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Mullins M, Kabeto M, Wallner L, Kobayashi L. Validation of Self-Reported Cancer Diagnoses by Respondent Cognitive Status in the U.S. Health and Retirement Study. J Gerontol A Biol Sci Med Sci 2023; 78:1239-1245. [PMID: 36583244 PMCID: PMC10329217 DOI: 10.1093/gerona/glac248] [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: 09/28/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Cancer and dementia are becoming increasingly common co-occurring conditions among older adults. Yet, the influence of participant cognitive status on the validity of self-reported data among older adults in population-based cohorts is unknown. We thus compared self-reported cancer diagnoses in the U.S. Health and Retirement Study (HRS) against claims from linked Medicare records to ascertain the validity of self-reported diagnoses by participant cognitive and proxy interview status. METHODS Using data from HRS participants aged ≥67 who had at least 90% continuous enrollment in fee-for-service Medicare, we examined the validity of self-reported first incident cancer diagnoses from biennial HRS interviews against diagnostic claim records in linked Medicare data (reference standard) for interviews from 2000 to 2016. Cognitive status was classified as normal, cognitive impairment no dementia (CIND), or dementia using the Langa-Weir method. We calculated the sensitivity, specificity, and κ for cancer diagnosis. RESULTS Of the 8 280 included participants, 23.6% had cognitive impairment without dementia (CIND) or dementia, and 10.7% had a proxy respondent due to an impairment. Self-reports of first incident cancer diagnoses for participants with normal cognition had 70.2% sensitivity and 99.8% specificity (κ = 0.79). Sensitivity declined substantially with cognitive impairment and proxy response (56.7% for CIND, 53.0% for dementia, 60.0% for proxy respondents), indicating poor validity for study participants with CIND, dementia, or a proxy respondent. CONCLUSIONS Self-reported cancer diagnoses in the U.S. HRS have poor validity for participants with cognitive impairment, dementia, or a proxy respondent. Population-based cancer research among older adults will be strengthened with linkage to Medicare claims.
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Affiliation(s)
- Megan A Mullins
- Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mohammed Kabeto
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Lauren P Wallner
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Cancer Control and Population Sciences Program, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Lindsay C Kobayashi
- Cancer Control and Population Sciences Program, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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Ogawa T, Takahashi H, Saito H, Sagawa M, Aoki D, Matsuda K, Nakayama T, Kasahara Y, Kato K, Saitoh E, Morisada T, Saika K, Sawada N, Matsumura Y, Sobue T. Novel Algorithm for the Estimation of Cancer Incidence Using Claims Data in Japan: A Feasibility Study. JCO Glob Oncol 2023; 9:e2200222. [PMID: 36749909 PMCID: PMC10166397 DOI: 10.1200/go.22.00222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
PURPOSE We developed algorithms to identify patients with newly diagnosed cancer from a Japanese claims database to identify the patients with newly diagnosed cancer of the sample population, which were compared with the nationwide cancer incidence in Japan to assess the validity of the novel algorithms. METHODS We developed two algorithms to identify patients with stomach, lung, colorectal, breast, and cervical cancers: diagnosis only (algorithm 1), and combining diagnosis, treatments, and medicines (algorithm 2). Patients with newly diagnosed cancer were identified from an anonymized commercial claims database (JMDC Claims Database) in 2017 with two inclusions/exclusion criteria: selecting all patients with cancer (extract 1) and excluding patients who had received cancer treatments in 2015 or 2016 (extract 2). We estimated the cancer incidence of the five cancer sites and compared it with the Japan National Cancer Registry incidence (calculated standardized incidence ratio with 95% CIs). RESULTS The number of patients with newly diagnosed cancer ranged from 219 to 17,840 by the sites, algorithms, and exclusion criteria. Standardized incidence ratios were significantly higher in the JMDC Claims Database than in the national registry data for extract 1 and algorithm 1, extract 1 and algorithm 2, and extract 2 and algorithm 1. In extract 2 and algorithm 2, colorectal cancer in male and stomach, lung, and cervical cancers in females showed similar cancer incidence in the JMDC and national registry data. CONCLUSION The novel algorithms are effective for extracting information about patients with cancer from claims data by using the combined information on diagnosis, procedures, and medicines (algorithm 2), with 2-year cancer-treatment history as an exclusion criterion (extract 2).
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Affiliation(s)
- Toshio Ogawa
- Division of Public Health, Faculty of Agriculture, Setsunan University, Osaka, Japan
| | | | | | - Motoyasu Sagawa
- Division of Endoscopy, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Miyagi, Japan
| | - Daisuke Aoki
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuo Matsuda
- Fukui Health Promotion Center, Fukui Health Care Society, Fukui, Japan
| | - Tomio Nakayama
- National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Yoshio Kasahara
- Department of Breast Surgery, Fukui Prefecture-Saiseikai Hospital, Fukui, Japan
| | - Katsuaki Kato
- Cancer Detection Center, Miyagi Cancer Society, Miyagi, Japan
| | - Eiko Saitoh
- Department of Preventive Medicine Center, International University of Health and Welfare, Tokyo, Japan
| | - Tohru Morisada
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kyorin University, Tokyo, Japan
| | - Kumiko Saika
- National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Norie Sawada
- National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Yasushi Matsumura
- National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Tomotaka Sobue
- Graduate School of Medicine, Osaka University School of Medicine, Osaka, Japan
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Fujiwara T, Kanemitsu T, Tajima K, Yuri A, Iwasaku M, Okumura Y, Tokumasu H. Accuracy of algorithms to identify patients with a diagnosis of major cancers and cancer-related adverse events in an administrative database: a validation study in an acute care hospital in Japan. BMJ Open 2022; 12:e055459. [PMID: 35831049 PMCID: PMC9280899 DOI: 10.1136/bmjopen-2021-055459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Validation studies in oncology are limited in Japan. This study was conducted to evaluate the accuracy of diagnosis and adverse event (AE) definitions for specific cancers in a Japanese health administrative real-world database (RWD). DESIGN AND SETTING Retrospective observational validation study to assess the diagnostic accuracy of electronic medical records (EMRs) and claim coding regarding oncology diagnosis and AEs based on medical record review in the RWD. The sensitivity and positive predictive value (PPV) with 95% CIs were calculated. PARTICIPANTS The validation cohort included patients with lung (n=2257), breast (n=1121), colorectal (n=1773), ovarian (n=216) and bladder (n=575) cancer who visited the hospital between January 2014 and December 2018, and those with prostate cancer (n=3491) visiting between January 2009 and December 2018, who were identified using EMRs. OUTCOMES Key outcomes included primary diagnosis, deaths and AEs. RESULTS For primary diagnosis, sensitivity and PPV for the respective cancers were as follows: lung, 100.0% (96.6 to 100.0) and 81.0% (74.9 to 86.2); breast, 100.0% (96.3 to 100.0) and 74.0% (67.3 to 79.9); colorectal, 100.0% (96.6 to 100.0) and 80.5% (74.3 to 85.8); ovarian, 89.8% (77.8 to 96.6) and 75.9% (62.8 to 86.1); bladder, 78.6% (63.2 to 89.7) and 67.3% (52.5 to 0.1); prostate, 100.0% (93.2 to 100.0) and 79.0% (69.7 to 86.5). Sensitivity and PPV for death were as follows: lung, 97.0% (84.2 to 99.9) and 100.0% (84.2 to 100.0); breast, 100.0% (1.3 to 100.0) and 100.0% (1.3 to 100.0); colorectal, 100.0% (28.4 to 100.0) and 100.0% (28.4 to 100.0); ovarian, 100.0% (35.9 to 100.0) and 100.0% (35.9 to 100.0); bladder, 100.0% (9.4-100.0) and 100.0% (9.4 to 100.0); prostate, 75.0% (19.4 to 99.4) and 100.0% (19.4 to 100.0). Overall, PPV tended to be low, with the definition based on International Classification of Diseases, 10th revision alone for AEs. CONCLUSION Diagnostic accuracy was not so high, and therefore needs to be further investigated. TRIAL REGISTRATION NUMBER University Hospital Medical Information Network (UMIN) Clinical Trials Registry (UMIN000039345).
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Affiliation(s)
- Takashi Fujiwara
- Department of Management, Clinical Research Center, Kurashiki Central Hospital, Kurashiki, Japan
- Department of Otolaryngology/Head and Neck Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takashi Kanemitsu
- Medical Affairs Division, Chugai Pharmaceutical Co Ltd, Tokyo, Japan
| | - Kosei Tajima
- Clinical Development Division, Chugai Pharmaceutical Co Ltd, Tokyo, Japan
| | - Akinori Yuri
- Drug Safety Division, Chugai Pharmaceutical Co Ltd, Tokyo, Japan
| | - Masahiro Iwasaku
- Department of Management, Clinical Research Center, Kurashiki Central Hospital, Kurashiki, Japan
| | | | - Hironobu Tokumasu
- Department of Management, Clinical Research Center, Kurashiki Central Hospital, Kurashiki, Japan
- Real world Data Co., Ltd, Kyoto, Japan
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Zhou B, Kwan B, Desai MJ, Nalawade V, Ruddy KJ, Nathan PC, Henk HJ, Murphy JD, Whitcomb BW, Su HI. Long-term antimüllerian hormone patterns differ by cancer treatment exposures in young breast cancer survivors. Fertil Steril 2022; 117:1047-1056. [PMID: 35216831 PMCID: PMC9081208 DOI: 10.1016/j.fertnstert.2022.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To compare antimüllerian hormone (AMH) patterns by cancer status and treatment exposures across 6 years after incident breast cancer using administrative data. DESIGN In a cross-sectional design, AMH levels in patients who developed incident breast cancer between ages 15-39 years during 2005-2019 were matched 1:10 to levels in females without cancer in the OptumLabs Data Warehouse. Modeled AMH patterns were compared among cyclophosphamide-based chemotherapy, non-cyclophosphamide-based chemotherapy, no chemotherapy, and no breast cancer groups. SETTING Commercially insured females in the United States. PATIENT(S) Females with and without breast cancer. EXPOSURE(S) Breast cancer, cyclophosphamide- and non-cyclophosphamide-based chemotherapy. MAIN OUTCOME MEASURE(S) AMH levels. RESULT(S) A total of 233 patients with breast cancer (mean age, 34 years; standard deviation, 3.7 years) contributed 278 AMH levels over a median of 2 years (range, 0-6.7 years) after diagnosis; 52% received cyclophosphamide-based chemotherapy, 17% received non-cyclophosphamide-based chemotherapy (80% platinum-based), and 31% received no chemotherapy. A total of 2,777 matched females without cancer contributed 2,780 AMH levels. The pattern of AMH levels differed among the 4 groups. Among females without cancer and breast cancer survivors who did not undergo chemotherapy, AMH declined linearly over time. In contrast, among those who received cyclophosphamide-based and noncyclophosphamide-based chemotherapy, a nonlinear pattern of AMH level of initial fall during chemotherapy, followed by an increase over 2-4 years, and then by a plateau over 1-2 years before a decline was observed. CONCLUSION(S) In breast cancer survivors, AMH levels from administrative data supported ovarian toxicity of non-cyclophosphamide-based chemotherapy in breast cancer and efficiently depicted the timing and duration of changes in ovarian reserve to reflect the residual reproductive lifespan.
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Affiliation(s)
- Beth Zhou
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Brian Kwan
- Division of Biostatistics and Bioinformatics, Herbert Wertheim School of Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
- Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Drive, La Jolla, CA 92093, USA
| | - Milli J. Desai
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Vinit Nalawade
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Kathryn J. Ruddy
- Department of Oncology, Mayo Clinic, Rochester, 200 1st St SW, Rochester, MN 55905, USA
| | - Paul C. Nathan
- The Hospital for Sick Children, 555 University Avenue Toronto ON M5G 1X8, CA
| | - Henry J. Henk
- OptumLabs, 11000 Optum Cir, Eden Prarie, MN 55344, USA
| | - James D. Murphy
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Brian W. Whitcomb
- Department of Biostatistics & Epidemiology, School of Public Health & Health Sciences, University of Massachusetts, 433 Arnold House, Amherst, MA, 01003, USA
| | - H. Irene Su
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
- Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Drive, La Jolla, CA 92093, USA
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Beyrer J, Abedtash H, Hornbuckle K, Murray JF. A review of stakeholder recommendations for defining fit-for-purpose real-world evidence algorithms. J Comp Eff Res 2022; 11:499-511. [PMID: 35296149 DOI: 10.2217/cer-2022-0006] [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: 11/21/2022] Open
Abstract
Aim: The credibility and value of real-world evidence (RWE) are either supported or undermined by the algorithms (i.e., operational definitions) used. Methods: We conducted a targeted evidence review of key RWE decision makers' published recommendations on RWE algorithms through April 2021. Stakeholders were regulatory bodies, other governmental agencies and payer organizations. Results: Our review identified recommended criteria: relevance, validity, reliability, responsiveness, transparency and replicability, safety, feasibility and quality process. Stakeholders routinely recommended accuracy measures, subgroups evaluation and specific considerations for assessing exposures and covariates and the underlying real-world data (RWD) quality. Conclusion: The importance of stakeholder guidance on fit-for-purpose RWE algorithms is growing. We highlight gaps that future guidance and stakeholder recommendations could address.
