Sensitivity of Medicare Claims to Identify Cancer Recurrence in Elderly Colorectal and Breast Cancer Patients.
Sensitivity of Medicare Claims to Identify Cancer Recurrence in Elderly Colorectal and Breast Cancer Patients.
复制标题
DOI：
10.1097/mlr.0000000000000058
复制
发表时间：
2016-08
期刊：
影响因子：
3
通讯作者：
Yabroff KR
中科院分区：
文献类型：
--
作者：
Warren JL;Mariotto A;Melbert D;Schrag D;Doria-Rose P;Penson D;Yabroff KR
研究人员越来越有兴趣使用观察数据来评估治疗后的癌症结果，包括癌症复发和无病生存率。由于基于人群的癌症登记不收集复发数据，复发通常由健康声明估算，主要是通过确定初始治疗后的后续癌症治疗。这一方法的有效性尚未确定。我们使用SEER-医疗保险数据来评估医疗保险索赔对极有可能复发的患者癌症复发的敏感性。我们选择了1994-2003年期间新诊断的II/III期结直肠癌（CRC n= 6，910）和女性乳腺癌（n= 3，826）患者，这些患者接受了初次癌症手术，中断了治疗，然后在1994-2008年死于癌症。我们审查了从治疗中断到死亡的所有复发指标。我们将额外的癌症治疗（手术、化疗、放疗）作为主要指标，并使用多变量logistic回归分析来评估与额外治疗相关的患者因素。我们还评估了转移诊断和临终关怀作为复发指标。额外治疗是38.8%的CRC患者和35.2%的乳腺癌患者复发的第一指标。在校正分析中，70岁及以上的患者不太可能接受额外治疗（p<0.05）。超过20%的患者在死前没有复发指标，或者将临终关怀作为首要指标。通过医疗保险索赔中的额外癌症治疗来识别复发将错过很大一部分复发患者，特别是那些年龄较大的患者。
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. We used the linked SEER- 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 (CRC n=6,910) and female breast cancer (n=3,826) 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. Additional treatment was the first indicator of recurrence for 38.8% of CRC patients and 35.2% of breast cancer patients. Patients ages 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. Identifying recurrence through additional cancer treatment in Medicare claims will miss a large percentage of patients with recurrences; particularly those who are older.