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• W2318784125 abstract "Purpose/Objective(s)Many population-based studies that have used the Surveillance, Epidemiology, and End Results (SEER) Database have concluded that radiation therapy (RT) is underutilized in breast cancer patients belonging to certain demographic groups. The validity of such studies is highly dependent on the accuracy of RT coding in the SEER dataset. We sought to evaluate the accuracy of the SEER dataset in coding RT receipt compared to the Medicare billing claims using the linked SEER-Medicare database.Materials/MethodsWe used SEER data to identify 73,077 patients age ≥66 with non-metastatic breast cancer diagnosed from 2001-2007. Demographic information included age, gender, race, and year of diagnosis. Treatment information included receipt of RT as a component of initial treatment, chemotherapy, breast-conserving surgery and mastectomy. Sensitivity, specificity, and kappa were calculated for RT receipt as coded by the SEER data in comparison to Medicare billing claims which were considered the gold standard. A logistic regression model was used to identify independent factors associated with accuracy of RT coding by SEER.ResultsThe median age at diagnosis was 75 years, with 56.9% of patients treated with breast conserving surgery, 37.8% with mastectomy and 18.0% with chemotherapy. The overall underestimation of receipt of RT in the SEER database was 9.5%. The overall kappa was 89.1% (SE 0.4%) for all patients with a sensitivity of 80.7% (95% CI 80.5%-80.8%), and a specificity of 97.2% (95% CI 97.0%-97.4%). Delay in the start of RT was associated with a decrease in sensitivity (-0.12%/day, 95% CI 0.11-0.13%/day). Registries were deemed high quality (n = 8, sensitivity >80%, range 80.1%-93.9%), or low quality (n = 8, sensitivity <80%, range 68.8%-79.6%). In an adjusted analysis, factors associated with underreporting of RT included increasing age (OR 1.01; p = 0.018), residence in a low, as compared to high, quality registry (OR 2.24; p < 0.0001), treatment with mastectomy (OR 1.19; p < 0.0001), and increasing interval (in days) from diagnosis to start of RT (OR 1.01; p < 0.0001). The overall underestimation of receipt of RT varied by registry from a low of 3.2% to a high of 14.5%.ConclusionsSEER registry data regarding receipt of RT is highly variable and depends on patient factors and the quality of the population-based registry charged with collecting this data. Studies relying on SEER data alone should be extremely cautious when reporting RT utilization. Purpose/Objective(s)Many population-based studies that have used the Surveillance, Epidemiology, and End Results (SEER) Database have concluded that radiation therapy (RT) is underutilized in breast cancer patients belonging to certain demographic groups. The validity of such studies is highly dependent on the accuracy of RT coding in the SEER dataset. We sought to evaluate the accuracy of the SEER dataset in coding RT receipt compared to the Medicare billing claims using the linked SEER-Medicare database. Many population-based studies that have used the Surveillance, Epidemiology, and End Results (SEER) Database have concluded that radiation therapy (RT) is underutilized in breast cancer patients belonging to certain demographic groups. The validity of such studies is highly dependent on the accuracy of RT coding in the SEER dataset. We sought to evaluate the accuracy of the SEER dataset in coding RT receipt compared to the Medicare billing claims using the linked SEER-Medicare database. Materials/MethodsWe used SEER data to identify 73,077 patients age ≥66 with non-metastatic breast cancer diagnosed from 2001-2007. Demographic information included age, gender, race, and year of diagnosis. Treatment information included receipt of RT as a component of initial treatment, chemotherapy, breast-conserving surgery and mastectomy. Sensitivity, specificity, and kappa were calculated for RT receipt as coded by the SEER data in comparison to Medicare billing claims which were considered the gold standard. A logistic regression model was used to identify independent factors associated with accuracy of RT coding by SEER. We used SEER data to identify 73,077 patients age ≥66 with non-metastatic breast cancer diagnosed from 2001-2007. Demographic information included age, gender, race, and year of diagnosis. Treatment information included receipt of RT as a component of initial treatment, chemotherapy, breast-conserving surgery and mastectomy. Sensitivity, specificity, and kappa were calculated for RT receipt as coded by the SEER data in comparison to Medicare billing claims which were considered the gold standard. A logistic regression model was used to identify independent factors associated with accuracy of RT coding by SEER. ResultsThe median age at diagnosis was 75 years, with 56.9% of patients treated with breast conserving surgery, 37.8% with mastectomy and 18.0% with chemotherapy. The overall underestimation of receipt of RT in the SEER database was 9.5%. The overall kappa was 89.1% (SE 0.4%) for all patients with a sensitivity of 80.7% (95% CI 80.5%-80.8%), and a specificity of 97.2% (95% CI 97.0%-97.4%). Delay in the start of RT was associated with a decrease in sensitivity (-0.12%/day, 95% CI 0.11-0.13%/day). Registries were deemed high quality (n = 8, sensitivity >80%, range 80.1%-93.9%), or low quality (n = 8, sensitivity <80%, range 68.8%-79.6%). In an adjusted analysis, factors associated with underreporting of RT included increasing age (OR 1.01; p = 0.018), residence in a low, as compared to high, quality registry (OR 2.24; p < 0.0001), treatment with mastectomy (OR 1.19; p < 0.0001), and increasing interval (in days) from diagnosis to start of RT (OR 1.01; p < 0.0001). The overall underestimation of receipt of RT varied by registry from a low of 3.2% to a high of 14.5%. The median age at diagnosis was 75 years, with 56.9% of patients treated with breast conserving surgery, 37.8% with mastectomy and 18.0% with chemotherapy. The overall underestimation of receipt of RT in the SEER database was 9.5%. The overall kappa was 89.1% (SE 0.4%) for all patients with a sensitivity of 80.7% (95% CI 80.5%-80.8%), and a specificity of 97.2% (95% CI 97.0%-97.4%). Delay in the start of RT was associated with a decrease in sensitivity (-0.12%/day, 95% CI 0.11-0.13%/day). Registries were deemed high quality (n = 8, sensitivity >80%, range 80.1%-93.9%), or low quality (n = 8, sensitivity <80%, range 68.8%-79.6%). In an adjusted analysis, factors associated with underreporting of RT included increasing age (OR 1.01; p = 0.018), residence in a low, as compared to high, quality registry (OR 2.24; p < 0.0001), treatment with mastectomy (OR 1.19; p < 0.0001), and increasing interval (in days) from diagnosis to start of RT (OR 1.01; p < 0.0001). The overall underestimation of receipt of RT varied by registry from a low of 3.2% to a high of 14.5%. ConclusionsSEER registry data regarding receipt of RT is highly variable and depends on patient factors and the quality of the population-based registry charged with collecting this data. Studies relying on SEER data alone should be extremely cautious when reporting RT utilization. SEER registry data regarding receipt of RT is highly variable and depends on patient factors and the quality of the population-based registry charged with collecting this data. Studies relying on SEER data alone should be extremely cautious when reporting RT utilization." @default.
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• W2318784125 title "Evaluating the Accuracy of Receipt of Breast Radiation Therapy in the Surveillance, Epidemiology, and End Results Database" @default.
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