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Affiliation(s)
- Julie Beyrer
- Department of Value, Evidence, and Outcomes (VEO) & Global Patient Safety, Eli Lilly & Company, Indianapolis, IN 46285, USA
| | - Hamed Abedtash
- Department of Value, Evidence, and Outcomes (VEO) & Global Patient Safety, Eli Lilly & Company, Indianapolis, IN 46285, USA
| | - Kenneth Hornbuckle
- Department of Value, Evidence, and Outcomes (VEO) & Global Patient Safety, Eli Lilly & Company, Indianapolis, IN 46285, USA
| | - James F Murray
- Department of Value, Evidence, and Outcomes (VEO) & Global Patient Safety, Eli Lilly & Company, Indianapolis, IN 46285, USA
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Huepenbecker SP, Zhao H, Sun CC, Fu S, He W, Giordano SH, Meyer LA. Algorithm to Identify Incident Epithelial Ovarian Cancer Cases Using Claims Data. JCO Clin Cancer Inform 2022; 6:e2100187. [PMID: 35297648 PMCID: PMC8955078 DOI: 10.1200/cci.21.00187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To create an algorithm to identify incident epithelial ovarian cancer cases in claims-based data sets and evaluate performance of the algorithm using SEER-Medicare claims data. METHODS We created a five-step algorithm on the basis of clinical expertise to identify incident epithelial ovarian cancer cases using claims data for (1) ovarian cancer diagnosis, (2) receipt of platinum-based chemotherapy, (3) no claim for platinum-based chemotherapy but claim for tumor debulking surgery, (4) removed cases with nonplatinum chemotherapy, and (5) removed patients with prior claims with personal history of ovarian cancer code to exclude prevalent cases. We evaluated algorithm performance using SEER-Medicare claims data by creating four cohorts: incident epithelial ovarian cancer, a 5% random sample of cancer-free Medicare beneficiaries, a 5% random sample of incident nonovarian cancer, and prevalent ovarian cancer cases. RESULTS Using SEER tumor registry data as the gold standard, our algorithm correctly classified 89.9% of incident epithelial ovarian cancer cases (cohort n = 572) and almost 100% of cancer-free controls (n = 97,127), nonovarian cancer (n = 714), and prevalent ovarian cancer cases (n = 3,712). The overall algorithm sensitivity was 89.9%, the positive predictive value was 93.8%, and the specificity and negative predictive value were > 99.9%. Patients were more likely to be correctly classified as incident ovarian cancer if they had stage III or IV disease compared with early stage I or II disease (93.5% v 83.7%, P < .01), and grade 1-4 compared with unknown grade tumors (93.8% v 81.4%, P < .01). CONCLUSION Our algorithm correctly identified most incident epithelial ovarian cancer cases, especially those with advanced disease. This algorithm will facilitate research in other claims-based data sets where cancer registry data are unavailable.
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Affiliation(s)
- Sarah P. Huepenbecker
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hui Zhao
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Charlotte C. Sun
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shuangshuang Fu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Weiguo He
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
- Present affiliation: Ford Motor Company, Dearborn, MI
| | - Sharon H. Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Larissa A. Meyer
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
- Larissa A. Meyer, MD, MPH, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1362, Houston, TX 77030; e-mail:
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Mullins MA, Kler JS, Eastman MR, Kabeto M, Wallner LP, Kobayashi LC. Validation of self-reported cancer diagnoses using Medicare diagnostic claims in the U.S. Health and Retirement Study, 2000-2016. Cancer Epidemiol Biomarkers Prev 2021; 31:287-292. [PMID: 34737206 DOI: 10.1158/1055-9965.epi-21-0835] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/07/2021] [Accepted: 10/22/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The US Health Retirement Study (HRS) is an ongoing population-representative cohort of US adults aged >50 with rich data on health during aging. Self-reported cancer diagnoses have been collected since 1998, but they have not been validated. We compared self-reported cancer diagnoses in HRS interviews against diagnostic claims from linked Medicare records. METHODS Using HRS-Medicare linked data, we examined the validity of first incident cancer diagnoses self-reported in biennial interviews from 2000-2016 against ICD-9 and ICD-10 diagnostic claim records as the gold standard. Data were from 8,242 HRS participants aged {greater than or equal to}65 with 90% continuous enrollment in fee-for-service Medicare. We calculated the sensitivity, specificity, and k for first incident invasive cancer diagnoses (all cancers combined, and each of bladder, breast, colorectal/anal, uterine, kidney, lung, and prostate cancers) cumulatively over the follow-up and at each biennial study interview. RESULTS Overall, self-reports of first incident cancer diagnoses from 2000-2016 had 73.2% sensitivity and 96.2% specificity against Medicare claims (k=0.73). For specific cancer types, sensitivities ranged from 44.7% (kidney) to 75.0% (breast), and specificities ranged from 99.2% (prostate) and 99.9% (bladder, uterine, and kidney). Results were similar in sensitivity analyses restricting to individuals with 100% continuous fee-for-service Medicare enrollment and when restricting to individuals with at least 24 months of Medicare enrollment. CONCLUSION Self-reported cancer diagnoses in the HRS have reasonable validity for use in population-based research that is maximized with linkage to Medicare. IMPACT These findings inform the use of the HRS for population-based cancer and aging research.
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Affiliation(s)
- Megan A Mullins
- Center for Improving Patient and Population Health, University of Michigan Rogel Cancer Center
| | - Jasdeep S Kler
- Epidemiology, University of Michigan School of Public Health
| | | | | | - Lauren P Wallner
- Internal Medicine and Epidemiology, University of Michigan–Ann Arbor
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Hara K, Kobayashi Y, Tomio J, Ito Y, Svensson T, Ikesu R, Chung UI, Svensson AK. Claims-based algorithms for common chronic conditions were efficiently constructed using machine learning methods. PLoS One 2021; 16:e0254394. [PMID: 34570785 PMCID: PMC8476042 DOI: 10.1371/journal.pone.0254394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/25/2021] [Indexed: 11/29/2022] Open
Abstract
Identification of medical conditions using claims data is generally conducted with algorithms based on subject-matter knowledge. However, these claims-based algorithms (CBAs) are highly dependent on the knowledge level and not necessarily optimized for target conditions. We investigated whether machine learning methods can supplement researchers' knowledge of target conditions in building CBAs. Retrospective cohort study using a claims database combined with annual health check-up results of employees' health insurance programs for fiscal year 2016-17 in Japan (study population for hypertension, N = 631,289; diabetes, N = 152,368; dyslipidemia, N = 614,434). We constructed CBAs with logistic regression, k-nearest neighbor, support vector machine, penalized logistic regression, tree-based model, and neural network for identifying patients with three common chronic conditions: hypertension, diabetes, and dyslipidemia. We then compared their association measures using a completely hold-out test set (25% of the study population). Among the test cohorts of 157,822, 38,092, and 153,608 enrollees for hypertension, diabetes, and dyslipidemia, 25.4%, 8.4%, and 38.7% of them had a diagnosis of the corresponding condition. The areas under the receiver operating characteristic curve (AUCs) of the logistic regression with/without subject-matter knowledge about the target condition were .923/.921 for hypertension, .957/.938 for diabetes, and .739/.747 for dyslipidemia. The logistic lasso, logistic elastic-net, and tree-based methods yielded AUCs comparable to those of the logistic regression with subject-matter knowledge: .923-.931 for hypertension; .958-.966 for diabetes; .747-.773 for dyslipidemia. We found that machine learning methods can attain AUCs comparable to the conventional knowledge-based method in building CBAs.
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Affiliation(s)
- Konan Hara
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yasuki Kobayashi
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Jun Tomio
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yuki Ito
- Department of Economics, University of California, Berkeley, Berkeley, California, United States of America
| | - Thomas Svensson
- Precision Health, Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
- School of Health Innovation, Kanagawa University of Human Services, Kawasaki-shi, Kanagawa, Japan
| | - Ryo Ikesu
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Precision Health, Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Ung-il Chung
- Precision Health, Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- School of Health Innovation, Kanagawa University of Human Services, Kawasaki-shi, Kanagawa, Japan
- Clinical Biotechnology, Center for Disease Biology and Integrative Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Akiko Kishi Svensson
- Precision Health, Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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9
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Ruddy KJ, Herrin J, Sangaralingham L, Freedman RA, Jemal A, Haddad TC, Allen SV, Hieken T, Boughey JC, Ganz PA, Havyer RD, Shah ND. Follow-up Care for Breast Cancer Survivors. J Natl Cancer Inst 2020; 112:111-113. [PMID: 31613369 DOI: 10.1093/jnci/djz203] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/20/2019] [Accepted: 10/11/2019] [Indexed: 11/13/2022] Open
Abstract
Breast cancer survivorship guidelines recommend at least annual follow-up visits, yet the degree to which this occurs in clinical practice is uncertain. Claims data from a US commercial insurance database (OptumLabs) were used to identify women treated with curative intent surgery for newly diagnosed breast cancer between 2006 and 2014. In 25 035 women, median follow-up was 3 years. In the second year after surgery, 9.6% of the patients did not visit a primary care provider, an oncologist, or a surgeon (guideline-nonadherent). The guideline-nonadherent proportion increased from 7.8% in women diagnosed in 2006 to 12.2% in those diagnosed in 2014 (two-sided Wald P < .001). During years 2-6, guideline-nonadherence was also associated with older age, nonwhite race, no radiation, no chemotherapy, no endocrine therapy, and increasing time after surgery. There is a substantial and increasing rate of inadequate follow-up among breast cancer survivors. This has the potential to impair outcomes.
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Affiliation(s)
| | - Jeph Herrin
- Division of Cardiology, Yale School of Medicine, New Haven, CT
| | - Lindsey Sangaralingham
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.,OptumLabs, Cambridge
| | - Rachel A Freedman
- Division of Community Internal Medicine.,Dana-Farber Cancer Institute, Boston, MA
| | - Ahmedin Jemal
- Division of Health Care Policy and Research (NDS), Mayo Clinic, Rochester, MN.,American Cancer Society, Atlanta, GA
| | | | | | | | | | - Patricia A Ganz
- Dana-Farber Cancer Institute, Boston, MA.,UCLA Fielding School of Public Health, David Geffen School of Medicine, Los Angeles, CA
| | | | - Nilay D Shah
- Division of Health Care Policy and Research (NDS), Mayo Clinic, Rochester, MN.,OptumLabs, Cambridge
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Smith BD, Lei X, Diao K, Xu Y, Shen Y, Smith GL, Giordano SH, DeSnyder SM, Hunt KK, Teshome M, Jagsi R, Shaitelman SF, Peterson SK, Swanick CW. Effect of Surgeon Factors on Long-Term Patient-Reported Outcomes After Breast-Conserving Therapy in Older Breast Cancer Survivors. Ann Surg Oncol 2020; 27:1013-1022. [PMID: 31916092 DOI: 10.1245/s10434-019-08165-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND The effect of surgeon factors on patient-reported quality-of-life outcomes after breast-conserving therapy (BCT) is unknown and may help patients make informed care decisions. METHODS We performed a survey study of women aged ≥ 67 years with non-metastatic breast cancer diagnosed in 2009 and treated with guideline-concordant BCT, to determine the association of surgeon factors with patient-reported outcomes. The treating surgeon was identified using Medicare claims, and surgeon factors were identified via the American Medical Association Physician Masterfile. The primary outcome was patient-reported cosmetic satisfaction measured by the Cancer Surveillance and Outcomes Research Team (CanSORT) Satisfaction with Breast Cosmetic Outcome instrument, while secondary outcomes included BREAST-Q subdomains. All patient, treatment, and surgeon covariables were included in a saturated multivariable linear regression model with backward elimination applied until remaining variables were p < 0.1. RESULTS Of 1650 women randomly selected to receive the questionnaire, 489 responded, of whom 289 underwent BCT. Median age at diagnosis was 72 years and the time from diagnosis to survey was 6 years. The mean adjusted CanSORT score was higher for patients treated by surgical oncologists than patients treated by non-surgical oncologists (4.01 [95% confidence interval [CI] 3.65-4.38] vs. 3.53 [95% CI 3.28-3.77], p = 0.006). Similarly, mean adjusted BREAST-Q Physical Well-Being (91.97 [95% CI 86.13-97.80] vs. 83.04 [95% CI 80.85-85.22], p = 0.006) and Adverse Radiation Effects (95.28 [95% CI 91.25-99.31] vs. 88.90 [95% CI 86.23-91.57], p = 0.004) scores were better among patients treated by surgical oncologists. CONCLUSIONS Specialized surgical oncology training is associated with improved long-term patient-reported outcomes. These findings underscore the value of specialized training and may be useful to patients choosing their care team.
