 |
The 130th Annual Meeting of APHA |
|
The 130th Annual Meeting of APHA |
Catherine D. Cooksley, DrPH, Department of Biostatistics, Section of Health Services Research, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd. Box 196, Houston, TX 77030, 713-792-4993, ccooksle@mail.mdanderson.org and Linda S. Elting, DrPH, Department of Biostatistics, Section Chief, Health Services Research, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Box 196, Houston, TX 77030.
Objective: Comparison of local to national cancer survival rates is routinely employed as a vehicle by which to gauge the quality of cancer care. We examined the impact of different analytic techniques and comparison populations on this sentinel quality indicator.
Methods: Patients diagnosed between 1973 and 1997 were identified from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) public use data file and the Tumor Registry at The U.T. M.D. Anderson Cancer Center (MDACC). Patients with in situ and unstaged malignancies were excluded. The comparability of the populations was examined by comparing patient proportions by cancer site and disease stage. Cumulative 5-year survival rates by diagnostic disease stage were calculated for each of 23 cancer sites. MDACC rates were then directly adjusted to the SEER population to compensate for discrepancies in cancer site and stage.
Results: MDACC had 64% more patients with distant stage disease, nearly 40% fewer patients with local stage disease and more than 3 times as many hematologic malignancies. While MDACC’s unadjusted overall cumulative 5-year survival rate was poorer compared to SEER (46% vs 49%, p=<0.001) once adjusted by cancer site and stage, it was superior (52% vs 49%, p=<0.001).
Conclusions: Failure to account for differences in population demographics may lead to erroneous estimates of quality relative to published, national indicators. Among characteristics likely to affect such estimates, ethnicity and age may need to be considered. Accurate comparisons relayed to the public are important as they make informed decisions about their healthcare.
Learning Objectives: After reviewing this poster, the attendee will be able to
Keywords: Cancer, Quality of Care
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.