communicable disease outbreaks and other health disruptions. In this study, cancer registry and related health data available 2-3 months from diagnosis were used to predict changes in cancer detection that otherwise would not have been identified until full registry processing was completed about 18-24 months later. A key question was whether these earlier data could be used to predict cancer incidence ahead of full processing by the cancer registry as a guide to more timely health responses. The setting was the Australian State of New South Wales, covering 31 % of the Australian population. The study year was 2020, the year of emergence of the COVID-19 pandemic. METHODS Cancer detection in 2020 was modelled using data available 2-3 months after diagnosis. This was compared with data from full registry processing available from 2022. Data from pre-pandemic 2018 were used for exploratory model building. Models were tested using pre-pandemic 2019 data. Candidate predictor variables included pathology, surgery and radiation therapy reports, numbers of breast screens, colonoscopies, PSA tests, and melanoma excisions recorded by the universal Medical Benefits Schedule (MBS). Data were analysed for all cancers collectively and 5 leading types. RESULTS Compared with full registry processing, modelled data for 2020 had a >95 % accuracy overall, indicating key points of inflexion of cancer detection over the COVID-disrupted 2020 period. These findings highlight the potential of predictive modelling of cancer-related data soon after diagnosis to reveal changes in cancer detection during epidemics and other health disruptions. CONCLUSIONS Data available 2-3 months from diagnosis in the pandemic year indicated changes in cancer detection that were ultimately confirmed by fully-processed cancer registry data about 24 months later. This indicates the potential utility of using these early data in an early-warning system.
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Affiliation(s)
- Muktar Ahmed
- Cancer Research Institute, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia; Cancer Epidemiology and Population Health, University of South Australia, Adelaide, SA 5001, Australia; Cancer Institute NSW, PO Box 41, Alexandria, NSW 1435, Australia
| | - Richard Walton
- Cancer Institute NSW, PO Box 41, Alexandria, NSW 1435, Australia
| | - Nicola Creighton
- Cancer Institute NSW, PO Box 41, Alexandria, NSW 1435, Australia
| | | | - Nitu Saini
- Cancer Institute NSW, PO Box 41, Alexandria, NSW 1435, Australia
| | - Peter Moritz
- Cancer Institute NSW, PO Box 41, Alexandria, NSW 1435, Australia
| | - David Roder
- Cancer Research Institute, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia; Cancer Epidemiology and Population Health, University of South Australia, Adelaide, SA 5001, Australia; Cancer Institute NSW, PO Box 41, Alexandria, NSW 1435, Australia.
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Smith SJ, Moorin R, Taylor K, Newton J, Smith S. Collecting routine and timely cancer stage at diagnosis by implementing a cancer staging tiered framework: the Western Australian Cancer Registry experience. BMC Health Serv Res 2024; 24:770. [PMID: 38943091 PMCID: PMC11214229 DOI: 10.1186/s12913-024-11224-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 06/20/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND Current processes collecting cancer stage data in population-based cancer registries (PBCRs) lack standardisation, resulting in difficulty utilising diverse data sources and incomplete, low-quality data. Implementing a cancer staging tiered framework aims to improve stage collection and facilitate inter-PBCR benchmarking. OBJECTIVE Demonstrate the application of a cancer staging tiered framework in the Western Australian Cancer Staging Project to establish a standardised method for collecting cancer stage at diagnosis data in PBCRs. METHODS The tiered framework, developed in collaboration with a Project Advisory Group and applied to breast, colorectal, and melanoma cancers, provides business rules - procedures for stage collection. Tier 1 represents the highest staging level, involving complete American Joint Committee on Cancer (AJCC) tumour-node-metastasis (TNM) data collection and other critical staging information. Tier 2 (registry-derived stage) relies on supplementary data, including hospital admission data, to make assumptions based on data availability. Tier 3 (pathology stage) solely uses pathology reports. FINDINGS The tiered framework promotes flexible utilisation of staging data, recognising various levels of data completeness. Tier 1 is suitable for all purposes, including clinical and epidemiological applications. Tiers 2 and 3 are recommended for epidemiological analysis alone. Lower tiers provide valuable insights into disease patterns, risk factors, and overall disease burden for public health planning and policy decisions. Capture of staging at each tier depends on data availability, with potential shifts to higher tiers as new data sources are acquired. CONCLUSIONS The tiered framework offers a dynamic approach for PBCRs to record stage at diagnosis, promoting consistency in population-level staging data and enabling practical use for benchmarking across jurisdictions, public health planning, policy development, epidemiological analyses, and assessing cancer outcomes. Evolution with staging classifications and data variable changes will futureproof the tiered framework. Its adaptability fosters continuous refinement of data collection processes and encourages improvements in data quality.