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Affiliation(s)
- Benjamin D Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. .,Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Xiudong Lei
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kevin Diao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ying Xu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yu Shen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Grace L Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sharon H Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sarah M DeSnyder
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kelly K Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mediget Teshome
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Simona F Shaitelman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susan K Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Cameron W Swanick
- Department of Radiation Oncology, Orlando Health UF Health Cancer Center, Orlando, FL, USA
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Shi C, Liu M, Liu Z, Guo C, Li F, Xu R, Liu F, Liu Y, Li J, Cai H, He Z, Ke Y. Using health insurance reimbursement data to identify incident cancer cases. J Clin Epidemiol 2019; 114:141-149. [DOI: 10.1016/j.jclinepi.2019.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 05/16/2019] [Accepted: 06/12/2019] [Indexed: 11/29/2022]
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12
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Advani PG, Lei X, Swanick CW, Xu Y, Shen Y, Goodwin NA, Smith GL, Giordano SH, Hunt KK, Jagsi R, Smith BD. Local Therapy Decisional Regret in Older Women With Breast Cancer: A Population-Based Study. Int J Radiat Oncol Biol Phys 2019; 104:383-391. [PMID: 30716524 PMCID: PMC6624842 DOI: 10.1016/j.ijrobp.2019.01.089] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/23/2019] [Accepted: 01/25/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Older women with nonmetastatic breast cancer can often choose from several surgery and radiation treatment options. Little is known regarding how these choices contribute to decisional regret, which is a negative emotion reflecting the idea that another surgery or radiation decision might have been preferable. We sought to characterize the burden of and examine potential risk factors for local therapy decisional regret among a population-based cohort of older breast cancer survivors. METHODS AND MATERIALS National Medicare claims for age ≥67 female breast cancer incident in 2009 identified patients treated with lumpectomy plus whole-breast irradiation, brachytherapy, or endocrine therapy or mastectomy with or without radiation. We sampled 330 patients per treatment group (N = 1650), of whom 1253 agreed to receive a paper survey including the Decisional Regret Scale and EQ-5D-3L Health-Utility Scale. Local therapy regret was defined as neutral or worse response to questions regarding surgery- or radiation-related decisional regret. Local therapy regret risk factors were evaluated using a multivariable generalized linear model. Association of local therapy regret with health utility was modeled using multivariable linear regression. RESULTS The response rate was 30.2% (n = 498 of 1650); 421 surveys were included in this analysis. Median diagnosis age was 72 years, and surveys were completed 6 years after diagnosis. Overall, 23.8% of respondents (n = 100) reported experiencing local therapy decisional regret. Type of local therapy was not associated with local therapy regret. Predictors of increased regret included black race (risk ratio [RR], 2.09; 95% confidence interval [CI], 1.33-3.29), high school education or less (RR, 1.87; 95% CI, 1.27-2.75), and axillary nodal dissection (RR, 2.13; 95% CI, 1.33-3.41). Local therapy regret was not associated with health utility (P = .37). CONCLUSIONS Local therapy regret afflicts nearly one quarter of our cohort of older breast cancer survivors, and it is associated with black race, less education, and more extensive nodal dissection, but not breast surgery. Regret is distinct from health utility, suggesting that it is a unique psychosocial construct that merits further study and mitigation strategies.
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Affiliation(s)
- Pragati G Advani
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Xiudong Lei
- Health Service Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Cameron W Swanick
- Department of Radiation Oncology, Orlando Health UF Health Cancer Center, Orlando, Florida
| | - Ying Xu
- Health Service Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yu Shen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nathan A Goodwin
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Grace L Smith
- Health Service Research, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sharon H Giordano
- Health Service Research, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kelly K Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Reshma Jagsi
- Department of Radiation Oncology, Center for Bioethics and Social Sciences in Medicine, The University of Michigan, Ann Arbor, Michigan
| | - Benjamin D Smith
- Health Service Research, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Leveraging Linkage of Cohort Studies With Administrative Claims Data to Identify Individuals With Cancer. Med Care 2019; 56:e83-e89. [PMID: 29334524 DOI: 10.1097/mlr.0000000000000875] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In an effort to overcome quality and cost constraints inherent in population-based research, diverse data sources are increasingly being combined. In this paper, we describe the performance of a Medicare claims-based incident cancer identification algorithm in comparison with observational cohort data from the Nurses' Health Study (NHS). METHODS NHS-Medicare linked participants' claims data were analyzed using 4 versions of a cancer identification algorithm across 3 cancer sites (breast, colorectal, and lung). The algorithms evaluated included an update of the original Setoguchi algorithm, and 3 other versions that differed in the data used for prevalent cancer exclusions. RESULTS The algorithm that yielded the highest positive predictive value (PPV) (0.52-0.82) and κ statistic (0.62-0.87) in identifying incident cancer cases utilized both Medicare claims and observational cohort data (NHS) to remove prevalent cases. The algorithm that only used NHS data to inform the removal of prevalent cancer cases performed nearly equivalently in statistical performance (PPV, 0.50-0.79; κ, 0.61-0.85), whereas the version that used only claims to inform the removal of prevalent cancer cases performed substantially worse (PPV, 0.42-0.60; κ, 0.54-0.70), in comparison with the dual data source-informed algorithm. CONCLUSIONS Our findings suggest claims-based algorithms identify incident cancer with variable reliability when measured against an observational cohort study reference standard. Self-reported baseline information available in cohort studies is more effective in removing prevalent cancer cases than are claims data algorithms. Use of claims-based algorithms should be tailored to the research question at hand and the nature of available observational cohort data.
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Karuturi MS, Lei X, Shen Y, Giordano SH, Swanick CW, Smith BD. Long-term decision regret surrounding systemic therapy in older breast cancer survivors: A population-based survey study. J Geriatr Oncol 2019; 10:973-979. [PMID: 30940493 DOI: 10.1016/j.jgo.2019.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/01/2018] [Accepted: 03/20/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Little is known regarding regret experienced by older breast cancer survivors surrounding the choice for adjuvant systemic therapy, which limits providers' ability to optimally engage in the shared decision-making process. To address this, we evaluated endocrine therapy and chemotherapy decisional regret in a population-based cohort of older breast cancer survivors. MATERIALS AND METHODS Nationally comprehensive Medicare claims identified women age ≥67 living in the US with non-metastatic breast cancer diagnosed in 2009 and still alive in 2015. The Decision Regret Scale, a validated index that assesses regret regarding treatment decisions on a scale of 0 (no regret) to 100, was used to measure regret for endocrine therapy and chemotherapy approximately 6 years after diagnosis and was adjusted for sampling weight. Multivariable logistic regression adjusted for patient, demographic, and treatment characteristics identified predictors of endocrine therapy and chemotherapy decision regret. RESULTS Of the 480 respondents, 299 patients (61.1%) reported receiving endocrine therapy and 133 (27%) chemotherapy. The overall weighted decision-regret score was 17.2 (95%CI 13.6-20.8) for endocrine therapy and 17.7 (95%CI 12.1-23.3) for chemotherapy. Risk factors for higher endocrine therapy regret included white race (referent non-white race; estimate 12.8, 95%CI 3.0-22.7; P = 0.01) and post-graduate educational attainment (referent college education; 11.6, 95%CI 1.9-21.3; P = 0.02). The only risk factor for chemotherapy regret, albeit marginal, was age ≥75 (referent age 67-74; 12.0, 95%CI -0.1-24.2; P = 0.05) CONCLUSION: Overall, decision regret levels regarding systemic therapy in older breast cancer survivors are reassuringly low. However, further studies are needed to explore drivers of regret in certain vulnerable subgroups of patients.
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Affiliation(s)
- Meghan Sri Karuturi
- Department of Breast Medical Oncology, The University of Texas, MD Anderson Cancer Center, United States of America.
| | - Xiudong Lei
- Department of Health Services, The University of Texas, MD Anderson Cancer Center, United States of America
| | - Yu Shen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, United States of America
| | - Sharon H Giordano
- Department of Breast Medical Oncology, The University of Texas, MD Anderson Cancer Center, United States of America; Department of Health Services, The University of Texas, MD Anderson Cancer Center, United States of America
| | - Cameron W Swanick
- Department of Radiation Oncology, Orlando Health UF Health Cancer Center, United States of America
| | - Benjamin D Smith
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, United States of America
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Chun DS, Lund JL, Stürmer T. Pharmacoepidemiology and Drug Safety's special issue on validation studies. Pharmacoepidemiol Drug Saf 2019; 28:123-125. [PMID: 30714240 DOI: 10.1002/pds.4694] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 10/05/2018] [Accepted: 10/11/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Danielle S Chun
- Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Jennifer L Lund
- Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Til Stürmer
- Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
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Lavery JA, Lipitz-Snyderman A, Li DG, Bach PB, Panageas KS. Identifying Cancer-Directed Surgeries in Medicare Claims: A Validation Study Using SEER-Medicare Data. JCO Clin Cancer Inform 2019; 3:1-24. [PMID: 30715928 PMCID: PMC6648680 DOI: 10.1200/cci.18.00093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2018] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Medicare claims provide a rich data source for large-scale quality assessment because data are available for all beneficiaries nationally. For cancer surgery, the absence of information regarding site of cancer and date of diagnosis on an administrative claim necessitates testing to ensure accurate quality assessment and public reporting. METHODS Using the SEER Medicare-linked database as the gold standard, we developed and tested an approach to identify cancer-directed surgeries from Medicare fee-for-service claims alone. Our analysis evaluated two questions: (1) Can we identify a large percentage of patients who underwent a cancer-directed surgery using only Medicare claims? (2) Of all patients identified as having undergone a cancer-directed surgery, what percentage had cancer? We evaluated this approach for 17 primary cancer sites. RESULTS The number of Medicare beneficiaries diagnosed with their first cancer during the years 2011 to 2013 and who underwent cancer-directed surgery ranged from 45 patients (bones and joints) to 20,163 patients (breast). The percentage of cancer-directed surgeries identified using Medicare claims alone ranged from 62% (skin melanoma) to 94% (prostate). For all but three cancer sites (skin melanoma, thyroid, and urinary bladder), more than 80% of cancer-directed surgeries were identified using our approach. Of all surgeries identified, more than 90% were for patients with cancer. CONCLUSION Identifying patients who underwent a cancer-directed surgery from Medicare claims is feasible for many cancer sites, although careful consideration needs to be given to the validity of each site. Our findings support the use of Medicare claims for large-scale quality assessment of cancer surgery by disease site.
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Affiliation(s)
| | | | - Diane G. Li
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Peter B. Bach
- Memorial Sloan Kettering Cancer Center, New York, NY
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Leal AD, Van Houten H, Sangaralingham L, Freedman RA, Jemal A, Neuman HB, Haddad TC, Mutter RW, Keegan THM, Mougalian SS, Loprinzi CL, Gross CP, Shah N, Ruddy KJ. Breast Cancer Survivorship Care Variations Between Adjuvant Chemotherapy Regimens. Clin Breast Cancer 2018; 18:e513-e520. [PMID: 29054689 PMCID: PMC6208362 DOI: 10.1016/j.clbc.2017.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/12/2017] [Accepted: 09/15/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Treatment-related toxicity can vary substantially between chemotherapy regimens. In this study we evaluated the frequency of outpatient office visits among a cohort of early stage breast cancer survivors after completion of 4 different adjuvant chemotherapy regimens to better understand how differences in toxicities between regimens might affect health care use. MATERIALS AND METHODS We analyzed administrative claims data from a US commercial insurance database (OptumLabs) to identify women who received adjuvant doxorubicin/cyclophosphamide (AC), AC followed or preceded by docetaxel or paclitaxel (AC-T), AC concurrent with docetaxel or paclitaxel (TAC), or docetaxel/cyclophosphamide (TC) between 2008 and 2014. We compared mean numbers of visits per patient (adjusted for age, race/ethnicity, region, year, surgery type, radiation, chronic conditions, and previous hospitalizations) across the different regimens (TC = reference) for 12 months, starting 4 months after the end of chemotherapy. RESULTS In 6247 eligible patients, the mean adjusted number of outpatient visits per patient was significantly higher in patients who received AC-T (8.1) or TAC (7.3) than TC (6.5) or AC (6.0; P < .001 for comparisons of AC-T and TAC with TC), primarily because of differences in Medical Oncology visits. Approximately 40% did not see a primary care provider at all during this time frame. CONCLUSIONS AC-T and TAC are associated with more subsequent outpatient visits than TC. Visits to primary care providers are infrequent during the year after completion of chemotherapy.
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Affiliation(s)
- Alexis D Leal
- Division of Medical Oncology, Mayo Clinic, Rochester, MN
| | - Holly Van Houten
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; OptumLabs, Cambridge, MA
| | - Lindsey Sangaralingham
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; OptumLabs, Cambridge, MA
| | | | | | - Heather B Neuman
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine, Madison, WI
| | - Tufia C Haddad
- Division of Medical Oncology, Mayo Clinic, Rochester, MN
| | | | - Theresa H M Keegan
- Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Sarah S Mougalian
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University, New Haven, CT
| | | | - Cary P Gross
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University, New Haven, CT
| | - Nilay Shah
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; OptumLabs, Cambridge, MA
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18
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Hirth JM, Hatch SS, Lin YL, Giordano SH, Silva HC, Kuo YF. Development and validation of algorithms to differentiate ductal carcinoma in situ from invasive breast cancer within administrative claims data. Cancer 2018; 124:2815-2823. [PMID: 29669162 DOI: 10.1002/cncr.31393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/08/2018] [Accepted: 03/20/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Overtreatment is a common concern for patients with ductal carcinoma in situ (DCIS), but this entity is difficult to distinguish from invasive breast cancers in administrative claims data sets because DCIS often is coded as invasive breast cancer. Therefore, the authors developed and validated algorithms to select DCIS cases from administrative claims data to enable outcomes research in this type of data. METHODS This retrospective cohort using invasive breast cancer and DCIS cases included women aged 66 to 70 years in the 2004 through 2011 Texas Cancer Registry (TCR) data linked to Medicare administrative claims data. TCR records were used as "gold" standards to evaluate the sensitivity, specificity, and positive predictive value (PPV) of 2 algorithms. Women with a biopsy enrolled in Medicare parts A and B at 12 months before and 6 months after their first biopsy without a second incident diagnosis of DCIS or invasive breast cancer within 12 months in the TCR were included. Women in 2010 Medicare data were selected to test the algorithms in a general sample. RESULTS In the TCR data set, a total of 6907 cases met inclusion criteria, with 1244 DCIS cases. The first algorithm had a sensitivity of 79%, a specificity of 89%, and a PPV of 62%. The second algorithm had a sensitivity of 50%, a specificity of 97%. and a PPV of 77%. Among women in the general sample, the specificity was high and the sensitivity was similar for both algorithms. However, the PPV was approximately 6% to 7% lower. CONCLUSIONS DCIS frequently is miscoded as invasive breast cancer, and thus the proposed algorithms are useful to examine DCIS outcomes using data sets not linked to cancer registries. Cancer 2018;124:2815-2823. © 2018 American Cancer Society.
