Augmenting Smoking History in Cancer Registry Data through Health Administrative Claims Data

Transcription

1 Augmenting Smoking History in Cancer Registry Data through Health Administrative Claims Data Quan Chen, Eric Tai, Shayne Gallaway, Sherri L. Stewart, Thomas Tucker, Jaclyn Nee, Bin Huang 2018 NAACCR June 14 Pittsburgh, PA

2 Background Cigarette smoking status is an important factor for population-based cancer outcome research. Smoking causes cancers of the lung, pancreas, colon, and rectum etc. In 2011, 221,130 new cases of lung cancer occurred, 90% of which were attributable to smoking Smoking not only cause cancers, but is also associated with comorbidity status and survival for cancer patients. COPD, heart disease, stroke, TB. Due to limited resources, smoking history is either not well captured or not at all in population-based cancer registry data.

3 Background Cont. Kentucky Cancer Registry (KCR) data linkage projects Link KCR ( ) with claims from SEER*Medicare( ), Medicaid( ), private insurance groups( ) Probabilistic linkage and manual review Six cancer types: Lung, Colorectal, Breast, Pancreatic, Ovary, and Prostate Augmenting results: Treatments: Chemotherapy, Radiotherapy, Hormone therapy; Comorbidities Smoking History

4 Research Aim Examining the feasibility to augment smoking history in the registry data with health administrative claims Examining the prevalence of smoking and smoking cessation among tobacco related cancers (TRC) and non tobacco related cancers (ntrc) TRC: Lung, Colorectal, and Pancreatic ntrc: Breast, Ovary, and Prostate

5 Methods Linked Kentucky cancer cases diagnosed in were included in this study. Smoking history in KCR data were captured as Cigarette Pack Years Tobacco history 0 Never used Non-Smoker 1 Cigarette smoker 2 Cigar/pipe smoker 3 Snuff/chew/smokeless tobacco user 4 Mixed use of more than one type of tobacco product Smoker 5 E-cigarettes 6 E-cigarettes plus another type of tobacco product 9 Not recorded/unknown Unknown

6 Methods Cont. Smoking history in Claims data was calculated by identifying ICD and CPT codes of personal history of tobacco use or disorder, and smoking cessation and counseling HCPCS/CPT: G0436 G0437 G0375 G0376 S9075 S9453 ICD: x V15.82

7 Methods Cont. The following algorithm was used to augment the smoking history in KCR : Limited the claims within 12 months before cancer diagnosis. If smoking history in KCR was either Non Smoker or Unknown, and claims captured smoking history information, then KCR data was augmented as Smoker. Smoking cessation (counseling or pharmacotherapy) were captured based on claims within 12 months before or 12 months after cancer diagnosis. Nicotine replacement therapy (NRT) Bupropion (Zyban, Wellbutrin ) Varenicline (Chantix )

8 Results- Smoking History for TRC Cancer Type # of Patient s KCR Smoker Claims Smoker Both Sources Augmented Data N % N % N % N % TRC Lung Colorect al Pancrea s % % % % % % % % % % % % % % % %

9 Results- Smoking History for ntrc Cancer Type # of Patient s KCR Smoker Claims Smoker Both Sources Augmented Data N % N % N % N % NTRC Breast Ovary Prostate % % % % % % % % % % % % % % % %

10 Results - % Extra smokers captured by health claims data 30% 23% 21% 15% 15% 8% 10% 8% 11% 10% 8% 12% 0% TRC Colorectal NTRC Ovary

11 Results - Smoking cessation counseling usage identified through claims Cancer Smokers identifie d in Claims Pre-Dx Post-Dx Pre and Post - Dx N % N % N % N % TRC % % % % Lung % % % % Colorecta 2.14% 2 l % 0.24% % Pancreas % % % % N-TRC % % % % Breast % % % % Ovary % % % % Prostate % % % % All

12 Results - Smoking related pharmacotherapy usage identified through claims Cancer Smokers identifie d in Claims Pre-Dx Post-Dx Pre and Post - Dx All N % N % N % N % TRC % % % % Lung % % % % Colorecta % 5.69% l % % 48 Pancreas % % % % NTRC % % % % Breast % % % % Ovary % % % % Prostate % % % %

13 Global Moran's I Spatial Autocorrelation High-High Counties with high smoking prevalence surrounded by counties with high smoking prevalence High-Low Low-High Low-Low

14 Summary Health administrative claims data are good sources to improve cancer registry data on smoking history. Smoking history information have been augmented about 10% for both TRC and ntrc patients. Comparing to ntrc, TRC patients were more likely to have history of smoking (64.3% vs. 40.0%) although the differences mainly come from lung cancer.

15 Summary Cont. The large percentages of smokers in ntrc reflects the high smoker rates in the background population BRFSS- KY 29% smoking rate, 1 st in US In Kentucky, only 6.4% of lung cancer patients had post diagnosis smoking cessation counseling and 4.5% of them received pharmacotherapy. Studies have found that tobacco cessation usage among lung cancer patients after diagnosis may increase overall survival by 9 months.

16 Acknowledgement Funding Support: CDC U48DP SIP NCI SEER HHSN

17 Thank you! Quan Chen, University of Kentucky