Cancer-related hospitalisations and ‘unknown’ stage prostate cancer: a population-based record linkage study

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Abstract

Objectives

To identify reasons for prostate cancer stage being recorded as ‘unknown’ in Australia's largest population-based cancer registry.

Design

Prospective population-based cohort.

Setting

New South Wales (NSW) is the most populous state in Australia, with almost one third of the total national population.

Participants

NSW Cancer Registry (NSWCR) records for prostate cancer cases diagnosed in 2001–2009 were linked to the NSW Admitted Patient Data Collection (APDC) for 2000–2010. All patients in this study had a minimum of 12 months follow-up in the hospital episode records after their date of diagnosis as recorded by the NSWCR.

Main outcome measures

Incidence of ‘unknown’ stage prostate cancer and cancer-specific survival.

Results

Of 50 597 prostate cancer cases, 39.9% were recorded as having ‘unknown’ stage. Up to 4 months after diagnosis, 77.2% of cases without a hospital-reported cancer diagnosis were recorded as having ‘unknown’ stage. Among those patients with a hospital-reported cancer diagnosis, stage was ‘unknown’ for 7.6% of cases who received a radical prostatectomy (RP) and for 34.0% of cases who had procedures other than RP. In the latter group, the factors that were related to having ‘unknown’ stage were living in disadvantaged areas (adjusted OR (aOR) range: 1.13 to 1.20), attending a private hospital (aOR range: 1.25 to 2.13), having day-only admission for care (aOR=1.23, 95% CI 1.11 to 1.36), or having procedures other than multiple procedures with imaging (eg, biopsy only, aOR range: 1.11 to 1.45).

Conclusions

Over half of ‘unknown’ stage prostate cancer cases did not have a hospital-reported prostate cancer diagnosis within the 4 months after initial diagnosis. We identified differences in the likelihood of cases being recorded as ‘unknown’ stage based on socioeconomic status and facility type, which suggests that further investigation of reporting practices in relation to diagnostic and treatment pathways is required.

Related collections

Most cited references 11

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Rural-urban differences in stage at diagnosis. Possible relationship to cancer screening.

Deborah Greenberg, Lesley W. Chow, J Liff (1991)

Stage at diagnosis was examined for various malignancies identifiable through screening to determine whether rural-urban differences exist in Georgia. Data were obtained from a population-based cancer registry which registers all incident cancers among residents of metropolitan Atlanta and ten neighboring rural counties. Black and white patients with a first primary invasive malignancy newly diagnosed between 1978 and 1985 were included in this study. Residents of the rural area were twice as likely to have unstaged cancers (18.3%) as were urban residents (9.6%). Among patients with known stage at diagnosis, rural patients tended to have more advanced disease than urban patients. The relative excess of nonlocalized malignancies in rural Georgia was 21% for whites and 37% for blacks. The rural excess of nonlocalized prostate cancer among blacks was especially pronounced. Differences in access to or utilization of early detection methods may contribute to the rural-urban differential in the extent of disease at diagnosis.

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Using linked routinely collected health data to describe prostate cancer treatment in New South Wales, Australia: a validation study

David E. Goldsbury, David Smith, Bruce Armstrong … (2011)

Background Population-based patterns of care studies are important for monitoring cancer care but conducting them is expensive and resource-intensive. Linkage of routinely collected administrative health data may provide an efficient alternative. Our aim was to determine the accuracy of linked routinely collected administrative data for monitoring prostate cancer care in New South Wales (NSW), Australia. Methods The NSW Prostate Cancer Care and Outcomes Study (PCOS), a population-based survey of patterns of care for men aged less than 70 years diagnosed with prostate cancer in NSW, was linked to the NSW Cancer Registry, electronic hospital discharge records and Medicare and Pharmaceutical claims data from Medicare Australia. The main outcome measures were treatment with radical prostatectomy, any radiotherapy, external beam radiotherapy, brachytherapy or androgen deprivation therapy, and cancer staging. PCOS data were considered to represent the true treatment status. The sensitivity and specificity of the administrative data were estimated and relevant patient characteristics were compared using chi-squared tests. Results The validation data set comprised 1857 PCOS patients with treatment information linked to Cancer Registry records. Hospital and Medicare claims data combined described treatment more accurately than either one alone. The combined data accurately recorded radical prostatectomy (96% sensitivity) and brachytherapy (93% sensitivity), but not androgen deprivation therapy (76% sensitivity). External beam radiotherapy was rarely captured (5% sensitivity), but this was improved by including Medicare claims for radiation field setting or dosimetry (86% sensitivity). False positive rates were near 0%. Disease stage comparisons were limited by one-third of cases having unknown stage in the Cancer Registry. Administrative data recorded treatment more accurately for cases in urban areas. Conclusions Cancer Registry and hospital inpatient data accurately captured radical prostatectomy and brachytherapy treatment, but not external beam radiotherapy or disease stage. Medicare claims data substantially improved the accuracy with which all major treatments were recorded. These administrative data combined are valid for population-based studies of some aspects of prostate cancer care.