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Affiliation(s)
- Jacqueline M Hirth
- Department of Obstetrics and Gynecology, Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch, Galveston, Texas
| | - Sandra S Hatch
- Department of Radiation Oncology, The University of Texas Medical Branch, Galveston, Texas
| | - Yu-Li Lin
- Office of Biostatistics, Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston, Texas
| | - Sharon H Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - H Colleen Silva
- Department of Oncology Surgery, The University of Texas Medical Branch, Galveston, Texas
| | - Yong-Fang Kuo
- Office of Biostatistics, Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston, Texas
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Hara K, Tomio J, Svensson T, Ohkuma R, Svensson AK, Yamazaki T. Association measures of claims-based algorithms for common chronic conditions were assessed using regularly collected data in Japan. J Clin Epidemiol 2018; 99:84-95. [DOI: 10.1016/j.jclinepi.2018.03.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 02/23/2018] [Accepted: 03/07/2018] [Indexed: 10/17/2022]
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Yuen E, Louis D, Cisbani L, Rabinowitz C, De Palma R, Maio V, Leoni M, Grilli R. Using administrative data to identify and stage breast cancer cases: Implications for assessing quality of care. TUMORI JOURNAL 2018; 97:428-35. [DOI: 10.1177/030089161109700403] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background The study evaluated the use of Italian hospital discharge data (SDO, scheda di dimissione ospedaliera) for identifying women with incident breast cancer, determining stage at diagnosis and assessing quality of care. Study design Women aged 20+ years residing in the Regione Emilia-Romagna, Italy, between 2002 and 2005 were studied. Case identification using algorithms based on ICD-9-CM codes on hospital discharge data were compared with AIRTUM-accredited cancer registry data. Sensitivity, specificity and positive predictive value were computed overall, by age and cancer stage. Compliance with guidelines for radiation therapy using registry and hospital data were compared. Results A total of 11,615 women was identified by AIRTUM-accredited cancer registries as incident cases, whereas 10,876 women were identified by the SDO algorithm. Sensitivity was 84.8%, specificity was 99.9%, and the positive predictive value was 90.6%. Of the 1,022 who were false positives, 363 (35.5%) were women identified in registry data as having an incident case prior to 2002 and therefore were not included in the analysis. There were 1,761 false negatives; nearly 50% were over 70 years of age or did not undergo a surgical procedure and therefore were not included in our SDO-based case finding. Sensitivity declined as the patient population became older. However, we observed relatively good positive predictive value for all age groups. Algorithms using the SDO data did not clearly identify specific cancer stages. However, the algorithm may have utility where stages are grouped together for use in quality measures. Conclusions Cases were identified with good sensitivity, specificity and positive predictive value with SDO data, with better rates than similar previously published algorithms based on Italian data. These hospital claims-based algorithms facilitate quality of care analyses for large populations when registry data are not available by identifying individual women and their subsequent use of health care services.
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Affiliation(s)
- Elaine Yuen
- Center for Research in Medical Education and Health Care, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Jefferson School of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Daniel Louis
- Center for Research in Medical Education and Health Care, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Luca Cisbani
- Agenzia Sanitaria e Sociale Regionale, Regione Emilia-Romagna
| | - Carol Rabinowitz
- Center for Research in Medical Education and Health Care, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Vittorio Maio
- Center for Research in Medical Education and Health Care, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Jefferson School of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Maurizio Leoni
- Agenzia Sanitaria e Sociale Regionale, Regione Emilia-Romagna
- Ospedale Civile Ravenna, Regione Emilia-Romagna, Italy
| | - Roberto Grilli
- Agenzia Sanitaria e Sociale Regionale, Regione Emilia-Romagna
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Swanick CW, Lei X, Xu Y, Shen Y, Goodwin NA, Smith GL, Giordano SH, Hunt KK, Jagsi R, Shaitelman SF, Peterson SK, Smith BD. Long-term Patient-Reported Outcomes in Older Breast Cancer Survivors: A Population-Based Survey Study. Int J Radiat Oncol Biol Phys 2017; 100:882-890. [PMID: 29485067 DOI: 10.1016/j.ijrobp.2017.11.047] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 11/02/2017] [Accepted: 11/30/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE For older women with breast cancer, local therapy options may include lumpectomy plus whole-breast irradiation (Lump + WBI), lumpectomy plus brachytherapy (Lump + Brachy), lumpectomy alone (Lump alone), mastectomy without radiation therapy (Mast alone), and mastectomy plus radiation therapy (Mast + RT). We surveyed a population-based cohort of older breast cancer survivors to assess the association of local therapy with long-term quality-of-life outcomes. METHODS AND MATERIALS We used nationally comprehensive Medicare claims to identify women aged ≥67 years in whom nonmetastatic breast cancer was diagnosed in 2009, who were treated with 1 of the 5 aforementioned treatment options, and who were still alive in 2015. From this cohort, 1650 patients (330 patients per treatment) were randomly selected. A survey that included the CanSORT (Cancer Surveillance and Outcomes Research Team) Satisfaction with Breast Cosmetic Outcome, BREAST-Q, Decisional Regret Scale, and EQ-5D-3L was mailed to potential participants. We used multivariable linear regression to assess associations between local therapy and outcomes after adjusting for patient, disease, and treatment covariates. RESULTS Among the 489 women who returned the surveys (30% response rate), the median age at diagnosis was 72 years (range, 67-87 years). The interval from diagnosis to survey completion was approximately 6 years for all patients. Compared with Lump + WBI (adjusted score, 3.40), the CanSORT cosmetic satisfaction scores were higher for Lump + Brachy (score, 3.77; P = .007) and Lump alone (score, 3.80; P = .04) and lower for Mast + RT (score, 3.01; P = .006). Similar trends were seen for BREAST-Q cosmetic satisfaction. BREAST-Q psychosocial, sexual, and physical well-being and EQ-5D-3L global health status tended to be better in patients treated with less irradiation and less surgery. BREAST-Q adverse radiation effects were worse for Lump + WBI compared with Lump + Brachy. Decisional regret regarding surgery and radiation therapy did not differ across groups. Compared with patients treated with Lump + WBI, patients treated with Lump + Brachy and Lump alone reported slightly higher rates of in-breast recurrence (excess risk of 5.8% and 6.4%, respectively; P = .01). CONCLUSIONS In this nationally diverse cohort, less irradiation and less surgery were associated with better long-term quality-of-life outcomes. However, patient regret regarding surgery and radiation therapy was similar across all groups.
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Affiliation(s)
- Cameron W Swanick
- Department of Radiation Oncology, Orlando Health UF Health Cancer Center, Orlando, Florida
| | - Xiudong Lei
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ying Xu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yu Shen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nathan A Goodwin
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Grace L Smith
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sharon H Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kelly K Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Reshma Jagsi
- Department of Radiation Oncology, The University of Michigan, Ann Arbor, Michigan
| | - Simona F Shaitelman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Susan K Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Benjamin D Smith
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Adams AS, Madden JM, Zhang F, Lu CY, Ross-Degnan D, Lee A, Soumerai SB, Gilden D, Chawla N, Griggs JJ. Effects of Transitioning to Medicare Part D on Access to Drugs for Medical Conditions among Dual Enrollees with Cancer. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:1345-1354. [PMID: 29241894 PMCID: PMC5734096 DOI: 10.1016/j.jval.2017.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 05/19/2017] [Accepted: 05/25/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To evaluate the impact of transitioning from Medicaid to Medicare Part D drug coverage on the use of noncancer treatments among dual enrollees with cancer. METHODS We leveraged a representative 5% national sample of all fee-for-service dual enrollees in the United States (2004-2007) to evaluate the impact of the removal of caps on the number of reimbursable prescriptions per month (drug caps) under Part D on 1) prevalence and 2) average days' supply dispensed for antidepressants, antihypertensives, and lipid-lowering agents overall and by race (white and black). RESULTS The removal of drug caps was associated with increased use of lipid-lowering medications (days' supply 3.63; 95% confidence interval [CI] 1.57-5.70). Among blacks in capped states, we observed increased use of lipid-lowering therapy (any use 0.08 percentage points; 95% CI 0.05-0.10; and days' supply 4.01; 95% CI 2.92-5.09) and antidepressants (days' supply 2.20; 95% CI 0.61-3.78) and increasing trends in antihypertensive use (any use 0.01 percentage points; 95% CI 0.004-0.01; and days' supply 1.83; 95% CI 1.25-2.41). The white-black gap in the use of lipid-lowering medications was immediately reduced (-0.09 percentage points; 95% CI -0.15 to -0.04). We also observed a reversal in trends toward widening white-black differences in antihypertensive use (level -0.08 percentage points; 95% CI -0.12 to -0.05; and trend -0.01 percentage points; 95% CI -0.02 to -0.01) and antidepressant use (-0.004 percentage points; 95% CI -0.01 to -0.0004). CONCLUSIONS Our findings suggest that the removal of drug caps under Part D had a modest impact on the treatment of hypercholesterolemia overall and may have reduced white-black gaps in the use of lipid-lowering and antidepressant therapies.
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Affiliation(s)
- Alyce S Adams
- Kaiser Permanente Division of Research, Oakland, CA, USA.
| | - Jeanne M Madden
- School of Pharmacy, Northeastern University, Boston, MA, USA; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Fang Zhang
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Christine Y Lu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Dennis Ross-Degnan
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | | | - Stephen B Soumerai
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Dan Gilden
- Jen Associates, Inc., Cambridge, MA, USA
| | - Neetu Chawla
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Jennifer J Griggs
- Departments of Internal Medicine, Hematology/Oncology, and Health Management and Policy, University of Michigan, Ann Arbor, MI, USA
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Accuracy of Medicare Claim–based Algorithm to Detect Breast, Prostate, or Lung Cancer Bone Metastases. Med Care 2017; 55:e144-e149. [DOI: 10.1097/mlr.0000000000000539] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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Nannavecchia AM, Rashid I, Cuccaro F, Chieti A, Bruno D, Burgio Lo Monaco MG, Tanzarella C, Bisceglia L. Cancer incidence estimation method: an Apulian experience. Eur J Cancer Prev 2017; 26 Joining forces for better cancer registration in Europe:S153-S156. [PMID: 28574869 PMCID: PMC5610559 DOI: 10.1097/cej.0000000000000374] [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] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 04/12/2017] [Indexed: 11/25/2022]
Abstract
The Cancer Registry of Puglia (RTP) was instituted in 2008 as a regional population-based cancer registry. It consists of six sections (Foggia, Barletta-Andria-Tran, Bari, Brindisi, Lecce, and Taranto) and covers more than 4 000 000 inhabitants. At present, four of six sections have received accreditation by AIRTUM (53% of regional population). To point out possible regional geographic variability in cancer incidence and also to support health services planning, we developed an original estimation method to ensure a complete territorial coverage. Incidence data of the four accredited RTP sections for the shared incidence period 2006-2008, the 2001-2009 hospitalization regional data, and 2006-2009 mortality data were considered. To take into account specific health features of different provinces, we performed an estimate of cancer incidence rates of nonaccredited sections using a combination of accredited sections rates and a factor that combines mortality and hospitalization ratios available for all the sections. Finally, we validated the method and we applied it to estimate regional cancer rates as the population-weighted average of accredited sections and nonaccredited sections adjusted rates. The validation process shows that estimated rates are close to real incidence data. The most frequent neoplasms in Apulia are breast (direct standardized rates 96.8 per 100 000 inhabitants), colon-rectum (36.6), and thyroid cancer (25.3) in women and prostate (70.2), lung (68.4), and colon-rectum cancer (52.2) in men. This method could be useful to assess the cancer incidence when complete cancer registration data are not available, but hospitalization, mortality, and neighbouring incidence data are available.
