Expanding SEER Reporting with Comorbidity Data Colorectal Cancer HORNBROOK

© 2012, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH

Adding Comorbidity Data to the Hawai‘i SEER Registry for Kaiser Permanente Hawai‘i Members

HMO Research Network Annual Meeting

April 30, 2012

Mark C. Hornbrook, PhD and Joan Holup, MAThe Center for Health Research, Kaiser Permanente

Marsha E. Reichman, PhD, MPHThe Food and Drug Administration

Marc T. Goodman, PhD, MPHCancer Research Center of Hawai‘i, University of Hawai‘i

Robin Yabroff, PhDDCCPS, National Cancer Institute


Research Site


Project Team

CHR Hawai‘i Aileen Uchida, MPH Mark M. Schmidt

SEER Hawai‘i (Hawai‘i Tumor Registry, Cancer Research Center of Hawai‘i) Michael Green, CTR Alan Y. Mogi, CDP

IMS Inc. Jennifer Stevens


Funding and IRB

National Cancer Institute IRB approvals

KP Hawai‘i KP Northwest delegated to KPH University of Hawai‘i


Why?

A cancer registry focuses exclusively on malignancies, which can generate an incomplete picture of the patient’s health state

New developments in health informatics make it feasible and affordable to extract and transfer comorbidity data to a disease registry Cancer can be examined within the context of

other significant health problems


Comorbidities

Comorbidities may influence medical decisionmaking “Numerous biologic ties between cancer and

comorbidity exist, one example being an association of diabetes with an increased risk of disease recurrence and mortality in the setting of colon cancer.”

Need to understand the role of comorbidities on cancer treatment and outcomes to personalize care and derive optimal benefit

Pal SK, Hurria A. Impact of age, sex, and comorbidity on cancer therapy and disease progression. J Clin Oncol. 2010 Sep 10;28(26):4086-93. Epub 2010 Jul 19.


Aims—SEER

Develop and test pathway for up-loading comorbidity data on KPH cancer patients to the Hawai‘i SEER Registry

To illustrate the utility of comorbidity data to a cancer or other disease registry


Challenges

IRB issues Data linkage issues


Human Subjects Protection Issues

Univ. of Hawai‘i Committee on Human Studies, IRB for Hawai‘i SEER (Hawaii Tumor Registry) Approved receipt of PHI and comorbidity data from KPH Did not approve sending PHI for KPH cancer cases not

recorded by KPH for their members

KPH IRB Since KPH is already sending PHI to HTR, approval provided

to resubmit PHI (for linking purposes) with additional diagnosis and medication comorbidity variables

Did not approve releasing PHI for patients NOT reported to the Hawai‘i Tumor Registry


Phase I: PHI File—KPH to HTR

Match and reconcile KPH records to HTR records for cancer diagnosed between January 1, 2000 and December 31, 2008

Tabulate KPH comorbidities by tumor to match with HTR tumor records


980

1,134 1,132 1,0901,201

1,2761,173 1,224 1,179

0

200

400

600

800

1000

1200

1400

2000 2001 2002 2003 2004 2005 2006 2007 2008

KPH Tumor Records Sent to HTR, 2000-2008


Perfect Fuzzy0

1000

2000

3000

4000

5000

6000

7000

8000

6935

2611

73%

17%

Number of Matches: KPH to HTR

Matching Keys: Site, Histology, Behavior, Laterality, Date of Diagnosis


94% 94% 94% 92% 89% 91% 92% 89% 92% 92%

0%10%20%30%40%50%60%70%80%90%

100%

2000 2001 2002 2003 2004 2005 2006 2007 2008 All Years

KPH Tumor Records Matched to HTR Using Dx Date, Name, Birth Date, and Other PHI, 2000-2008


1 2 3 4 5 6 7 8 90%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

776 866 846739 786

783 692 678769

142 205 219265 287

381 388411

313

62 63 67 86 128 112 93 135 97

50 41 59 72 84 150 134 155 172

Perfect Match (KPH to HTR) Fuzzy Match (KPH to HTR)Unmatched, on KPH file, not HTR Unmatched, on HTR file, not KPH

Matching Tumor Records

2000 2001 2002 2003 2004 2005 2006 2007 2008


Comorbidity Measurement

12 months 1 month

Cancer Diagnosed

Comorbidity Assessment Period

One-month gap between comorbidity assessment period and date of cancer diagnosis reduces influence of cancer-related “rule-out” diagnoses on comorbidity measure.