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Affiliation(s)
- Shantelle J Smith
- School of Population Health, Curtin University, Perth, WA, Australia.
- Faculty of Health Sciences, Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia.
| | - Rachael Moorin
- School of Population Health, Curtin University, Perth, WA, Australia
- Faculty of Health Sciences, Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia
- School of Population and Global Health, The University of Western Australia, Crawley, WA, Australia
| | - Karen Taylor
- Cancer Network WA, North Metropolitan Health Service, Perth, WA, Australia
| | - Jade Newton
- School of Population Health, Curtin University, Perth, WA, Australia
- Faculty of Health Sciences, Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia
| | - Stephanie Smith
- School of Population Health, Curtin University, Perth, WA, Australia
- Curtin Medical School, Curtin University, Perth, WA, Australia
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3
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Chong K, Maida J, Ong HI, Proud D, Lin J, Burgess A, Heriot A, Smart P, Mohan H. Cancer incidence and outcomes registries in an Australian context: a systematic review. ANZ J Surg 2023; 93:2314-2336. [PMID: 37668278 DOI: 10.1111/ans.18678] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Multiple cancer registries in Australia are used to track the incidence of cancer and the outcomes of their treatment. These registries can be broadly classed into a few types with an increasing number of registries comes a greater potential for collaboration and linkage. This article aims to critically review cancer registry types in Australia and evaluate the Australian Cancer registry landscape to identify these areas. METHODS A systematic review was performed through MEDLINE, EMBASE and Cochrane Library, updated to September 2022 using a predefined search strategy. Inclusion criteria were those that only analysed Australian and/or New Zealand based cancer registries, appraised the utility of cancer outcomes and/or incidence registries, and explored the utility of linked databases using cancer outcomes and/or incidence registries. The grey literature was searched for all operating cancer registries in Australia. Details of registry infrastructure was extracted for analysis and comparison. RESULTS Three thousand two hundred and sixteen articles identified from the three databases. Twelve met the inclusion criteria. Twenty-eight registries were identified using the grey literature. Strengths and weaknesses of Cancer Outcome Registries(COR) and Cancer Incidence Registries(CIR) were compared. Data linkage between registries or with other healthcare databases show great benefits in improving evidence for cancer research but are challenging to implement. Both registry types utilize differing modes of administration, influencing their accuracy and completeness. CONCLUSION Outcome registries provide detailed data but their weakness lies in incomplete data coverage. Incidence registries record a large dataset which contain inaccuracies. Improving coverage of quality outcome registries, and quality assurance of data in incidence registries is required to ensure collection of accurate, meaningful data. Areas for collaboration identified included establishment of defined definitions and outcomes, data linkage between registry types or with healthcare databases, and collaboration in logistical planning to improve clinical utility of cancer registries.
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Affiliation(s)
- Kit Chong
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Jack Maida
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Hwa Ian Ong
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia
| | - David Proud
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia
| | - James Lin
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Adele Burgess
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Alexander Heriot
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Philip Smart
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Helen Mohan
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Woods JA, Katzenellenbogen JM, Murray K, Johnson CE, Thompson SC. Occurrence and timely management of problems requiring prompt intervention among Indigenous compared with non-Indigenous Australian palliative care patients: a multijurisdictional cohort study. BMJ Open 2021; 11:e042268. [PMID: 33727263 PMCID: PMC7970279 DOI: 10.1136/bmjopen-2020-042268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Anticipation and prompt relief of symptoms among patients with a life-limiting illness is a core element of palliative care. Indigenous Australians commonly encounter cultural barriers in healthcare that may impair outcomes. The Palliative Care Outcomes Collaboration collects patient care data for the purposes of continuous quality improvement and benchmarking, with each recorded care episode divided into phases that reflect a patient's condition. We aimed to investigate differences between Indigenous and non-Indigenous patients in the occurrence and duration of 'unstable' phases (which indicate unanticipated deterioration in a patient's condition or circumstances), and determine attainment of the relevant benchmark (resolution of unstable phases in ≤3 days in 90% of cases) for both groups. DESIGN Cohort study. SETTING Australia-wide hospital-based and community-based specialist palliative care (1 January 2010 to 30 June 2015). PARTICIPANTS 139 556 (1502 Indigenous and 138 054 non-Indigenous) adult patients. OUTCOME MEASURES Indigenous and non-Indigenous patients were compared on (1) the risk of a phase being categorised as unstable, (2) the duration of unstable phases, and (3) the risk of unstable phases being prolonged (>3 days). Crude and adjusted estimates were produced from three-level robust Poisson regression and complementary log-log discrete time survival models. RESULTS Unstable phases occurred with similar frequency overall among Indigenous and non-Indigenous patients (adjusted relative risks 1.06; 95% CI 1.00 to 1.11; not significant after correction for multiple comparisons). The duration and risk of prolongation of unstable phases were similar in both patient groups, with no significant differences evident among subgroups. The benchmark was not met for either Indigenous or non-Indigenous patients (unstable phase duration >3 days in 24.3% vs 25.5%; p=0.398). CONCLUSIONS Despite well-documented shortcomings of healthcare for Indigenous Australians, there is no clear evidence of greater occurrence or prolongation of unanticipated problems among Indigenous patients accessing specialist palliative care services in hospital or the community.