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Affiliation(s)
| | - Ivan Rashid
- Cancer Registry of Apulia, Health Regional Agency of Apulia
| | - Francesco Cuccaro
- Cancer Registry of Apulia, Local Health Unit of Barletta-Andria-Trani, Bari, Italy
| | - Antonio Chieti
- Cancer Registry of Apulia, Health Regional Agency of Apulia
| | - Danila Bruno
- Cancer Registry of Apulia, Health Regional Agency of Apulia
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Czwikla J, Jobski K, Schink T. The impact of the lookback period and definition of confirmatory events on the identification of incident cancer cases in administrative data. BMC Med Res Methodol 2017; 17:122. [PMID: 28806932 PMCID: PMC5556662 DOI: 10.1186/s12874-017-0407-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 08/06/2017] [Indexed: 11/22/2022] Open
Abstract
Background This cohort study examined the impact of the lengths of lookback and confirmation periods as well as the definition of confirmatory events on the number of incident cancer cases identified and age-standardized cumulative incidences (ACI) estimated in administrative data using German cancer registry data as a benchmark. Methods ACI per 100,000 insured persons for breast, prostate and colorectal cancer were estimated using BARMER Statutory Health Insurance claims data. Incident cancer cases were defined as having an in- or outpatient diagnosis in 2013, no diagnosis in a lookback period of 1 year and a second diagnosis (or death) in a confirmation period of 1 quarter. We varied lookback periods from 1 to 7 years, confirmation periods from 1 to 4 quarters as well as the definition of confirmatory events and compared ACI estimates to cancer registry data. Results ACI were higher for breast (138.7) and prostate (103.6) but lower for colorectal cancer (42.1) when compared to cancer registries (119.3, 98.0 and 45.5, respectively). Extending the lookback period to 7 years reduced ACI to 129.0, 95.1 and 38.3. An extended confirmation period of 4 quarters increased ACI to 151.3, 114.9 and 46.8. Including breast and colorectal surgeries as a confirmatory event reduced ACI to 114.9 and 37.1, respectively. Conclusions The choice of lookback and confirmation periods and the definition of confirmatory events have considerable impact on the number of incident cancer cases identified and ACI estimated. Researchers need to be aware of potential misclassification when identifying incident cancer cases in administrative data. Further validation studies as well as studies using administrative data to estimate cancer incidences should consider several choices of the lookback and confirmation periods and the definition of confirmatory events to show how these parameters impact the validity and robustness of their results. Electronic supplementary material The online version of this article (doi:10.1186/s12874-017-0407-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jonas Czwikla
- Department of Health, Long-term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, P.O. Box 33 04 40, 28334, Bremen, Germany. .,High-Profile Area Health Sciences, University of Bremen, P.O. Box 33 04 40, 28334, Bremen, Germany.
| | - Kathrin Jobski
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, P.O. Box 2503, 26111, Oldenburg, Germany
| | - Tania Schink
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Drug Safety Unit, Achterstrasse 30, 28359, Bremen, Germany
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26
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Impact of treatment regimen on acute care use during and after adjuvant chemotherapy for early-stage breast cancer. Breast Cancer Res Treat 2017; 164:515-525. [DOI: 10.1007/s10549-017-4280-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
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Capri S, Russo A. Cost of breast cancer based on real-world data: a cancer registry study in Italy. BMC Health Serv Res 2017; 17:84. [PMID: 28122558 PMCID: PMC5267401 DOI: 10.1186/s12913-017-2006-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 01/12/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In European countries, it is difficult for local health organizations to determine the resources allocated to different hospitals for breast cancer. The aim of the current study was to examine the costs of breast cancer during the different phases of the diagnostictherapeutic sequence based on real world data. METHODS To identify breast cancer cases diagnosed between 2007 and 2011, we used the cancer registry of the Agency for Health Protection of the Province of Milan (3.2 million inhabitants). A generalized linear model controlling for patient age, cancer stage and Charlson co-morbidity index was used to calculate the adjusted mean costs for each hospital and for each study phase. Regression analyses were based on dependent variables of individual costs (diagnosis, treatment, follow-up and total cost were logtransformed. The following independent variables were included as covariates: age at diagnosis, hospital volume, stage, job category, educational level, marital status, comorbidities, deprivation index. Total and mean costs were computed for several variables and for each phase. On average for each subject, the costs were collected over 2.5 years. RESULTS A total of 12,580 breast cancer cases were studied. The mean cost of diagnosis was €414, the mean cost of treatment was €8,780, the mean overall cost of follow-up was approximately €2,351, and the mean total direct medical cost was €10,970. The age of the patients, stage of tumor and employment level of the patient were significantly correlated with the variability of the costs. The highest variability in costs was observed for the follow-up costs, in which 38% of hospitals fell outside the 95% confidence interval. In the overspending-hospitals, patients received an intensive follow-up regimen with scintigraphy and thoracic CAT (computerized axial tomography). CONCLUSIONS In this study, which represents the first population-level study of its kind in Italy, we estimated all direct medical costs for the 6-month period before the diagnosis of breast cancer and the first two years after diagnosis. Patients were identified from the local cancer registry. The analysis offers insight into the utilization of resources incurred by one major area of interest of cancer care in Italy.
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Affiliation(s)
- Stefano Capri
- School of Economics and Business, Cattaneo-LIUC University, Corso Matteotti 22, 21053 Castellanza, VA Italy
| | - Antonio Russo
- Epidemiology Unit, Agency for Health Protection of the Province of Milan, C.so Italia 19, 20122 Milan, Italy
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Smith BD, Jiang J, Shih YC, Giordano SH, Huo J, Jagsi R, Momoh AO, Caudle AS, Hunt KK, Shaitelman SF, Buchholz TA, Shirvani SM. Cost and Complications of Local Therapies for Early-Stage Breast Cancer. J Natl Cancer Inst 2017; 109:2905640. [PMID: 27678203 PMCID: PMC6075189 DOI: 10.1093/jnci/djw178] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 06/09/2016] [Accepted: 06/21/2016] [Indexed: 01/26/2023] Open
Abstract
Background Guideline-concordant local therapy options for early breast cancer include lumpectomy plus whole breast irradiation (Lump+WBI), lumpectomy plus brachytherapy, mastectomy alone, mastectomy plus reconstruction, and, in older women, lumpectomy alone. We performed a comparative examination of each treatment's complications and cost to assess their relative values. Methods Using the MarketScan database of younger women with private insurance and the SEER-Medicare database of older women with public insurance, we identified 105 211 women with early breast cancer diagnosed between 2000 and 2011. We used diagnosis and procedural codes to identify treatment complications within 24 months of diagnosis and compared complications by treatment using two-sided logistic regression. Mean total and complication-related cost, relative to Lump+WBI, were calculated from a payer's perspective and adjusted for differences in covariables using linear regression. All statistical tests were two-sided. Results Lump+WBI was the most commonly used treatment. Mastectomy plus reconstruction was associated with nearly twice the complication risk of Lump+WBI (Marketscan: 54.3% vs 29.6%, relative risk [RR] = 1.87, 95% confidence interval [CI] = 1.82 to 1.91, P < .001; SEER-Medicare: 66.1% vs 37.6%, RR = 1.75, 95% CI = 1.69 to 1.82, P < .001) and was also associated with higher adjusted total cost (Marketscan: $22 481 greater than Lump+WBI; SEER-Medicare: $1748 greater) and complication-related cost (Marketscan: $9017 greater; SEER-Medicare: $2092 greater). Brachytherapy had modestly higher total cost and complications than WBI. Lumpectomy alone entailed lower cost and complications in the SEER-Medicare cohort only. Conclusions Mastectomy plus reconstruction results in substantially higher complications and cost than other guideline-concordant treatment options for early breast cancer. These findings are relevant to patients evaluating their local therapy options and to value-based population health management.
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Affiliation(s)
- Benjamin D. Smith
- Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS)
| | - Jing Jiang
- Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS)
| | - Ya-ChenTina Shih
- Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS)
| | - Sharon H. Giordano
- Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS)
| | - Jinhai Huo
- Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS)
| | - Reshma Jagsi
- Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS)
| | - Adeyiza O. Momoh
- Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS)
| | - Abigail S. Caudle
- Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS)
| | - Kelly K. Hunt
- Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS)
| | - Simona F. Shaitelman
- Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS)
| | - Thomas A. Buchholz
- Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS)
| | - Shervin M. Shirvani
- Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS)
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Gillespie EF, Matsuno RK, Xu B, Triplett DP, Hwang L, Boero IJ, Einck JP, Yashar C, Murphy JD. Geographic Disparity in the Use of Hypofractionated Radiation Therapy Among Elderly Women Undergoing Breast Conservation for Invasive Breast Cancer. Int J Radiat Oncol Biol Phys 2016; 96:251-258. [PMID: 27473817 PMCID: PMC5014714 DOI: 10.1016/j.ijrobp.2016.05.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 04/10/2016] [Accepted: 05/04/2016] [Indexed: 01/02/2023]
Abstract
PURPOSE To evaluate geographic heterogeneity in the delivery of hypofractionated radiation therapy (RT) for breast cancer among Medicare beneficiaries across the United States. METHODS AND MATERIALS We identified 190,193 patients from the Centers for Medicare and Medicaid Services Chronic Conditions Warehouse. The study included patients aged >65 years diagnosed with invasive breast cancer treated with breast conservation surgery followed by radiation diagnosed between 2000 and 2012. We analyzed data by hospital referral region based on patient residency ZIP code. The proportion of women who received hypofractionated RT within each region was analyzed over the study period. Multivariable logistic regression models identified predictors of hypofractionated RT. RESULTS Over the entire study period we found substantial geographic heterogeneity in the use of hypofractionated RT. The proportion of women receiving hypofractionated breast RT in individual hospital referral regions varied from 0% to 61%. We found no correlation between the use of hypofractionated RT and urban/rural setting or general geographic region. The proportion of hypofractionated RT increased in regions with higher density of radiation oncologists, as well as lower total Medicare reimbursements. CONCLUSIONS This study demonstrates substantial geographic heterogeneity in the use of hypofractionated RT among elderly women with invasive breast cancer treated with lumpectomy in the United States. This heterogeneity persists despite clinical data from multiple randomized trials proving efficacy and safety compared with standard fractionation, and highlights possible inefficiency in health care delivery.
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Affiliation(s)
| | | | - Beibei Xu
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Daniel P Triplett
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Lindsay Hwang
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Isabel J Boero
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - John P Einck
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Catheryn Yashar
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - James D Murphy
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
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Joshi V, Adelstein BA, Schaffer A, Srasuebkul P, Dobbins T, Pearson SA. Validating a proxy for disease progression in metastatic cancer patients using prescribing and dispensing data. Asia Pac J Clin Oncol 2016; 13:e246-e252. [PMID: 27665738 DOI: 10.1111/ajco.12602] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 09/24/2015] [Accepted: 01/12/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Routine data collections are used increasingly to examine outcomes of real-world cancer drug use. These datasets lack clinical details about important endpoints such as disease progression. AIM To validate a proxy for disease progression in metastatic cancer patients using prescribing and dispensing claims. METHODS We used data from a cohort study of patients undergoing chemotherapy who provided informed consent to the collection of cancer-treatment data from medical records and linkage to pharmaceutical claims. We derived proxy decision rules based on changes to drug treatment in prescription histories (n = 36 patients) and validated the proxy in prescribing data (n = 62 patients). We adapted the decision rules and validated the proxy in dispensing data (n = 109). Our gold standard was disease progression ascertained in patient medical records. Individual progression episodes were the unit of analysis for sensitivity and Positive Predictive Value (PPV) calculations and specificity and Negative Predictive Value (NPV) were calculated at the patient level. RESULTS The sensitivity of our proxy in prescribing data was 74.3% (95% Confidence Interval (CI), 55.6-86.6%) and PPV 61.2% (95% CI, 45.0-75.3%); specificity and NPV were 87.8% (95% CI, 73.8-95.9%) and 100% (95% CI, 90.3-100%), respectively. In dispensing data, the sensitivity of our proxy was 64% (95% CI, 55.0-77.0%) and PPV 56.0% (95% CI, 43.0-69.0%); specificity and NPV were 81% (95% CI, 70.05-89.0%) and 91.0% (95% CI, 82.0-97.0%), respectively. CONCLUSION Our proxy overestimated episodes of disease progression. The proxy's performance is likely to improve if the date of prescribing is used instead of date of dispensing in claims data and by incorporating medical service claims (such as imaging prior to drug changes) in the algorithm. Our proxy is not sufficiently robust for use in real world comparative effectiveness research for cancer medicines.
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Affiliation(s)
- Vikram Joshi
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Barbara-Ann Adelstein
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Andrea Schaffer
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Faculty of Pharmacy, University of Sydney, Sydney, Australia
| | - Preeyaporn Srasuebkul
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Faculty of Pharmacy, University of Sydney, Sydney, Australia
| | - Timothy Dobbins
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Sallie-Anne Pearson
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Faculty of Pharmacy, University of Sydney, Sydney, Australia.,School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
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- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Centre for Health Economics Research and Evaluation (CHERE), University of Technology, Sydney, Australia
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Yang J, Neugut AI, Wright JD, Accordino M, Hershman DL. Nonadherence to Oral Medications for Chronic Conditions in Breast Cancer Survivors. J Oncol Pract 2016; 12:e800-9. [PMID: 27407167 DOI: 10.1200/jop.2016.011742] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Nonadherence to oral endocrine therapy is common among women with breast cancer (BC). Less is known about nonadherence to medications for other chronic conditions among survivors of BC. METHODS We used the MarketScan Database to identify women older than 18 years who had nonmetastatic BC diagnosed between January 1, 2009, and December 31, 2013. Prescriptions were identified for the following six non-cancer-related conditions: hypertension, thyroid disease, hyperlipidemia, gastroesophageal reflux disease, diabetes, and osteoporosis. The study period was defined as 1 year before BC diagnosis (index date) through 1.5 years after the index date, with a 6-month washout period after the index data to control for adherence during the preoperative period and during chemotherapy if necessary. Adherence was defined as a medication possession ratio ≥ 80%. Change in adherence was defined as a 20% decrease in the medication possession ratio from the time before diagnosis compared with after treatment. Factors associated with change in adherence were evaluated in multivariable logistic models. RESULTS Among 36,149 patients diagnosed with BC, the average adherence to these medications before BC was 91.4%. However, after BC treatment, adherence decreased to 77.9% (P < .001). Looking at drugs for each condition, nonadherence ranged from 15.6% to 38% (P < .001). Factors associated with an increase in nonadherence included older age, insurance type, number of medications, and comorbid conditions. CONCLUSION Decreased adherence to medications for chronic diseases was found in the first year after breast cancer treatment. Breast cancer survivors may need additional interventions to improve their adherence to their medications for chronic conditions.
