Canadian Cancer Treatment Linkage Project

Transcription

1 Canadian Cancer Treatment Linkage Project Telling Canada s story in numbers Patti Murison On behalf of the CCTLP Team: Health Statistics Division Health Analysis Division Special Surveys Division 2017 NAACCR Conference, Albuquerque NM. June 19, 2017

2 Need for Comprehensive Canadian Cancer Data Treatment Patient Tumour Staging 2

3 Alignment of Objectives Coordinated Data Development Initiative Identifying a core set of treatment data elements Testing the feasibility of obtaining treatment data through linkage of existing data sets or other data collection means Seeking provincial alignment to common data standards 3 Greater use of administrative data to fill information gaps Greater use of record linkage to create new data sources Move forward with enhancing the CCR by adding surgical treatment data Close data gaps in priority areas Expand analytical products using innovative approaches including data linkage Engage with stakeholders to enable better use of health data and information Make data more accessible

4 The Canadian Cancer Registry (CCR) 4 Reference date: Jan 1 st, 1992 Annually: 180,000 new tumour records Products: CANSIM tables (incidence and survival), Health Reports, Health at a Glance, peer review articles Data Users: Canadian Cancer Society Canadian Partnership Against Cancer Public Health Agency of Canada, Health Canada Research Data Centres, internal and external clients External calls for Data: CiNA, CI5

5 Foundation for the CCTLP Previous linkage feasibility study: Breast, colorectal and prostate Four provinces Data from

6 Project Overview - Objectives Develop a surgical treatment code list for selected cancers: breast, colorectal, prostate, urinary bladder, thyroid, lung and bronchus Link the CCR with two hospital administrative databases Discharge Abstract Database (DAD) and the National Ambulatory Care Reporting System (NACRS); Create an analytical file 6

7 Project Overview - Steps and Results Record linkage (process and results) Creation of treatment code set (sources, validation) Tumour cohort Treatment rates 7

8 Social Data Linkage Environment 8 For more information, visit

9 Record Linkage CCR, DAD, NACRS, CVSD Linkage was done in the Social Data Linkage Environment (SDLE) CCR ( ) DAD ( ) NACRS ( ) CVSD ( ) Linkage keys CCR (95%) CVSD(66%)* DAD (85%) NACRS (87%) Linked analysis file ( ) * Includes deaths before 1980

10 Record Linkage Results Analysis File CCR (2010 to 2012) (6 cancers): 99% DAD (19 years and older) 2009/2010: 91.8% 2010/2011: 92.1% 2011/2012: 92.2% 2012/2013: 92.3% 2013/2014: 91.7% NACRS (19 years and older) 2009/2010: 93.2% 2010/2011: 93.1% 2011/2012: 92.9% 2012/2013: 92.7% 2013/2014: 91.9% Generally consistent across regions lower rates in the Territories

11 Core Treatment Data Elements Surgical Treatment Definitions: Procedure Date: The date on which a cancerdirected surgical procedure was performed during the initial course of treatment for the cancer; Primary Procedure: Describes the surgical procedures used to treat the primary site of the reportable tumour. This item records that portion of the first course of surgical treatment given at the reporting facility 11

12 Analysis File - Cancer Tumour Definition Type Site (ICD-O-3) Histology Behaviour Breast C50.0-C50.9 malignant Prostate C61.9 malignant Colon and Rectum C18.0, C18.2-C18.9, C26.0; C19.9, C20.9 (Rectum/rectosigmoid junction) Excludes: mesothelioma M-9050 to M-9055; Kaposi Sarcoma M- 9140; Hematopoietic and Lymphoid Neoplasms M-9590 to M-9992 malignant Lung C34.0-C34.9 malignant Thyroid C73.9 malignant Bladder C67.0-C67.9 malignant and in situ* Note: only single primary tumours are being considered; multiple tumours (same site) were excluded

13 Cancer tumour Cohort Female Breast 50,740 Colorectal 44,970 Prostate 52,905 Lung and bronchus 49,135 Urinary bladder 14,990 Thyroid 12,585 Total cohort* linked to the DRD 225,330 *Excludes Quebec, patients aged LT19 yrs at date of tumour diagnosis, multiple primary tumours. Source: February 2015 IARC master tabulation file, Statistics Canada. Represents 97% of all tumours diagnosed

14 Identifying Surgical Treatments for Cancer Surgical Procedure Codes NCCN FORDS SEER CCI Female breast Prostate Colorectal Lung & bronchus Thyroid Review: CIHI code experts Review: Clinicians Review: CCTLP working group Final Code Sets Bladder Treatment code sets had to be developed for each cancer site (and will be required for each subsequent cancer added) Code sets act as the content standard for identifying cancer-directed surgical interventions for each site

15 Surgical Treatment Rates ( ) Proportion of cancer tumours with at least one surgical intervention during the 1 year follow-up period, 19+ years of age, Canada (excluding Quebec), Breast Colorectal Prostate Lung Bladder Thyroid CANADA 88.2% 83.0% 31.2% 19.1% 91.0% 93.0%

16 Deepening Linkage Proficiency using SDLE Through the CCTLP, a number of new insights into linkage methodology were obtained: Linkage rates for the DAD and NACRS gradually declined in the most recent years Issue: Up-to-date variables (e.g., births, deaths, postal codes) in the Derived Record Depository (contains personal identifiers on all Canadians) are required to generate maximal linkage rates Recent birth and death data, as well as postal code updates, that were not present in the DRD during the linkage resulted in lower rates and potentially lost surgical interventions Use of Health Insurance Number increases the linkage rates HIN was introduced as a new linkage variable, and with it, rates for DAD and NACRS were raised above 90% for the most recent 5 years of data HIN could be effectively used as a linkage variable, however (a) not all provincial cancer registries report HIN to Statistics Canada, and (b) HINs are not static

17 From Feasibility to Sustainability Permanent inclusion of surgical treatment data on the CCR would require: Continuously improving the linkage rates to the DAD and NACRS; Developing an approach to report on patients with multiple tumours in the same organ and/or multiple cancer surgeries; Approach: New linkage will be conducted on the CCR from Add death information Create equity indicators

18 Using data to Improve Cancer Care in Canada Assessing treatment rates by stage of disease Using vital status to determine eligibility for surgical treatment & refine treatment rates by jurisdiction Effect of age, sex, and geography on treatment accessibility Timeliness of surgical treatment for cancer By stage By jurisdiction By proximity to treatment center

19 Thanks! CCTLP team (StatCan): Kim Newman, Jonathan Ellison, Claudia Sanmartin, Shirley Bryan, Richard Trudeau, Cathy Trainor, Caroline Pelletier Gisèle Carrière, Austin Snow, Patti Murison, Nathan Farrar CCTLP Advisory Group: Mary Jane King (ON) Heather Stuart-Panko (SK) Sheila Fukumura (MB) Kim Vriends (PEI) Maureen MacIntyre (NS) Gordon Walsh (NS) Ryan Woods (BC), Greg Webster (CIHI) Janet Manuel (CIHI) Alana Lane (CIHI) Clinical Consultants: Dr Ralph Gilbert, University Health Network (Thyroid) Dr. Geoffrey Gotto, University of Calgary (Bladder) Dr. Christian Finley, McMaster University (Lung)