Expanding SEER Reporting with Comorbidity Data Colorectal Cancer HORNBROOK

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, MA
The Center for Health Research, Kaiser Permanente
Marsha E. Reichman, PhD, MPH
The Food and Drug Administration
Marc T. Goodman, PhD, MPH
Cancer Research Center of Hawai„i, University of Hawai„i
Robin Yabroff, PhD
DCCPS, National Cancer Institute

© 2012, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH

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.” 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.

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

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


KPH Tumor Records Sent to HTR, 2000-2008

1400

1200 1,276
1,201 1,224 1,179
1,134 1,132 1,090 1,173
1000
980
800

600

400

200

0
2000 2001 2002 2003 2004 2005 2006 2007 2008


Number of Matches: KPH to HTR
Matching Keys: Site, Histology, Behavior, Laterality, Date of Diagnosis

8000
7000
73%
6000
5000
4000
6935
3000 17%
2000
1000 2611

0
Perfect Fuzzy


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

100% 94% 94% 94% 92%
89% 91% 92% 89% 92% 92%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
2000 2001 2002 2003 2004 2005 2006 2007 2008 All Years

Matching Tumor Records
100% 50 41 59 72 84 150 134 155
62 63 67 172
90% 86 128
112 93 135 97
80% 142 205 219
265 287
70% 381 388 313
411
60%
50%
40% 776 866 846
30% 739 786
783 692 769
678
20%
10%
0%
1
2000 2
2001 3
2002 4
2003 5
2004 6
2005 7
2006 8
2007 9
2008
Unmatched, on HTR file, not KPH Unmatched, on KPH file, not HTR
Fuzzy Match (KPH to HTR) Perfect Match (KPH to HTR)

Comorbidity Measurement

Cancer Diagnosed

Comorbidity Assessment Period Treatment

12 months 1 month

One-month gap between comorbidity assessment period and date of
cancer diagnosis reduces influence of cancer-related “rule-out”
diagnoses on comorbidity measure. 1


Charlson-Deyo Comorbidity Classes
 Myocardial infarction  Rheumatoid arthritis
 Congestive heart disease  Peptic ulcer disease
 Peripheral vascular  Mild liver disease
disease  Diabetes
 Cerebrovascular disease  Diabetes complications
 Dementia  Paralysis
 Chronic obstructive  Renal disease
pulmonary disease
 Severe liver disease
 Rheumatoid arthritis


Presence of Comorbid Diagnoses by
Cancer Site
Total # of % of Tumors with
Cancer Site Tumors 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 Diagnoses
Total 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% 36%
Congestive Heart Disease 413 7%
Myocardial Infarction 269 4%
Peripheral Vascular Disease 280 5%

Cancers of Digestive Organs
# of Tumors
# of with # of Comorbidities
Digestive Organs Tumors Comorbidities Comorbidities 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 Cancers
Total 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
© 2012, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH 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

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