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Nordstrom BL, Simeone JC, Malley KG, Fraeman KH, Klippel Z, Durst M, Page JH, Xu H. Validation of Claims Algorithms for Progression to Metastatic Cancer in Patients with Breast, Non-small Cell Lung, and Colorectal Cancer. Front Oncol 2016; 6:18. [PMID: 26870695 PMCID: PMC4733924 DOI: 10.3389/fonc.2016.00018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 01/17/2016] [Indexed: 11/13/2022] Open
Abstract
Background Validated algorithms for identifying progression to metastatic cancer could permit the use of administrative claims databases for research in this area. Objective To identify simple algorithms that could accurately detect cancer progression to metastatic breast, non-small cell lung, and colorectal cancer (CRC) using medical and pharmacy claims data. Methods Adults with stage I–III breast, non-small cell lung cancer (NSCLC), or CRC in the Geisinger Health System from 2004 to 2011 were selected. Evidence of progression was extracted via manual chart review as the reference standard. In addition to secondary malignancy diagnosis (ICD-9 code for metastases), diagnoses, procedures, and treatments were selected with clinician input as indicators of cancer progression. Random forests models provided variable importance scores. In addition to codes for secondary malignancy, several more complex algorithms were constructed and performance measures calculated. Results Among those with breast cancer [17/502 (3.4%) progressed], the performance of a secondary malignancy code was suboptimal [sensitivity: 64.7%; specificity: 86.0%; positive predictive value (PPV): 13.9; negative predictive value (NPV): 98.6%]; requiring malignancy at another site or initiation of immunotherapy increased PPV and specificity but decreased sensitivity. For NSCLC [61/236 (25.8%) progressed], codes for secondary malignancy alone (PPV: 47.4%; NPV: 84.8%; sensitivity: 60.7%; specificity: 76.6%) performed similarly or better than more complex algorithms. For CRC [33/276 (12.0%) progressed], secondary malignancy codes had good specificity (92.7%) and NPV (92.3%) but low sensitivity (42.4%) and PPV (43.8%); an algorithm with change in chemotherapy increased sensitivity but decreased other metrics. Conclusion Selected algorithms performed similarly to the presence of a secondary tumor diagnosis code, with low sensitivity/PPV and higher specificity/NPV. Accurate identification of cancer progression likely requires verification through chart review.
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Kehl KL, Shen C, Litton JK, Arun B, Giordano SH. Rates of BRCA1/2 mutation testing among young survivors of breast cancer. Breast Cancer Res Treat 2016; 155:165-73. [PMID: 26706041 PMCID: PMC5521172 DOI: 10.1007/s10549-015-3658-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 12/08/2015] [Indexed: 02/07/2023]
Abstract
Guidelines in the United States recommend consideration of testing for mutations in the BRCA1 and BRCA2 genes for women diagnosed with breast cancer under age 45. Identification of mutations among survivors has implications for secondary prevention and familial risk reduction. Although only 10 % of breast cancers are diagnosed under age 45, there are approximately 2.8 million breast cancer survivors in the United States, such that the young survivor population likely numbers in the hundreds of thousands. However, little is known about genetic testing rates in this population. We assessed trends in BRCA1/2 testing among breast cancer survivors who were under age 45 at diagnosis and were treated from 2005 to 2012. Using insurance claims from a national database (MarketScan), we identified incident breast cancer cases among (1) women aged ≤40 and (2) women aged 41-45. We measured BRCA1/2 testing using Kaplan-Meier analysis and Cox proportional hazards models. Among 26,985 patients analyzed, BRCA1/2 testing rates increased with each year of diagnosis from 2005 to 2012 (P < 0.001). However, among women treated in earlier years, testing rates did not approach those of patients treated later, even after extended follow-up (median time from surgery to testing among patients treated in 2005, not reached; median time to testing among patients treated in 2012, 0.2 months for women aged ≤40 and 1.0 month for women aged 41-45). Women aged 41-45 had lower rates than women aged ≤40 throughout the analysis period (P < 0.001 for each year). BRCA1/2 testing rates among young women with incident breast cancer increased substantially in the last decade. However, most survivors treated in earlier years have never been tested. Our results demonstrate a need to better incorporate genetic counseling into survivorship and primary care for this population.
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Affiliation(s)
- Kenneth L Kehl
- Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 463, Houston, TX, 77030, USA.
| | - Chan Shen
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jennifer K Litton
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Banu Arun
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sharon H Giordano
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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An Evaluation of Algorithms for Identifying Metastatic Breast, Lung, or Colorectal Cancer in Administrative Claims Data. Med Care 2015; 53:e49-57. [PMID: 23524464 DOI: 10.1097/mlr.0b013e318289c3fb] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Administrative health care claims data are used for epidemiologic, health services, and outcomes cancer research and thus play a significant role in policy. Cancer stage, which is often a major driver of cost and clinical outcomes, is not typically included in claims data. OBJECTIVES Evaluate algorithms used in a dataset of cancer patients to identify patients with metastatic breast (BC), lung (LC), or colorectal (CRC) cancer using claims data. METHODS Clinical data on BC, LC, or CRC patients (between January 1, 2007 and March 31, 2010) were linked to a health care claims database. Inclusion required health plan enrollment ≥3 months before initial cancer diagnosis date. Algorithms were used in the claims database to identify patients' disease status, which was compared with physician-reported metastases. Generic and tumor-specific algorithms were evaluated using ICD-9 codes, varying diagnosis time frames, and including/excluding other tumors. Positive and negative predictive values, sensitivity, and specificity were assessed. RESULTS The linked databases included 14,480 patients; of whom, 32%, 17%, and 14.2% had metastatic BC, LC, and CRC, respectively, at diagnosis and met inclusion criteria. Nontumor-specific algorithms had lower specificity than tumor-specific algorithms. Tumor-specific algorithms' sensitivity and specificity were 53% and 99% for BC, 55% and 85% for LC, and 59% and 98% for CRC, respectively. CONCLUSIONS Algorithms to distinguish metastatic BC, LC, and CRC from locally advanced disease should use tumor-specific primary cancer codes with 2 claims for the specific primary cancer >30-42 days apart to reduce misclassification. These performed best overall in specificity, positive predictive values, and overall accuracy to identify metastatic cancer in a health care claims database.
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Lipitz-Snyderman A, Ma Q, Pollack MF, Barron J, Elkin EB, Bach PB, Malin JL. Complications Associated With Use of Long-Term Central Venous Catheters Among Commercially Insured Women With Breast Cancer. J Oncol Pract 2015; 11:505-10. [PMID: 26265170 DOI: 10.1200/jop.2015.004796] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Despite some advantages to their use, long-term central venous catheters (CVCs) are associated with complications for patients who require chemotherapy. Understanding of these risks in commercially insured populations is limited. This information can inform medical policies that ensure the appropriate use of venous access devices. This study's objectives were to assess the extent of variation in use of long-term CVCs in a cohort of commercially insured women with breast cancer, and to assess risks of associated complications. METHODS Retrospective cohort analysis was conducted using health insurance claims between January 2006 and October 2013. The cohort included commercially insured women age ≥ 18 years diagnosed with breast cancer who received infusion chemotherapy (N = 31,047). We conducted matched and case-mix adjusted Cox proportional hazard modeling to assess differences in bloodstream infections and thrombovascular complications between patients using long-term CVCs and those using temporary intravenous catheters. RESULTS Approximately two thirds of the cohort had a long-term CVC, although rates varied across regions (57% to 75%), health plans (65% to 70%), and insurance coverage (63% to 68%). After propensity score matching, the adjusted hazard ratio for infection was 2.70 (95% CI, 2.31 to 3.16) and thrombovascular complications, 2.61 (95% CI, 2.33 to 2.93) in patients with long-term CVCs compared with those with temporary intravenous catheters. CONCLUSION Although long-term CVCs may have benefits, they are associated with increased morbidity. Regional and health plan variation in long-term CVC insertion suggests that some of their use reflects provider- or institution-driven variation in practice. Evidence-based guidelines and tools may help decrease discretionary use of long-term CVCs.
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Affiliation(s)
- Allison Lipitz-Snyderman
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY; HealthCore, Wilmington DE; and Anthem, Indianapolis, IN
| | - Qinli Ma
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY; HealthCore, Wilmington DE; and Anthem, Indianapolis, IN
| | - Michael F Pollack
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY; HealthCore, Wilmington DE; and Anthem, Indianapolis, IN
| | - John Barron
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY; HealthCore, Wilmington DE; and Anthem, Indianapolis, IN
| | - Elena B Elkin
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY; HealthCore, Wilmington DE; and Anthem, Indianapolis, IN
| | - Peter B Bach
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY; HealthCore, Wilmington DE; and Anthem, Indianapolis, IN
| | - Jennifer L Malin
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY; HealthCore, Wilmington DE; and Anthem, Indianapolis, IN
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Bekelman JE, Sylwestrzak G, Barron J, Liu J, Epstein AJ, Freedman G, Malin J, Emanuel EJ. Uptake and costs of hypofractionated vs conventional whole breast irradiation after breast conserving surgery in the United States, 2008-2013. JAMA 2014; 312:2542-50. [PMID: 25494006 PMCID: PMC4271796 DOI: 10.1001/jama.2014.16616] [Citation(s) in RCA: 160] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
IMPORTANCE Based on randomized evidence, expert guidelines in 2011 endorsed shorter, hypofractionated whole breast irradiation (WBI) for selected patients with early-stage breast cancer and permitted hypofractionated WBI for other patients. OBJECTIVES To examine the uptake and costs of hypofractionated WBI among commercially insured patients in the United States. DESIGN, SETTING, AND PARTICIPANTS Retrospective, observational cohort study, using administrative claims data from 14 commercial health care plans covering 7.4% of US adult women in 2013, we classified patients with incident early-stage breast cancer treated with lumpectomy and WBI from 2008 and 2013 into 2 cohorts: (1) the hypofractionation-endorsed cohort (n = 8924) included patients aged 50 years or older without prior chemotherapy or axillary lymph node involvement and (2) the hypofractionation-permitted cohort (n = 6719) included patients younger than 50 years or those with prior chemotherapy or axillary lymph node involvement. EXPOSURES Hypofractionated WBI (3-5 weeks of treatment) vs conventional WBI (5-7 weeks of treatment). MAIN OUTCOMES AND MEASURES Use of hypofractionated and conventional WBI, total and radiotherapy-related health care expenditures, and patient out-of-pocket expenses. Patient and clinical characteristics included year of treatment, age, comorbid disease, prior chemotherapy, axillary lymph node involvement, intensity-modulated radiotherapy, practice setting, and other contextual variables. RESULTS Hypofractionated WBI increased from 10.6% (95% CI, 8.8%-12.5%) in 2008 to 34.5% (95% CI, 32.2%-36.8%) in 2013 in the hypofractionation-endorsed cohort and from 8.1% (95% CI, 6.0%-10.2%) in 2008 to 21.2% (95% CI, 18.9%-23.6%) in 2013 in the hypofractionation-permitted cohort. Adjusted mean total health care expenditures in the 1 year after diagnosis were $28,747 for hypofractionated and $31,641 for conventional WBI in the hypofractionation-endorsed cohort (difference, $2894; 95% CI, $1610-$4234; P < .001) and $64,273 for hypofractionated and $72,860 for conventional WBI in the hypofractionation-permitted cohort (difference, $8587; 95% CI, $5316-$12,017; P < .001). Adjusted mean total 1-year patient out-of-pocket expenses were not significantly different between hypofractionated vs conventional WBI in either cohort. CONCLUSIONS AND RELEVANCE Hypofractionated WBI after breast conserving surgery increased among women with early-stage breast cancer in 14 US commercial health care plans between 2008 and 2013. However, only 34.5% of patients with hypofractionation-endorsed and 21.2% with hypofractionation-permitted early-stage breast cancer received hypofractionated WBI in 2013.
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Affiliation(s)
- Justin E Bekelman
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia2Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia3Leonard Davis Institute of Health E
| | | | | | | | - Andrew J Epstein
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia5Division of General Internal Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia6Center for Health Equity Research and
| | - Gary Freedman
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | | | - Ezekiel J Emanuel
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
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Park LS, Tate JP, Rodriguez-Barradas MC, Rimland D, Goetz MB, Gibert C, Brown ST, Kelley MJ, Justice AC, Dubrow R. Cancer Incidence in HIV-Infected Versus Uninfected Veterans: Comparison of Cancer Registry and ICD-9 Code Diagnoses. JOURNAL OF AIDS & CLINICAL RESEARCH 2014; 5:1000318. [PMID: 25580366 PMCID: PMC4285627 DOI: 10.4172/2155-6113.1000318] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Given the growing interest in the cancer burden in persons living with HIV/AIDS, we examined the validity of data sources for cancer diagnoses (cancer registry versus International Classification of Diseases, Ninth Revision [ICD-9 codes]) and compared the association between HIV status and cancer risk using each data source in the Veterans Aging Cohort Study (VACS), a prospective cohort of HIV-infected and uninfected veterans from 1996 to 2008. METHODS We reviewed charts to confirm potential incident cancers at four VACS sites. In the entire cohort, we calculated cancer-type-specific age-, sex-, race/ethnicity-, and calendar-period-standardized incidence rates and incidence rate ratios (IRR) (HIV-infected versus uninfected). We calculated standardized incidence ratios (SIR) to compare VACS and Surveillance, Epidemiology, and End Results rates. RESULTS Compared to chart review, both Veterans Affairs Central Cancer Registry (VACCR) and ICD-9 diagnoses had approximately 90% sensitivity; however, VACCR had higher positive predictive value (96% versus 63%). There were 6,010 VACCR and 13,386 ICD-9 incident cancers among 116,072 veterans. Although ICD-9 rates tended to be double VACCR rates, most IRRs were in the same direction and of similar magnitude, regardless of data source. Using either source, all cancers combined, most viral-infection-related cancers, lung cancer, melanoma, and leukemia had significantly elevated IRRs. Using ICD-9, eight additional IRRs were significantly elevated, most likely due to false positive diagnoses. Most ICD-9 SIRs were significantly elevated and all were higher than the corresponding VACCR SIR. CONCLUSIONS ICD-9 may be used with caution for estimating IRRs, but should be avoided when estimating incidence or SIRs. Elevated cancer risk based on VACCR diagnoses among HIV-infected veterans was consistent with other studies.