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Affiliation(s)
- John A Woods
- Western Australian Centre for Rural Health, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Judith M Katzenellenbogen
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Claire E Johnson
- The Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
- Eastern Health, Melbourne, Victoria, Australia
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Sandra C Thompson
- Western Australian Centre for Rural Health, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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Fahey PP, Page A, Stone G, Astell-Burt T. Augmenting cancer registry data with health survey data with no cases in common: the relationship between pre-diagnosis health behaviour and post-diagnosis survival in oesophageal cancer. BMC Cancer 2020; 20:496. [PMID: 32487049 PMCID: PMC7268470 DOI: 10.1186/s12885-020-06990-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 05/21/2020] [Indexed: 12/24/2022] Open
Abstract
Background For epidemiological research, cancer registry datasets often need to be augmented with additional data. Data linkage is not feasible when there are no cases in common between data sets. We present a novel approach to augmenting cancer registry data by imputing pre-diagnosis health behaviour and estimating its relationship with post-diagnosis survival time. Methods Six measures of pre-diagnosis health behaviours (focussing on tobacco smoking, ‘at risk’ alcohol consumption, overweight and exercise) were imputed for 28,000 cancer registry data records of US oesophageal cancers using cold deck imputation from an unrelated health behaviour dataset. Each data point was imputed twice. This calibration allowed us to estimate the misclassification rate. We applied statistical correction for the misclassification to estimate the relative risk of dying within 1 year of diagnosis for each of the imputed behaviour variables. Subgroup analyses were conducted for adenocarcinoma and squamous cell carcinoma separately. Results Simulated survival data confirmed that accurate estimates of true relative risks could be retrieved for health behaviours with greater than 5% prevalence, although confidence intervals were wide. Applied to real datasets, the estimated relative risks were largely consistent with current knowledge. For example, tobacco smoking status 5 years prior to diagnosis was associated with an increased age-adjusted risk of all cause death within 1 year of diagnosis for oesophageal squamous cell carcinoma (RR = 1.99 95% CI 1.24,3.12) but not oesophageal adenocarcinoma RR = 1.61, 95% CI 0.79,2.57). Conclusions We have demonstrated a novel imputation-based algorithm for augmenting cancer registry data for epidemiological research which can be used when there are no cases in common between data sets. The algorithm allows investigation of research questions which could not be addressed through direct data linkage.