Treatment

1


Charlson-Deyo Comorbidity Classes

Myocardial infarction Congestive heart disease Peripheral vascular

disease Cerebrovascular disease Dementia Chronic obstructive

pulmonary disease Rheumatoid arthritis

Rheumatoid arthritis Peptic ulcer disease Mild liver disease Diabetes Diabetes complications Paralysis Renal disease Severe liver disease


Presence of Comorbid Diagnoses by Cancer Site

Cancer SiteTotal # of Tumors

% of Tumors with Comorbidity

All Sites 9,546 37%

Respiratory & Intra-thoracic 1,133 54%

Colon & Rectum 1,110 40%

Prostate 1,080 37%

Breast 1,832 25%


Frequency of Comorbid DiagnosesTotal Number of Tumors 9,546 100%

Number of Tumors with C-D Comorbidities 3,503 37%

Total C-D Comorbidities 6,018 100%

Serious Chronic Conditions Number Percent

Diabetes Mellitus 1,578 26%

Chronic Obstructive Pulmonary Disease 1,487 25%

Complications of Diabetes Mellitus 585 10%

Renal Disease 486 8%

Cerebrovascular Disease 458 8%

Congestive Heart Disease 413 7%

Myocardial Infarction 269 4%

Peripheral Vascular Disease 280 5%

36%


Cancers of Digestive Organs

Digestive Organs# of

Tumors

# of Tumors with

Comorbidities# of

ComorbiditiesComorbidities

per Tumor

All Digestive System sites 1,110 448 804 1.8

Pelvic/Sigmoid/Sigmoid Flexure (C187) 260 90 152 1.7

Rectum (C209) 259 85 154 1.8

Ascending/Right (C182) 140 77 153 2.0

Cecum (C180) 121 47 81 1.7

Rectosigmoid/Colon and Rectum (C199) 109 38 55 1.4

Descending/Left (C186) 63 40 81 2.0

Transverse (C184) 62 28 55 2.0

Hepatic Flexure (C183) 39 21 34 1.6

Splenic Flexure (C185) 37 16 32 2.0

Appendix (C181) 10 2 2 1.0

Colon, NOS (C189) 7 3 4 1.3


Comorbidities of Digestive System CancersTotal Number of Digestive Organ Tumors 1,843

Number of Digestive Organ Tumors with C-D Comorbidities 807

C-D Comorbidities Number

Diabetes Mellitus 417

Chronic Obstructive Pulmonary Disease 274

Complications of Diabetes Mellitus 152

Renal Disease 105

Cerebrovascular Disease 104

Congestive Heart Disease 101

Myocardial Infarction 72

Peripheral Vascular Disease 67

Peptic Ulcer Disease 52

Mild Liver Disease 50

Dementia 25

Severe Liver Disease 17

Rheumatoid Arthritis 14

Paralysis 7

Total C-D Comorbidities 1,450


Implications

SEER registries should have comorbidity data Reporting laws may need amending Matching algorithms should include two-way

sharing of linkage files to identify and resolve linkage errors

Matching by patient attributes only is not sufficient Matching must include tumor attributes

Site, histology, behavior, laterality, date of diagnosis (year/month)


Expanding SEER Reporting with Comorbidity Data Colorectal Cancer HORNBROOK

Documents

health research

kaiser permanente center

cancer registry

kph cancer patients

research site

disease registry cancer

kph cancer cases

kph university of hawaii