Sensitivity of Medicare Claims to Identify Cancer Recurrence in Elderly Colorectal and Breast Cancer Patients

Bibliographic Data

ID9101924
AuthorsJoan L Warren (0000-0002-6467-6769, National Cancer Institute, corresponding author), Ângela Mariotto (National Cancer Institute), Angela B Mariotto (0000-0003-2423-1834, National Cancer Institute, corresponding author), Danielle Melbert (Information Management Services Inc., Beltsville, MD), Deborah Schrag (0000-0002-4334-5717, Dana-Farber Cancer Institute), Paul Doria-Rose (National Cancer Institute), V Paul Doria‐Rose (0000-0002-8802-5143, National Cancer Institute, corresponding author), David F Penson (0000-0002-2580-2697, Vanderbilt-Ingram Cancer Center), David Penson (Vanderbilt-Ingram Cancer Center), K Robin Yabroff (0000-0003-0644-5572, National Cancer Institute, corresponding author)
Year2016
Volume54
Issue8
Pagese47-e54
Publication date2016-08-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000000058
PMID24374419
PMCIDPMC4072852
OpenAlexW2047703402
LanguageEN
Citations received4
References cited20

BACKGROUND: Researchers are increasingly interested in using observational data to evaluate cancer outcomes following treatment, including cancer recurrence and disease-free survival. Because population-based cancer registries do not collect recurrence data, recurrence is often imputed from health claims, primarily by identifying later cancer treatments after initial treatment. The validity of this approach has not been established. RESEARCH DESIGN: We used the linked Surveillance, Epidemiology, and End Results-Medicare data to assess the sensitivity of Medicare claims for cancer recurrence in patients very likely to have had a recurrence. We selected newly diagnosed stage II/III colorectal (n=6910) and female breast cancer (n=3826) patients during 1994-2003 who received initial cancer surgery, had a treatment break, and then died from cancer in 1994-2008. We reviewed all claims from the treatment break until death for indicators of recurrence. We focused on additional cancer treatment (surgery, chemotherapy, radiation therapy) as the primary indicator, and used multivariate logistic regression analysis to evaluate patient factors associated with additional treatment. We also assessed metastasis diagnoses and end-of-life care as recurrence indicators. RESULTS: Additional treatment was the first indicator of recurrence for 38.8% of colorectal patients and 35.2% of breast cancer patients. Patients aged 70 and older were less likely to have additional treatment (P < 0.05), in adjusted analyses. Over 20% of patients either had no recurrence indicator before death or had end-of-life care as their first indicator. CONCLUSIONS: Identifying recurrence through additional cancer treatment in Medicare claims will miss a large percentage of patients with recurrences; particularly those who are older

Breast cancer · Cancer · Cancer registry · Colorectal cancer · Disease · Logistic regression · Multivariate analysis · Observational study · Population · Radiation therapy · Stage (stratigraphy) · Surveillance, Epidemiology, and End Results · Breast Cancer Treatment Studies · Cancer survivorship and care · Epidemiology · Global Cancer Incidence and Screening · Internal Medicine · Medicine · Oncology

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