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Affiliation(s)
- Paul P Fahey
- School of Science and Health, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Glenn Stone
- School of Computing, Engineering and Mathematics, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Thomas Astell-Burt
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW, 2522, Australia
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6
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Tew M, Dalziel KM, Petrie DJ, Clarke PM. Growth of linked hospital data use in Australia: a systematic review. AUST HEALTH REV 2019; 41:394-400. [PMID: 27444270 DOI: 10.1071/ah16034] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 06/05/2016] [Indexed: 11/23/2022]
Abstract
Objective The aim of the present study was to quantify and understand the utilisation of linked hospital data for research purposes across Australia over the past two decades. Methods A systematic review was undertaken guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 checklist. Medline OVID, PsycINFO, Embase, EconLit and Scopus were searched to identify articles published from 1946 to December 2014. Information on publication year, state(s) involved, type of data linkage, disease area and purpose was extracted. Results The search identified 3314 articles, of which 606 were included; these generated 629 records of hospital data linkage use across all Australian states and territories. The major contributions were from Western Australia (WA; 51%) and New South Wales (NSW; 32%) with the remaining states and territories having significantly fewer publications (total contribution only 17%). WA's contribution resulted from a steady increase from the late 1990s, whereas NSW's contribution is mostly from a rapid increase from 2010. Current data linkage is primarily used in epidemiological research (73%). Conclusion More than 80% of publications were from WA and NSW, whereas other states significantly lag behind. The observable growth in these two states clearly demonstrates the underutilised opportunities for data linkage to add value in health services research in the other states. What is known about the topic? Linking administrative hospital data to other data has the potential to be a cost-effective method to significantly improve health policy. Over the past two decades, Australia has made significant investments in improving its data linkage capabilities. However, several articles have highlighted the many barriers involved in using linked hospital data. What does this paper add? This paper quantitatively evaluates the performance across all Australian states in terms of the use of their administrative hospital data for research purposes. The performance of states varies considerably, with WA and NSW the clear stand-out performers and limited outputs currently seen for the other Australian states and territories. What are the implications for practitioners? Given the significant investments made into data linkage, it is important to continue to evaluate and monitor the performance of the states in terms of translating this investment into outputs. Where the outputs do not match the investment, it is important to identify and overcome those barriers limiting the gains from this investment. More generally, there is a need to think about how we improve the effective and efficient use of data linkage investments in Australia.
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Affiliation(s)
- Michelle Tew
- The University of Melbourne, Centre for Health Policy, Melbourne School of Population and Global Health, Level 4, 207 Bouverie Street, Carlton, Vic. 3053, Australia.
| | - Kim M Dalziel
- The University of Melbourne, Centre for Health Policy, Melbourne School of Population and Global Health, Level 4, 207 Bouverie Street, Carlton, Vic. 3053, Australia.
| | - Dennis J Petrie
- The University of Melbourne, Centre for Health Policy, Melbourne School of Population and Global Health, Level 4, 207 Bouverie Street, Carlton, Vic. 3053, Australia.
| | - Philip M Clarke
- The University of Melbourne, Centre for Health Policy, Melbourne School of Population and Global Health, Level 4, 207 Bouverie Street, Carlton, Vic. 3053, Australia.
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Roder D, Davy M, Selva-Nayagam S, Paramasivam S, Adams J, Keefe D, Miller C, Powell K, Fusco K, Buranyi-Trevarton D, Oehler MK. Exploring the added value of hospital-registry data for showing local service outcomes: cancers of the ovary, fallopian tube and peritoneum. BMJ Open 2019; 9:e024036. [PMID: 30782891 PMCID: PMC6367964 DOI: 10.1136/bmjopen-2018-024036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore the added value of hospital-registry data on invasive epithelial ovarian, tubal and peritoneal cancers. DESIGN Historic cohort analyses. METHODS Unadjusted and adjusted regression. SETTING Major South Australian hospitals. PARTICIPANTS 1596 women (1984-2015 diagnoses). RESULTS 5-Year and 10-year survival was 48% and 41%, respectively, equivalent to relative survival for Australia and the USA. After adjusting for age, clinical and geographic factors, risk of ovarian cancer death was 25% lower in 2010-2015 than 1984-1989. Women generally had surgical treatment (87%) in their first round of care. This was more common for younger patients (adjusted OR (95% CIs) 0.17 (0.04 to 0.65) for 80+ vs <40 years) and earlier International Federation of Gynecology and Obstetrics stages (adjusted OR 0.48 (0.13 to 1.78) for stage IIIB/C and 0.13 (0.04 to 0.45) for stage IV vs stage IA). Most (74%) had systemic therapy, which was more common for advanced stages (adjusted ORs >15.0 for stages III and IV vs stage IA). Few (9%) had radiotherapy. Women generally had systemic therapy (74%), without difference by service accessibility and socioeconomic disadvantage, suggesting equity. However, surgery was less common for residents of the most compared with least remote areas (adjusted OR 0.49 (0.24 to 0.99)); and more common prior to adjustment in the highest versus lowest socioeconomic category (unadjusted OR 1.55 (1.01 to 2.39)), but this elevation did not apply after adjustment (adjusted OR 0.19 (0.63 to 2.25)), with the difference largely explained by stage. CONCLUSIONS Hospital-registry data add value for assessing local service delivery. Equivalent survival to Australia-wide and USA survival, and temporal gains after adjusting for stage and other patient characteristics are reassuring. Survival gains may reflect therapeutic benefits of more extensive surgery and improved chemotherapy regimens.