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Affiliation(s)
- Lesley S Park
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
- Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, CT, USA
| | - Janet P Tate
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of General Internal Medicine, Veterans Affairs Healthcare System, West Haven, CT, USA
| | - Maria C Rodriguez-Barradas
- Infectious Diseases Section, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - David Rimland
- Medical Specialty Care Service Line, Atlanta Veterans Affairs Medical Center, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Matthew Bidwell Goetz
- Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Cynthia Gibert
- Section of Infectious Diseases, Washington DC Veterans Affairs Medical Center, Washington, DC, USA
- Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Sheldon T Brown
- Department of Medicine, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
- Department of Medicine, Icahn School of Medicine, Mt. Sinai, New York, NY, USA
| | - Michael J Kelley
- Office of Patient Care Services, Department of Veterans Affairs, Washington, DC, USA
- Hematology-Oncology Service, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Division of Medical Oncology, Duke University Medical Center, Durham, NC, USA
| | - Amy C Justice
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of General Internal Medicine, Veterans Affairs Healthcare System, West Haven, CT, USA
| | - Robert Dubrow
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
- Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, CT, USA
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Barcenas CH, Niu J, Zhang N, Zhang Y, Buchholz TA, Elting LS, Hortobagyi GN, Smith BD, Giordano SH. Risk of hospitalization according to chemotherapy regimen in early-stage breast cancer. J Clin Oncol 2014; 32:2010-7. [PMID: 24868022 DOI: 10.1200/jco.2013.49.3676] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To compare the risk of hospitalization between patients with early-stage breast cancer who received different chemotherapy regimens. PATIENT AND METHODS We identified 3,567 patients older than age 65 years from the SEER/Texas Cancer Registry-Medicare database and 9,327 patients younger than age 65 years from the MarketScan database who were diagnosed with early-stage breast cancer between 2003 and 2007. The selection was nonrandomized and nonprospectively collected. We categorized patients according to the regimens they received: docetaxel (T) and cyclophosphamide (C), doxorubicin (A) and C, TAC, AC + T, dose-dense AC + paclitaxel (P) or AC + weekly P. We compared the rates of chemotherapy-related hospitalizations that occurred within 6 months of chemotherapy initiation and used multivariable logistic regression analysis to identify the factors associated with these hospitalizations. RESULTS Among patients younger than age 65 years, the hospitalization rates ranged from 6.2% (dose-dense AC + P) to 10.0% (TAC), and those who received TAC and AC + T had significantly higher rates of hospitalization than did patients who received TC. Among patients older than age 65 years, these rates ranged from 12.7% (TC) to 24.2% (TAC) and the rates of hospitalization of patients who received TAC, AC + T, AC, or AC + weekly P were higher than those of patients who received TC. CONCLUSION TAC and AC + T were associated with the highest risk of hospitalization in patients younger than age 65 years. Among patients older than age 65 years, all regimens (aside from dose-dense AC + P) were associated with a higher risk of hospitalization than TC. Results may be affected by selection biases where less aggressive regimens are offered to frailer patients.
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Affiliation(s)
- Carlos H Barcenas
- All authors: The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jiangong Niu
- All authors: The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ning Zhang
- All authors: The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yufeng Zhang
- All authors: The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Thomas A Buchholz
- All authors: The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Linda S Elting
- All authors: The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Benjamin D Smith
- All authors: The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sharon H Giordano
- All authors: The University of Texas MD Anderson Cancer Center, Houston, TX.
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Wendt JK, Symanski E, Du XL. Estimation of asthma incidence among low-income children in Texas: a novel approach using Medicaid claims data. Am J Epidemiol 2012; 176:744-50. [PMID: 23024134 DOI: 10.1093/aje/kws150] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Few recent estimates of childhood asthma incidence exist in the literature, although the importance of incidence surveillance for understanding asthma risk factors has been recognized. Asthma prevalence, morbidity, and mortality reports have repeatedly shown that low-income children are disproportionately impacted by the disease. The aim of this study was to demonstrate the utility of Medicaid claims data for providing statewide estimates of asthma incidence. Medicaid analytic extract (MAX) data for Texas children aged 0-17 years enrolled in Medicaid between 2004 and 2007 were used to estimate incidence overall and by age group, gender, race, and county of residence. A ≥13-month period of continuous enrollment was required in order to distinguish incident from prevalent cases identified in the claims data. The age-adjusted incidence of asthma was 4.26/100 person-years during 2005-2007, higher than reported in other populations. Incidence rates decreased with age, were higher for males than females, differed by race, and tended to be higher in rural than urban areas. This study demonstrates the utility of Medicaid analytic extract data for estimating asthma incidence and describes the methodology required for a population with unstable enrollment.
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Affiliation(s)
- Judy K Wendt
- Department of Epidemiology, Human Genetics, and Environment Sciences, University of Texas School of Public Health, Houston, Texas 77030, USA
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Shaffer VA, Merkle EC, Fagerlin A, Griggs JJ, Langa KM, Iwashyna TJ. Chemotherapy was not associated with cognitive decline in older adults with breast and colorectal cancer: findings from a prospective cohort study. Med Care 2012; 50:849-55. [PMID: 22683591 PMCID: PMC3444668 DOI: 10.1097/mlr.0b013e31825a8bb0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study tested 2 hypotheses: (1) chemotherapy increases the rate of cognitive decline in breast and colorectal cancer patients beyond what is typical of normal aging and (2) chemotherapy results in systematic cognitive declines when compared with breast and colorectal cancer patients who did not receive chemotherapy. SUBJECTS Data came from personal interviews with a prospective cohort of patients with breast (n=141) or colorectal cancer (n=224) with incident disease drawn from the nationally representative Health and Retirement Study (1998-2006) with linked Medicare claims. MEASURES The 27-point modified Telephone Interview for Cognitive Status was used to assess cognitive functioning, focusing on memory and attention. We defined the smallest clinically significant change as 0.4 points per year. RESULTS We used Bayesian hierarchical linear models to test the hypotheses, adjusting for multiple possible confounders. Eighty-eight patients were treated with chemotherapy; 277 were not. The mean age at diagnosis was 75.5. Patients were followed for a median of 3.1 years after diagnosis, with a range of 0 to 8.3 years. We found no differences in the rates of cognitive decline before and after diagnosis for patients who received chemotherapy in adjusted models (P=0.86, one-sided 95% posterior intervals lower bound: 0.09 worse after chemotherapy), where patients served as their own controls. Moreover, the rate of cognitive decline after diagnosis did not differ between patients who had chemotherapy and those who did not (P=0.84, one-sided 95% posterior intervals lower bound: 0.11 worse for chemotherapy group in adjusted model). CONCLUSIONS There was no evidence of cognitive decline associated with chemotherapy in this sample of older adults with breast and colorectal cancer.
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Affiliation(s)
- Victoria A Shaffer
- Department of Health Sciences, School of Health Professions, University of Missouri, Columbia, MO 65221-4290, USA.
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Giordano SH, Lin YL, Kuo YF, Hortobagyi GN, Goodwin JS. Decline in the use of anthracyclines for breast cancer. J Clin Oncol 2012; 30:2232-9. [PMID: 22614988 DOI: 10.1200/jco.2011.40.1273] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To determine the patterns of use of anthracycline- and taxane-based chemotherapy for breast cancer treatment. METHODS Claims from a 5% national Medicare sample and from a nationally representative claims database (Marketscan) from 1998 to 2009 were used. Patients with International Classification of Diseases (ICD), ninth revision, codes indicating breast cancer, ICD and Common Procedural Terminology codes indicating breast surgery, and claims for chemotherapy between 3 months before and 12 months after surgery comprised the study cohort. Chemotherapy was classified as anthracycline-based or taxane-based, and the percentages of use were calculated. Piecewise regression models were used to identify the inflection points in the rates of chemotherapy use. The effect of patient characteristics on receiving different types of chemotherapy was estimated by multivariable logistic regression models. RESULTS A total of 4,458 patients were included in the Medicare cohort and 30,422 in the private insurance cohort. After 2005, a sharp increase in the use of taxane-based chemotherapy and a decline in anthracycline-based chemotherapy was seen. By 2008 in the Medicare cohort, 51% of patients received taxane-based and 32% received anthracycline-based chemotherapy. By the end of 2008, the majority of patients younger than 65 years were also receiving taxane-based chemotherapy. Patients younger than 35 years were less likely to be treated with a taxane-based regimen, whereas patients who underwent 21-gene recurrence score testing and those treated with trastuzumab were more likely to receive taxane-based chemotherapy. CONCLUSION The use of anthracycline-based chemotherapy has declined, and the majority of patients with breast cancer are instead receiving taxane-based chemotherapy. The potential impact on patient outcomes is unknown.
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Affiliation(s)
- Sharon H Giordano
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1354, Houston, TX 77030, USA.
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Nordstrom BL, Whyte JL, Stolar M, Mercaldi C, Kallich JD. Identification of metastatic cancer in claims data. Pharmacoepidemiol Drug Saf 2012; 21 Suppl 2:21-8. [DOI: 10.1002/pds.3247] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Smith GL, Xu Y, Buchholz TA, Giordano SH, Jiang J, Shih YCT, Smith BD. Association between treatment with brachytherapy vs whole-breast irradiation and subsequent mastectomy, complications, and survival among older women with invasive breast cancer. JAMA 2012; 307:1827-37. [PMID: 22550197 PMCID: PMC3397792 DOI: 10.1001/jama.2012.3481] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
CONTEXT Brachytherapy is a radiation treatment that uses an implanted radioactive source. In recent years, use of breast brachytherapy after lumpectomy for early breast cancer has increased substantially despite a lack of randomized trial data comparing its effectiveness with standard whole-breast irradiation (WBI). Because results of long-term randomized trials will not be reported for years, detailed analysis of clinical outcomes in a nonrandomized setting is warranted. OBJECTIVE To compare the likelihood of breast preservation, complications, and survival for brachytherapy vs WBI among a nationwide cohort of older women with breast cancer with fee-for-service Medicare. DESIGN Retrospective population-based cohort study of 92,735 women aged 67 years or older with incident invasive breast cancer, diagnosed between 2003 and 2007 and followed up through 2008. After lumpectomy 6952 patients were treated with brachytherapy vs 85,783 with WBI. MAIN OUTCOME MEASURES Cumulative incidence and adjusted risk of subsequent mastectomy (an indicator of failure to preserve the breast) and death were compared using the log-rank test and proportional hazards models. Odds of postoperative infectious and noninfectious complications within 1 year were compared using the χ(2) test and logistic models. Cumulative incidences of long-term complications were compared using the log-rank test. RESULTS Five-year incidence of subsequent mastectomy was higher in women treated with brachytherapy (3.95%; 95% CI, 3.19%-4.88%) vs WBI (2.18%; 95% CI, 2.04%-2.33%; P < .001) and persisted after multivariate adjustment (hazard ratio [HR], 2.19; 95% CI, 1.84-2.61, P < .001). Brachytherapy was associated with more frequent infectious (16.20%; 95% CI, 15.34%-17.08% vs 10.33%; 95% CI, 10.13%-10.53%; P < .001; adjusted odds ratio [OR], 1.76; 1.64-1.88) and noninfectious (16.25%; 95% CI, 15.39%-17.14% vs 9.00%; 95% CI, 8.81%-9.19%; P < .001; adjusted OR, 2.03; 95% CI, 1.89-2.17) postoperative complications; and higher 5-year incidence of breast pain (14.55%, 95% CI, 13.39%-15.80% vs 11.92%; 95% CI, 11.63%-12.21%), fat necrosis (8.26%; 95% CI, 7.27-9.38 vs 4.05%; 95% CI, 3.87%-4.24%), and rib fracture (4.53%; 95% CI, 3.63%-5.64% vs 3.62%; 95% CI, 3.44%-3.82%; P ≤ .01 for all). Five-year overall survival was 87.66% (95% CI, 85.94%-89.18%) in patients treated with brachytherapy vs 87.04% (95% CI, 86.69%-87.39%) in patients treated with WBI (adjusted HR, 0.94; 95% CI, 0.84-1.05; P = .26). CONCLUSION In a cohort of older women with breast cancer, treatment with brachytherapy compared with WBI was associated worse with long-term breast preservation and increased complications but no difference in survival.
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Affiliation(s)
- Grace L Smith
- Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
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Kasiske BL, Kukla A, Thomas D, Wood Ives J, Snyder JJ, Qiu Y, Peng Y, Dharnidharka VR, Israni AK. Lymphoproliferative disorders after adult kidney transplant: epidemiology and comparison of registry report with claims-based diagnoses. Am J Kidney Dis 2011; 58:971-80. [PMID: 21930332 DOI: 10.1053/j.ajkd.2011.07.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 07/13/2011] [Indexed: 01/11/2023]
Abstract
BACKGROUND Posttransplant lymphoproliferative disorder (PTLD) is a major complication of kidney transplant. STUDY DESIGN Retrospective cohort study comparing PTLD incidence rates using US Medicare claims and Organ Procurement and Transplantation Network (OPTN) data, examining risk factors for PTLD in OPTN data, and studying recipient and graft survival after PTLD diagnosis. SETTING & PARTICIPANTS All adult first-transplant patients who underwent deceased or living donor kidney-only transplants in 2000-2006 (n = 89,485) followed up through 3 years posttransplant. PREDICTORS Recipient and donor characteristics, HLA mismatches, viral serologic test results, and initial immunosuppression. OUTCOMES OPTN-reported or Medicare claims-based PTLD diagnosis, recipient and graft survival after OPTN-reported PTLD diagnosis. MEASUREMENTS Adjusted HRs for PTLD diagnosis estimated using a Cox proportional hazards model; probability of survival free of all-cause graft failure estimated using the Kaplan-Meier method. RESULTS The incidence rate of PTLD during the first posttransplant year was 2-fold higher in Medicare claims (0.46/100 patient-years; 95% CI, 0.39-0.53) than in OPTN data (0.22/100 patient-years; 95% CI, 0.17-0.27). Factors associated with increased rates of PTLD included older age, white race (vs African American), induction with T-cell-depleting antibodies, Epstein-Barr virus seronegativity at the time of transplant, and cytomegalovirus seronegativity at the time of transplant. The adjusted risk of death with graft function was 17.5 (95% CI, 14.3-21.4) times higher after a report of PTLD, and the risk of death-censored graft failure was 5.5 (95% CI, 3.9-7.7) times higher. LIMITATIONS Shortcomings inherent in large databases, including inconsistencies in patient follow-up, reporting, and coding practices by transplant centers; insufficient registry data to analyze acute rejection episodes and antirejection treatment; no available data for potential effects of different types of PTLD treatment on patient outcomes. CONCLUSIONS Despite the limitations of data collected by registries, PTLD clearly is an important complication; both mortality and death-censored graft failure increase after PTLD.
