Cancer recurrence: An important but missing variable in national cancer registries

Haejin In, Karl Y. Bilimoria, Andrew K. Stewart, Kristen E. Wroblewski, Mitchell C. Posner, Mark S. Talamonti, David P. Winchester

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Background: Cancer recurrence is a critically important outcome to patients and providers. However, no publicly available cancer registry data contain recurrence information. The National Cancer Data Base (NCDB) collects recurrence data; however, this information is not provided to researchers because of completeness and accuracy concerns. Our objective was to examine completeness of cancer recurrence information in the NCDB. Methods: Stage I-III thyroid/colon/melanoma/pancreas/breast cancers diagnosed in 2002-2005 were identified. Recurrence status, recurrence type, and recurrence date were evaluated for data completeness. Patient, tumor, and hospital factors were examined using generalized linear mixed models. Pseudo-R 2 statistics estimated the relative contribution of patient and hospital factors. Results: Of 702,144 patients with thyroid/colon/melanoma/pancreas/breast cancers treated in 1405 hospitals, recurrence information was incomplete in 21.5/24.0/20.2/34.8/ 18.2 % of patients, respectively. On average, hospitals had incomplete recurrence information on 56.7-66.7 % of their patients. Patients with incomplete information had more comorbidities, a higher cancer stage, non-private insurance, and lived farther from the hospital. Hospitals with the poorest collection were larger tertiary hospitals serving higher-income patients. However, these patients and hospital factors explained less than 3 %, while unexplained hospital variation accounted for the largest part of the observed variation (%ΔR 2 = 84 %). Conclusions: The majority of hospitals report incomplete recurrence information for more than half of their patients. The presence of incomplete recurrence information was largely dependent on undefined hospital factors, rather than patient or tumor characteristics. Attempts to improve cancer recurrence information should focus on hospital operational and process factors surrounding how the hospital tumor registries collect recurrence data.

Original languageEnglish (US)
Pages (from-to)1520-1529
Number of pages10
JournalAnnals of Surgical Oncology
Volume21
Issue number5
DOIs
StatePublished - 2014
Externally publishedYes

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Registries
Recurrence
Neoplasms
Pancreatic Neoplasms
Melanoma
Thyroid Gland
Colon
Databases
Breast Neoplasms
Insurance
Tertiary Care Centers
Comorbidity
Linear Models
Research Personnel

ASJC Scopus subject areas

  • Surgery
  • Oncology
  • Medicine(all)

Cite this

In, H., Bilimoria, K. Y., Stewart, A. K., Wroblewski, K. E., Posner, M. C., Talamonti, M. S., & Winchester, D. P. (2014). Cancer recurrence: An important but missing variable in national cancer registries. Annals of Surgical Oncology, 21(5), 1520-1529. https://doi.org/10.1245/s10434-014-3516-x

Cancer recurrence : An important but missing variable in national cancer registries. / In, Haejin; Bilimoria, Karl Y.; Stewart, Andrew K.; Wroblewski, Kristen E.; Posner, Mitchell C.; Talamonti, Mark S.; Winchester, David P.

In: Annals of Surgical Oncology, Vol. 21, No. 5, 2014, p. 1520-1529.

Research output: Contribution to journalArticle

In, H, Bilimoria, KY, Stewart, AK, Wroblewski, KE, Posner, MC, Talamonti, MS & Winchester, DP 2014, 'Cancer recurrence: An important but missing variable in national cancer registries', Annals of Surgical Oncology, vol. 21, no. 5, pp. 1520-1529. https://doi.org/10.1245/s10434-014-3516-x
In, Haejin ; Bilimoria, Karl Y. ; Stewart, Andrew K. ; Wroblewski, Kristen E. ; Posner, Mitchell C. ; Talamonti, Mark S. ; Winchester, David P. / Cancer recurrence : An important but missing variable in national cancer registries. In: Annals of Surgical Oncology. 2014 ; Vol. 21, No. 5. pp. 1520-1529.
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abstract = "Background: Cancer recurrence is a critically important outcome to patients and providers. However, no publicly available cancer registry data contain recurrence information. The National Cancer Data Base (NCDB) collects recurrence data; however, this information is not provided to researchers because of completeness and accuracy concerns. Our objective was to examine completeness of cancer recurrence information in the NCDB. Methods: Stage I-III thyroid/colon/melanoma/pancreas/breast cancers diagnosed in 2002-2005 were identified. Recurrence status, recurrence type, and recurrence date were evaluated for data completeness. Patient, tumor, and hospital factors were examined using generalized linear mixed models. Pseudo-R 2 statistics estimated the relative contribution of patient and hospital factors. Results: Of 702,144 patients with thyroid/colon/melanoma/pancreas/breast cancers treated in 1405 hospitals, recurrence information was incomplete in 21.5/24.0/20.2/34.8/ 18.2 {\%} of patients, respectively. On average, hospitals had incomplete recurrence information on 56.7-66.7 {\%} of their patients. Patients with incomplete information had more comorbidities, a higher cancer stage, non-private insurance, and lived farther from the hospital. Hospitals with the poorest collection were larger tertiary hospitals serving higher-income patients. However, these patients and hospital factors explained less than 3 {\%}, while unexplained hospital variation accounted for the largest part of the observed variation ({\%}ΔR 2 = 84 {\%}). Conclusions: The majority of hospitals report incomplete recurrence information for more than half of their patients. The presence of incomplete recurrence information was largely dependent on undefined hospital factors, rather than patient or tumor characteristics. Attempts to improve cancer recurrence information should focus on hospital operational and process factors surrounding how the hospital tumor registries collect recurrence data.",
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AU - In, Haejin