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MESH Headings
- Adenocarcinoma, Clear Cell/mortality
- Adenocarcinoma, Clear Cell/pathology
- Adenocarcinoma, Clear Cell/therapy
- Adenocarcinoma, Mucinous/mortality
- Adenocarcinoma, Mucinous/pathology
- Adenocarcinoma, Mucinous/therapy
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Agents/therapeutic use
- Carcinoma, Endometrioid/mortality
- Carcinoma, Endometrioid/pathology
- Carcinoma, Endometrioid/therapy
- Carcinoma, Ovarian Epithelial/mortality
- Carcinoma, Ovarian Epithelial/pathology
- Carcinoma, Ovarian Epithelial/therapy
- Cohort Studies
- Fallopian Tube Neoplasms/mortality
- Fallopian Tube Neoplasms/pathology
- Fallopian Tube Neoplasms/therapy
- Female
- Gynecologic Surgical Procedures
- Health Services Accessibility
- Hospitals
- Humans
- Middle Aged
- Neoplasm Staging
- Ovarian Neoplasms/mortality
- Ovarian Neoplasms/pathology
- Ovarian Neoplasms/therapy
- Peritoneal Neoplasms/mortality
- Peritoneal Neoplasms/pathology
- Peritoneal Neoplasms/therapy
- Proportional Hazards Models
- Radiotherapy
- Registries
- Social Class
- South Australia
- Survival Rate
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Affiliation(s)
- David Roder
- Cancer Epidemiology and Population Health, University of South Australia, Adelaide, South Australia, Australia
| | - Margaret Davy
- Private Consultant, Norwood, South Australia, Australia
| | - Sid Selva-Nayagam
- Royal Adelaide Hospital Cancer Centre, Adelaide, South Australia, Australia
| | | | - Jacqui Adams
- Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Dorothy Keefe
- Citi Centre Hindmarsh Square Adelaide, Adelaide, South Australia, Australia
| | - Caroline Miller
- Population Health Research Group South Australian Health & Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Kate Powell
- Population Health Research Group South Australian Health & Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
- SA Clinical Cancer Registry, SA Health, Adelaide, South Australia, Australia
| | - Kellie Fusco
- Cancer Epidemiology and Population Health, University of South Australia, Adelaide, South Australia, Australia
| | | | - Martin K Oehler
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
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8
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Roder D, Farshid G, Gill G, Kollias J, Koczwara B, Karapetis C, Adams J, Joshi R, Keefe D, Powell K, Fusco K, Eckert M, Buckley E, Beckmann K. Breast cancer screening-opportunistic use of registry and linked screening data for local evaluation. J Eval Clin Pract 2017; 23:508-516. [PMID: 27654906 DOI: 10.1111/jep.12640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 08/04/2016] [Accepted: 08/08/2016] [Indexed: 01/08/2023]
Abstract
RATIONALE Screening has been found to reduce breast cancer mortality at a population level in Australia, but these studies did not address local settings where numbers of deaths would generally have been too low for evaluation. Clinicians, administrators, and consumer groups are also interested in local service outcomes. We therefore use more common prognostic and treatment measures and survivals to gain evidence of screening effects among patients attending 4 local hospitals for treatment. AIMS AND OBJECTIVES To compare prognostic, treatment, and survival measures by screening history to determine whether expected screening effects are occurring. METHODS Employing routine clinical registry and linked screening data to investigate associations of screening history with these measures, using unadjusted and adjusted analyses. RESULTS Screened women had a 10-year survival from breast cancer of 92%, compared with 78% for unscreened women; and 79% of screened surgical cases had breast conserving surgery compared with 64% in unscreened women. Unadjusted analyses indicated that recently screened cases had earlier tumor node metastasis stages, smaller diameters, less nodal involvement, better tumor differentiation, more oestrogen and progesterone receptor positive lesions, more hormone therapy, and less chemotherapy. Radiotherapy tended to be more common in screening participants. More frequent use of adjunctive radiotherapy applied when breast conserving surgery was used. CONCLUSIONS Results confirm the screening effects expected from the scientific literature and demonstrate the value of opportunistic use of available registry and linked screening data for indicating to local health administrations, practitioners, and consumers whether local screening services are having the effects expected.