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Affiliation(s)
- Bertram L Kasiske
- Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN, USA.
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Tradeoffs of using administrative claims and medical records to identify the use of personalized medicine for patients with breast cancer. Med Care 2011; 49:e1-8. [PMID: 21422962 DOI: 10.1097/mlr.0b013e318207e87e] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Administrative claims and medical records are important data sources to examine healthcare utilization and outcomes. Little is known about identifying personalized medicine technologies in these sources. OBJECTIVES To describe agreement, sensitivity, and specificity of administrative claims compared with medical records for 2 pairs of targeted tests and treatments for breast cancer. RESEARCH DESIGN Retrospective analysis of medical records linked to administrative claims from a large health plan. We examined whether agreement varied by factors that facilitate tracking in claims (coding and cost) and that enhance medical record completeness (records from multiple providers). SUBJECTS Women (35 to 65 y of age) with incident breast cancer diagnosed in 2006 to 2007 (n=775). MEASURES Use of human epidermal growth factor receptor 2 (HER2) and gene expression profiling (GEP) testing, trastuzumab, and adjuvant chemotherapy in claims and medical records. RESULTS Agreement between claims and records was substantial for GEP, trastuzumab, and chemotherapy, and lowest for HER2 tests. GEP, an expensive test with unique billing codes, had higher agreement (91.6% vs. 75.2%), sensitivity (94.9% vs. 76.7%), and specificity (90.1% vs. 29.2%) than HER2, a test without unique billing codes. Trastuzumab, a treatment with unique billing codes, had slightly higher agreement (95.1% vs. 90%) and sensitivity (98.1% vs. 87.9%) than adjuvant chemotherapy. CONCLUSIONS Higher agreement and specificity were associated with services that had unique billing codes and high cost. Administrative claims may be sufficient for examining services with unique billing codes. Medical records provide better data for identifying tests lacking specific codes and for research requiring detailed clinical information.
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Smith GL, Xu Y, Buchholz TA, Smith BD, Giordano SH, Haffty BG, Vicini FA, White JR, Arthur DW, Harris JR, Shih YCT. Brachytherapy for Accelerated Partial-Breast Irradiation: A Rapidly Emerging Technology in Breast Cancer Care. J Clin Oncol 2011; 29:157-65. [DOI: 10.1200/jco.2009.27.0942] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Brachytherapy is a method for delivering partial-breast irradiation after breast-conserving surgery (BCS). It is currently used in the community setting, although its efficacy has yet to be validated in prospective comparative trials. Frequency and factors influencing use have not been previously identified. Methods In a nationwide database of 6,882 Medicare beneficiaries (age ≥ 65 years) with private supplemental insurance (MarketScan Medicare Supplemental), claims codes identified patients treated with brachytherapy versus external-beam radiation after BCS for incident breast cancer (diagnosed from 2001 to 2006). Logistic regression modeled predictors of brachytherapy use. Results Frequency of brachytherapy use as an alternative to external-beam radiation after BCS increased over time (< 1% in 2001, 2% in 2002, 3% in 2003, 5% in 2004, 8% in 2005, 10% in 2006; P < .001). Increased use correlated temporally with US Food and Drug Administration approval and Medicare reimbursement of brachytherapy technology. Brachytherapy use was more likely in women with lymph node–negative disease (odds ratio [OR], 2.19; 95% CI, 1.17 to 4.11) or axillary surgery (OR, 1.74; 95% CI, 1.23 to 2.44). Brachytherapy use was also more likely in women with non–health maintenance organization insurance (OR, 1.81; 95% CI, 1.24 to 2.64) and in areas with higher median income (OR, 1.58; 95% CI, 1.05 to 2.38), lower density of radiation oncologists (OR, 1.78; 95% CI, 1.11 to 2.86), or higher density of surgeons (OR, 1.57; 95% CI, 1.07 to 2.31). Conclusion Despite ongoing questions regarding efficacy, breast brachytherapy was rapidly incorporated into the care of older, insured patients. In our era of frequently emerging novel technologies yet growing demands to optimize costs and outcomes, results provide insight into how clinical, policy, and socioeconomic factors influence new technology diffusion into conventional care.
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Affiliation(s)
- Grace L. Smith
- From The University of Texas MD Anderson Cancer Center, Houston, TX; University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ; William Beaumont Hospital, Royal Oak, MI; Medical College of Wisconsin, Milwaukee, WI; Virginia Commonwealth University, Richmond, VA; and Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA
| | - Ying Xu
- From The University of Texas MD Anderson Cancer Center, Houston, TX; University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ; William Beaumont Hospital, Royal Oak, MI; Medical College of Wisconsin, Milwaukee, WI; Virginia Commonwealth University, Richmond, VA; and Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA
| | - Thomas A. Buchholz
- From The University of Texas MD Anderson Cancer Center, Houston, TX; University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ; William Beaumont Hospital, Royal Oak, MI; Medical College of Wisconsin, Milwaukee, WI; Virginia Commonwealth University, Richmond, VA; and Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA
| | - Benjamin D. Smith
- From The University of Texas MD Anderson Cancer Center, Houston, TX; University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ; William Beaumont Hospital, Royal Oak, MI; Medical College of Wisconsin, Milwaukee, WI; Virginia Commonwealth University, Richmond, VA; and Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA
| | - Sharon H. Giordano
- From The University of Texas MD Anderson Cancer Center, Houston, TX; University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ; William Beaumont Hospital, Royal Oak, MI; Medical College of Wisconsin, Milwaukee, WI; Virginia Commonwealth University, Richmond, VA; and Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA
| | - Bruce G. Haffty
- From The University of Texas MD Anderson Cancer Center, Houston, TX; University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ; William Beaumont Hospital, Royal Oak, MI; Medical College of Wisconsin, Milwaukee, WI; Virginia Commonwealth University, Richmond, VA; and Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA
| | - Frank A. Vicini
- From The University of Texas MD Anderson Cancer Center, Houston, TX; University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ; William Beaumont Hospital, Royal Oak, MI; Medical College of Wisconsin, Milwaukee, WI; Virginia Commonwealth University, Richmond, VA; and Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA
| | - Julia R. White
- From The University of Texas MD Anderson Cancer Center, Houston, TX; University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ; William Beaumont Hospital, Royal Oak, MI; Medical College of Wisconsin, Milwaukee, WI; Virginia Commonwealth University, Richmond, VA; and Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA
| | - Douglas W. Arthur
- From The University of Texas MD Anderson Cancer Center, Houston, TX; University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ; William Beaumont Hospital, Royal Oak, MI; Medical College of Wisconsin, Milwaukee, WI; Virginia Commonwealth University, Richmond, VA; and Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA
| | - Jay R. Harris
- From The University of Texas MD Anderson Cancer Center, Houston, TX; University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ; William Beaumont Hospital, Royal Oak, MI; Medical College of Wisconsin, Milwaukee, WI; Virginia Commonwealth University, Richmond, VA; and Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA
| | - Ya-Chen T. Shih
- From The University of Texas MD Anderson Cancer Center, Houston, TX; University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ; William Beaumont Hospital, Royal Oak, MI; Medical College of Wisconsin, Milwaukee, WI; Virginia Commonwealth University, Richmond, VA; and Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA
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Smith GL, Shih YCT, Xu Y, Giordano SH, Smith BD, Perkins GH, Tereffe W, Woodward WA, Buchholz TA. Racial disparities in the use of radiotherapy after breast-conserving surgery: a national Medicare study. Cancer 2010; 116:734-41. [PMID: 20014181 DOI: 10.1002/cncr.24741] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND In prior studies, the use of standard breast cancer treatments has varied by race, but previous analyses were not nationally representative. Therefore, in a comprehensive, national cohort of Medicare patients, racial disparities in the use of radiotherapy (RT) after breast-conserving surgery (BCS) for invasive breast cancer were quantified. METHODS A national Medicare database was used to identify all beneficiaries (age >65 years) treated with BCS for incident invasive breast cancer in 2003. Claims codes identified RT use, and Medicare demographic data indicated race. Logistic regression modeled RT use in white, black, and other-race patients, adjusted for demographic, clinical, and socioeconomic covariates. RESULTS Of 34,080 women, 91% were white, 6% were black, and 3% were another race. The mean age of the patients was 76 +/- 7 years. Approximately 74% of whites, 65% of blacks, and 66% of other-race patients received RT (P < .001). After covariate adjustment, whites were found to be significantly more likely to receive RT than blacks (odds ratio, 1.48; 95% confidence interval, 1.34-1.63 [P < .001]). Disparities between white and black patients varied by geographic region, with blacks in areas of the northeastern and southern United States demonstrating the lowest rates of RT use (57% in these regions). In patients age <70 years, racial disparities persisted. Specifically, 83% of whites, 73% of blacks, and 78% of other races in this younger group received RT (P < .001). CONCLUSIONS In this comprehensive national sample of older breast cancer patients, substantial racial disparities were identified in RT use after BCS across much of the United States. Efforts to improve breast cancer care require overcoming these disparities, which exist on a national scale.
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Affiliation(s)
- Grace L Smith
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
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Eide MJ, Krajenta R, Johnson D, Long JJ, Jacobsen G, Asgari MM, Lim HW, Johnson CC. Identification of patients with nonmelanoma skin cancer using health maintenance organization claims data. Am J Epidemiol 2010; 171:123-8. [PMID: 19969529 DOI: 10.1093/aje/kwp352] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Cancer registries usually exclude nonmelanoma skin cancers (NMSC), despite the large population affected. Health maintenance organization (HMO) and health system administrative databases could be used as sampling frames for ascertaining NMSC. NMSC patients diagnosed between January 1, 1988, and December 31, 2007, from such defined US populations were identified by using 3 algorithms: NMSC International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, NMSC treatment Current Procedural Terminology (CPT) codes, or both codes. A subset of charts was reviewed to verify NMSC diagnosis, including all records from HMO-enrollee members in 2007. Positive predictive values for NMSC ascertainment were calculated. Analyses of data from 1988-2007 ascertained 11,742 NMSC patients. A random sample of 965 cases was selected for chart review, and NMSCs were validated in 47.0% of ICD-9-CM-identified patients, 73.4% of CPT-identified patients, and 94.9% identified with both codes. All charts from HMO-health plan enrollees in 2007 were reviewed (n = 1,116). Cases of NMSC were confirmed in 96.5% of ICD-9-CM-identified patients, 98.3% of CPT-identified patients, and 98.7% identified with both codes. HMO administrative data can be used to ascertain NMSC with high positive predictive values with either ICD-9-CM or CPT code, but both codes may be necessary among non-HMO patient populations.
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Affiliation(s)
- Melody J Eide
- Department of Dermatology, Henry Ford Hospital, 3031 West Grand Boulevard, Suite 800, Detroit, MI 48202, USA.
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Breast-conserving surgery in older patients with invasive breast cancer: current patterns of treatment across the United States. J Am Coll Surg 2009; 209:425-433.e2. [PMID: 19801315 DOI: 10.1016/j.jamcollsurg.2009.06.363] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Revised: 06/15/2009] [Accepted: 06/16/2009] [Indexed: 02/03/2023]
Abstract
BACKGROUND Breast-conserving surgery (BCS) followed by radiotherapy is as effective as mastectomy for treatment of early invasive breast cancer. But earlier studies report low BCS use rates of 12% to 43% nationally, especially in older patients. We sought to determine current patterns and predictors of BCS use. STUDY DESIGN In a national Medicare database of all beneficiaries (age greater than 65 years) with incident invasive breast cancer treated with operation in 2003, claims codes identified BCS versus mastectomy and demographic, treatment, and geographic region covariates. The 2003 Area Resource File provided socioeconomic covariates. Logistic regression modeled predictors of BCS. RESULTS In 56,725 women, 59% were treated with BCS versus 41% with mastectomy. BCS was more likely in women who were younger than 70 years (odds ratio [OR], 1.37; 95% CI, 1.31 to 1.44; p < 0.001) and had lymph node-negative disease (OR, 1.60; 95% CI, 1.52 to 1.68; p < 0.001). Socioeconomic factors influenced use, with BCS more likely in areas with low poverty (OR, 1.05; 95% CI, 1.00 to 1.09; p = 0.03), high education (OR, 1.13; 95% CI, 1.08 to 1.19), high density of radiation oncologists (OR, 1.30; 95% CI, 1.06 to 1.59), and in metropolitan areas (OR, 1.20; 95% CI, 1.14 to 1.26). Significant geographic variation existed: 70% of women were treated with BCS in northeastern New England compared with only 48% to 50% in the South (p < 0.001). CONCLUSIONS Currently, more than half of older women across the US diagnosed with nonmetastatic invasive breast cancer treated surgically receive BCS, representing a substantial increased use compared with historical data. Lack of BCS use appears in part associated with socioeconomic disadvantage, suggesting that persistent barriers to breast conservation exist.
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