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Using administrative health data to describe colorectal and lung cancer care in New South Wales, Australia: a validation study

David E. Goldsbury, Katie Armstrong, Leonardo Simonella … (2012)

Background Monitoring treatment patterns is crucial to improving cancer patient care. Our aim was to determine the accuracy of linked routinely collected administrative health data for monitoring colorectal and lung cancer care in New South Wales (NSW), Australia. Methods Colorectal and lung cancer cases diagnosed in NSW between 2000 and 2002 were identified from the NSW Central Cancer Registry (CCR) and linked to their hospital discharge records in the NSW Admitted Patient Data Collection (APDC). These records were then linked to data from two relevant population-based patterns of care surveys. The main outcome measures were the sensitivity and specificity of data from the CCR and APDC for disease staging, investigative procedures, curative surgery, chemotherapy, radiotherapy, and selected comorbidities. Results Data for 2917 colorectal and 1580 lung cancer cases were analysed. Unknown disease stage was more common for lung cancer in the administrative data (18%) than in the survey (2%). Colonoscopies were captured reasonably accurately in the administrative data compared with the surveys (82% and 79% respectively; 91% sensitivity, 53% specificity) but all other colorectal or lung cancer diagnostic procedures were under-enumerated. Ninety-one percent of colorectal cancer cases had potentially curative surgery recorded in the administrative data compared to 95% in the survey (96% sensitivity, 92% specificity), with similar accuracy for lung cancer (16% and 17%; 92% sensitivity, 99% specificity). Chemotherapy (~40% sensitivity) and radiotherapy (sensitivity≤30%) were vastly under-enumerated in the administrative data. The only comorbidity that was recorded reasonably accurately in the administrative data was diabetes. Conclusions Linked routinely collected administrative health data provided reasonably accurate information on potentially curative surgical treatment, colonoscopies and comorbidities such as diabetes. Other diagnostic procedures, comorbidities, chemotherapy and radiotherapy were not well enumerated in the administrative data. Other sources of data will be required to comprehensively monitor the primary management of cancer patients.

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Journal

Journal ID (nlm-ta): BMJ Open

Journal ID (iso-abbrev): BMJ Open

Journal ID (hwp): bmjopen

Journal ID (publisher-id): bmjopen

Title: BMJ Open

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2044-6055

Publication date Collection: 2017

Publication date (Electronic): 11 January 2017

Volume: 7

Issue: 1

Electronic Location Identifier: e014259

Affiliations

[1 ]Cancer Research Division, Cancer Council NSW , Sydney, New South Wales, Australia

[2 ]Sydney School of Public Health, University of Sydney , Sydney, New South Wales, Australia

[3 ]Menzies Health Institute Queensland, Griffith University , Gold Coast, Queensland, Australia

[4 ]New South Wales Cancer Registry, Cancer Institute NSW , Sydney, New South Wales, Australia

[5 ]Discipline of Surgery, University of Sydney , Sydney, New South Wales, Australia

[6 ]Department of Urology, Westmead Hospital , Westmead, New South Wales, Australia

[7 ]School of Medicine and Public Health, University of Newcastle , Newcastle, New South Wales, Australia

Author notes

[Correspondence to ] Qingwei Luo; qingweil@ 123456nswcc.org.au

Author information

Qingwei Luo http://orcid.org/0000-0002-8902-6869

Article

Publisher ID: bmjopen-2016-014259

DOI: 10.1136/bmjopen-2016-014259

PMC ID: 5253597

PubMed ID: 28077413

SO-VID: ac96c035-d884-47c9-903e-37966f09629d

Copyright © Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

License:

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

History

Date received : 12 September 2016

Date revision received : 21 November 2016

Date accepted : 14 December 2016

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Cancer-related hospitalisations and ‘unknown’ stage prostate cancer: a population-based record linkage study

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Abstract

Objectives

Design

Setting

Participants

Main outcome measures

Results

Conclusions

Related collections

Karger: Oncology

Most cited references 11

Rural-urban differences in stage at diagnosis. Possible relationship to cancer screening.

Using linked routinely collected health data to describe prostate cancer treatment in New South Wales, Australia: a validation study

Using administrative health data to describe colorectal and lung cancer care in New South Wales, Australia: a validation study

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