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Affiliation(s)
- David Roder
- Cancer Epidemiology and Population Health, University of South Australia, Adelaide, SA, Australia
| | | | - Grantley Gill
- Breast Endocrine and Surgical Oncology Unit, RAH, Discipline of Surgery, University of Adelaide, Adelaide, SA, Australia
| | | | - Bogda Koczwara
- Department of Medical Oncology, Flinders University, Adelaide, SA, Australia
| | - Chris Karapetis
- Department of Medical Oncology, Flinders University, Bedford Park, SA, Australia
| | - Jacqui Adams
- Medical Oncology, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia
| | - Rohit Joshi
- Medical Oncology, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia
| | - Dorothy Keefe
- SA Health, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Kate Powell
- Population Health, South Australian Health and Medical Research Institute (SAHMRI), North Terrace, SA, Australia
| | - Kellie Fusco
- Centre for Population Health Research, University of South Australia, Adelaide, SA, Australia
| | - Marion Eckert
- Cancer Nursing, University of South Australia, Adelaide, SA, Australia
| | - Elizabeth Buckley
- Centre for Population Health Research, University of South Australia, Adelaide, SA, Australia
| | - Kerri Beckmann
- Centre for Population Health Research, University of South Australia, Adelaide, SA, Australia
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9
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Meehan E, Reid SM, Williams K, Freed GL, Sewell JR, Vidmar S, Donath S, Reddihough DS. Hospital admissions in children with cerebral palsy: a data linkage study. Dev Med Child Neurol 2017; 59:512-519. [PMID: 27900776 DOI: 10.1111/dmcn.13350] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2016] [Indexed: 01/06/2023]
Abstract
AIM The overall aim was to investigate the feasibility and utility of linking a cerebral palsy (CP) register to an administrative data set for health services research purposes. We sought to compare CP hospital admissions to general childhood population admissions, and identify factors associated with type and frequency of admissions in a CP cohort. METHOD The CP register for Victoria, Australia was linked to the state's hospital admissions database. Data pertaining to the admissions of a CP cohort (n=1748) that took place between 2007 and 2014 were extracted. Population data were also obtained. RESULTS Overall, 80% of the CP cohort (n=1401) had at least admission between 2007 and 2014, accounting for 11 012 admissions or 1.5% of all admissions in their age group. Compared to general population admissions, CP admissions were more costly and more likely to be elective (66% vs 57%; p<0.001), medical (71% vs 57%; p<0.001), and to take place in metropolitan hospitals (92% vs 78%; p<0.001). Increased CP severity and complexity were associated with having more admissions and a higher proportion of admissions attributable to respiratory illness. INTERPRETATION By linking with administrative data sets, CP registers may be useful for health services research and inform health service delivery.
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Affiliation(s)
- Elaine Meehan
- Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.,Developmental Disability and Rehabilitation Research, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Vic., Australia
| | - Susan M Reid
- Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.,Developmental Disability and Rehabilitation Research, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Vic., Australia
| | - Katrina Williams
- Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.,Developmental Disability and Rehabilitation Research, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,Developmental Medicine, The Royal Children's Hospital, Melbourne, Vic., Australia
| | - Gary L Freed
- Health Systems and Workforce Unit, Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, Vic., Australia
| | - Jillian R Sewell
- Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.,Centre for Community Child Health, Royal Children's Hospital, Melbourne, Vic., Australia
| | - Suzanna Vidmar
- Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.,Clinical Epidemiology and Biostatistics Unit, Data Science, Murdoch Childrens Research Institute, Melbourne, Vic., Australia
| | - Susan Donath
- Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.,Clinical Epidemiology and Biostatistics Unit, Data Science, Murdoch Childrens Research Institute, Melbourne, Vic., Australia
| | - Dinah S Reddihough
- Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.,Developmental Disability and Rehabilitation Research, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,Developmental Medicine, The Royal Children's Hospital, Melbourne, Vic., Australia
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10
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Corsini N, Fish J, Ramsey I, Sharplin G, Flight I, Damarell R, Wiggins B, Wilson C, Roder D, Eckert M. Cancer survivorship monitoring systems for the collection of patient-reported outcomes: a systematic narrative review of international approaches. J Cancer Surviv 2017; 11:486-497. [DOI: 10.1007/s11764-017-0607-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 02/14/2017] [Indexed: 01/23/2023]
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11
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Roder D, Buckley E. Administrative data provide vital research evidence for maximizing health-system performance and outcomes. Asia Pac J Clin Oncol 2017; 13:111-114. [PMID: 28120376 DOI: 10.1111/ajco.12644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 08/29/2016] [Accepted: 10/03/2016] [Indexed: 11/30/2022]
Abstract
Although the quality of administrative data is frequently questioned, these data are vital for health-services evaluation and complement data from trials, other research studies and registries for research. Trials generally provide the strongest evidence of outcomes in research settings but results may not apply in many service environments. High-quality observational research has a complementary role where trials are not applicable and for assessing whether trial results apply to groups excluded from trials. Administrative data have a broader system-wide reach, enabling system-wide health-services research and monitoring of performance markers. Where administrative data raise questions about service outcomes, follow-up enquiry may be required to investigate validity and service implications. Greater use should be made of administrative data for system-wide monitoring and for research on service effectiveness and equity.