AU - Bilimoria, Karl Y.

AU - Stewart, Andrew K.

AU - Wroblewski, Kristen E.

AU - Posner, Mitchell C.

AU - Talamonti, Mark S.

AU - Winchester, David P.

PY - 2014

Y1 - 2014

N2 - Background: Cancer recurrence is a critically important outcome to patients and providers. However, no publicly available cancer registry data contain recurrence information. The National Cancer Data Base (NCDB) collects recurrence data; however, this information is not provided to researchers because of completeness and accuracy concerns. Our objective was to examine completeness of cancer recurrence information in the NCDB. Methods: Stage I-III thyroid/colon/melanoma/pancreas/breast cancers diagnosed in 2002-2005 were identified. Recurrence status, recurrence type, and recurrence date were evaluated for data completeness. Patient, tumor, and hospital factors were examined using generalized linear mixed models. Pseudo-R 2 statistics estimated the relative contribution of patient and hospital factors. Results: Of 702,144 patients with thyroid/colon/melanoma/pancreas/breast cancers treated in 1405 hospitals, recurrence information was incomplete in 21.5/24.0/20.2/34.8/ 18.2 % of patients, respectively. On average, hospitals had incomplete recurrence information on 56.7-66.7 % of their patients. Patients with incomplete information had more comorbidities, a higher cancer stage, non-private insurance, and lived farther from the hospital. Hospitals with the poorest collection were larger tertiary hospitals serving higher-income patients. However, these patients and hospital factors explained less than 3 %, while unexplained hospital variation accounted for the largest part of the observed variation (%ΔR 2 = 84 %). Conclusions: The majority of hospitals report incomplete recurrence information for more than half of their patients. The presence of incomplete recurrence information was largely dependent on undefined hospital factors, rather than patient or tumor characteristics. Attempts to improve cancer recurrence information should focus on hospital operational and process factors surrounding how the hospital tumor registries collect recurrence data.

AB - Background: Cancer recurrence is a critically important outcome to patients and providers. However, no publicly available cancer registry data contain recurrence information. The National Cancer Data Base (NCDB) collects recurrence data; however, this information is not provided to researchers because of completeness and accuracy concerns. Our objective was to examine completeness of cancer recurrence information in the NCDB. Methods: Stage I-III thyroid/colon/melanoma/pancreas/breast cancers diagnosed in 2002-2005 were identified. Recurrence status, recurrence type, and recurrence date were evaluated for data completeness. Patient, tumor, and hospital factors were examined using generalized linear mixed models. Pseudo-R 2 statistics estimated the relative contribution of patient and hospital factors. Results: Of 702,144 patients with thyroid/colon/melanoma/pancreas/breast cancers treated in 1405 hospitals, recurrence information was incomplete in 21.5/24.0/20.2/34.8/ 18.2 % of patients, respectively. On average, hospitals had incomplete recurrence information on 56.7-66.7 % of their patients. Patients with incomplete information had more comorbidities, a higher cancer stage, non-private insurance, and lived farther from the hospital. Hospitals with the poorest collection were larger tertiary hospitals serving higher-income patients. However, these patients and hospital factors explained less than 3 %, while unexplained hospital variation accounted for the largest part of the observed variation (%ΔR 2 = 84 %). Conclusions: The majority of hospitals report incomplete recurrence information for more than half of their patients. The presence of incomplete recurrence information was largely dependent on undefined hospital factors, rather than patient or tumor characteristics. Attempts to improve cancer recurrence information should focus on hospital operational and process factors surrounding how the hospital tumor registries collect recurrence data.

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