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Affiliation(s)
- David Roder
- Centre for Population Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Elizabeth Buckley
- Centre for Population Health Research, University of South Australia, Adelaide, South Australia, Australia
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12
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Brown A, Roder D, Yerrell P, Cargo M, Reilly R, Banham D, Micklem J, Morey K, Stewart H. Cancer Data and Aboriginal Disparities Project (CanDAD)--an overdue cancer control initiative. Eur J Cancer Care (Engl) 2017; 25:208-13. [PMID: 26918683 DOI: 10.1111/ecc.12466] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2016] [Indexed: 11/30/2022]
Affiliation(s)
- A Brown
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA
| | - D Roder
- Centre for Population Health Research, University of South Australia, Adelaide, SA, Australia
| | - P Yerrell
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA
| | - M Cargo
- Centre for Population Health Research, University of South Australia, Adelaide, SA, Australia
| | - R Reilly
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA
| | - D Banham
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA
| | - J Micklem
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA
| | - K Morey
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA
| | - H Stewart
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA
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13
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Roder DM, Buckley E. High quality data are the key to understanding inequalities in cancer outcomes for Aboriginal and Torres Strait Islander Australians. Med J Aust 2016; 205:451-452. [PMID: 27852181 DOI: 10.5694/mja16.00980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 09/09/2016] [Indexed: 11/17/2022]
Affiliation(s)
- David M Roder
- Centre for Population Health Research, University of South Australia, Adelaide, SA
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14
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Roder D, Karapetis CS, Wattchow D, Moore J, Singhal N, Joshi R, Keefe D, Fusco K, Buranyi-Trevarton D, Sharplin G, Price TJ. Metastatic Colorectal Cancer Treatment and Survival: the Experience of Major Public Hospitals in South Australia Over Three Decades. Asian Pac J Cancer Prev 2016; 16:5923-31. [PMID: 26320474 DOI: 10.7314/apjcp.2015.16.14.5923] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Registry data from four major public hospitals indicate trends over three decades from 1980 to 2010 in treatment and survival from colorectal cancer with distant metastases at diagnosis (TNM stage IV). MATERIALS AND METHODS Kaplan-Meier product-limit estimates and Cox proportional hazards models for investigating disease-specific survival and multiple logistic regression analyses for indicating first-round treatment trends. RESULTS Two-year survivals increased from 10% for 1980-84 to 35% for 2005-10 diagnoses. Corresponding increases in five-year survivals were from 3% to 16%. Time-to-event risk of colorectal cancer death approximately halved (hazards ratio: 0.48 (0.40, 0.59) after adjusting for demographic factors, tumour differentiation, and primary sub-site. Survivals were not found to differ by place of residence, suggesting reasonable equity in service provision. About 74% of cases were treated surgically and this proportion increased over time. Proportions having systemic therapy and/or radiotherapy increased from 12% in 1980-84 to 61% for 2005-10. Radiotherapy was more common for rectal than colonic cases (39% vs 7% in 2005-10). Of the cases diagnosed in 2005-10 when less than 70 years of age, the percentage having radiotherapy and/or systemic therapy was 79% for colorectal, 74% for colon and 86% for rectum (and RS)) cancers. Corresponding proportions having: systemic therapies were 75%, 71% and 81% respectively; radiotherapy were 24%, 10% and 46% respectively; and surgery were 75%, 78% and 71% respectively. Based on survey data on uptake of offered therapies, it is likely that of these younger cases, 85% would have been offered systemic treatment and among rectum (and RS) cases, about 63% would have been offered radiotherapy. CONCLUSIONS Pronounced increases in survivals from metastatic colorectal cancer have occurred, in keeping with improved systemic therapies and surgical interventions. Use of radiotherapy and/or systemic therapy has increased markedly and patterns of change accord with clinical guideline recommendations.
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Affiliation(s)
- David Roder
- Centre for Population Health Research, University of South Australia, South Australia E-mail :
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15
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Roder D, Karapetis CS, Wattchow D, Moore J, Singhal N, Joshi R, Keefe D, Fusco K, Powell K, Eckert M, Price TJ. Colorectal cancer treatment and survival: the experience of major public hospitals in south Australia over three decades. Asian Pac J Cancer Prev 2016; 16:2431-40. [PMID: 25824777 DOI: 10.7314/apjcp.2015.16.6.2431] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Registry data from four major public hospitals indicate trends in clinical care and survival from colorectal cancer over three decades, from 1980 to 2010. MATERIALS AND METHODS Kaplan-Meier product- limit estimates and Cox proportional hazards models were used to investigate disease-specific survival and multiple logistic regression analyses to explore first-round treatment trends. RESULTS Five-year survivals increased from 48% for 1980-1986 to 63% for 2005-2010 diagnoses. Survival increases applied to each ACPS stage (Australian Clinico-Pathological Stage), and particularly stage C (an increase from 38% to 68%). Risk of death from colorectal cancer halved (hazards ratio: 0.50 (0.45, 0.56)) over the study period after adjusting for age, sex, stage, differentiation, primary sub-site, health administrative region, and measures of socioeconomic status and geographic remoteness. Decreases in stage were not observed. Survivals did not vary by sex or place of residence, suggesting reasonable equity in service access and outcomes. Of staged cases, 91% were treated surgically with lower surgical rates for older ages and more advanced stage. Proportions of surgical cases having adjuvant therapy during primary courses of treatment increased for all stages and were highest for stage C (an increase from 5% in 1980-1986 to 63% for 2005-2010). Radiotherapy was more common for rectal than colonic cases. Proportions of rectal cases receiving radiotherapy increased, particularly for stage C where the increase was from 8% in 1980-1986 to 60% in 2005-2010. The percentage of stage C colorectal cases less than 70 years of age having systemic therapy as part of their first treatment round increased from 3% in 1980-1986 to 81% by 1995-2010. Based on survey data on uptake of adjuvant therapy among those offered this care, it is likely that all these younger patients were offered systemic treatment. CONCLUSIONS We conclude that pronounced increases in survivals from colorectal cancer have occurred at major public hospitals in South Australia due to increases in stage-specific survivals. Use of adjuvant therapies has increased and the patterns of change accord with clinical guideline recommendations. Reasons for sub-optimal use of radiotherapy for rectal cases warrant further investigation, including the potential for limited rural access to impede uptake of treatments at metropolitan-based radiotherapy centres.
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Affiliation(s)
- David Roder
- School of Population Health, University of South Australia, Adelaide, South Australia E-mail :
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16
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Ellis DW, Srigley J. Does standardised structured reporting contribute to quality in diagnostic pathology? The importance of evidence-based datasets. Virchows Arch 2015; 468:51-9. [DOI: 10.1007/s00428-015-1834-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 08/08/2015] [Accepted: 08/13/2015] [Indexed: 01/07/2023]
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17
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Roder D, Buckley E. Translation from clinical trials to routine practice: How to demonstrate community benefit. Asia Pac J Clin Oncol 2015; 11:1-3. [DOI: 10.1111/ajco.12338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- David Roder
- Cancer Epidemiology and Population Health; University of South Australia and South Australian Health and Medical Research Institute; Adelaide South Australia Australia
| | - Elizabeth Buckley
- Cancer Epidemiology and Population Health; University of South Australia; Adelaide South Australia Australia
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18
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Knott V, Weller D. Informatics and e-health: advancing knowledge and improving cancer care. Eur J Cancer Care (Engl) 2014; 23:713-5. [DOI: 10.1111/ecc.12268] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2014] [Indexed: 01/16/2023]
Affiliation(s)
- V.E. Knott
- Epidemiology & Health Systems Division; Menzies School of Health Research; Brisbane Australia
| | - D. Weller
- University of Edinburgh; Edinburgh UK
- Cancer and Primary Care Research International Network (Ca-PRI); Edinburgh UK
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