Using the National Cancer Database for Outcomes Research: A Review.

Importance: The National Cancer Database (NCDB), a joint quality improvement initiative of the American College of Surgeons Commission on Cancer and the American Cancer Society, has created a shared research file that has changed the study of cancer care in the United States. A thorough understanding of the nuances, strengths, and limitations of the database by both readers and investigators is of critical importance. This review describes the use of the NCDB to study cancer care, with a focus on the advantages of using the database and important considerations that affect the interpretation of NCDB studies. Observations: The NCDB is one of the largest cancer registries in the world and has rapidly become one of the most commonly used data resources to study the care of cancer in the United States. The NCDB paints a comprehensive picture of cancer care, including a number of less commonly available details that enable subtle nuances of treatment to be studied. On the other hand, several potentially important patient and treatment attributes are not collected in the NCDB, which may affect the extent to which comparisons can be adjusted. Finally, the NCDB has undergone several significant changes during the past decade that may affect its completeness and the types of available data. Conclusions and Relevance: The NCDB offers a critically important perspective on cancer care in the United States. To capitalize on its strengths and adjust for its limitations, investigators and their audiences should familiarize themselves with the advantages and shortcomings of the NCDB, as well as its evolution over time.

Histamine-induced modulation of nociceptive responses.

Because previous studies suggest an antinociceptive role for the neuromodulator histamine (HA) in the periaqueductal grey or the nearby dorsal raphe (PAG/DR), a detailed pharmacological investigation of the effects of intracerebral HA on the hot-plate nociceptive test was performed in rats. Intracerebral microinjections of HA (1 microgram) into the PAG/DR or into the median raphe evoked a mild, reversible antinociceptive response; injections into lateral or dorsal midbrain evoked either a delayed response or no response, respectively. In the PAG/DR, the HA dose-response curve had an inverted U-shape, showing that HA can induce both antinociceptive (0.3-3 micrograms) and pro-nociceptive (10-30 micrograms) responses. Larger doses of HA (e.g., 100 micrograms) produced irreversible and highly variable antinociceptive responses that were accompanied by behavioral and histopathological changes; such effects, indicative of toxicity, were not observed after 0.3 microgram of HA, the peak antinociceptive dose. HA (0.3 microgram) antinociception was completely inhibited by intracerebral co-administration of the opiate antagonist naloxone (1 ng), the H1-receptor antagonist temelastine (20 pg), and the H2-receptor antagonist tiotidine (1 ng); none of these drugs altered nociceptive scores in the absence of HA. These results show that: (1) HA, a neurotransmitter in the PAG, can evoke antinociception in the absence of other behavioral or toxic effects; and (2) HA antinociception depends on the activation of both opiate and HA receptors in the PAG/DR.(ABSTRACT TRUNCATED AT 250 WORDS)

Case completeness and data accuracy in the Centers for Disease Control and Prevention's National Program of Cancer Registries.

BACKGROUND: Issues of case completeness (CC) and data quality within the National Program of Cancer Registries (NPCR)-Cancer Surveillance System (NPCR-CSS) are assessed in part by the NPCR Technical Assistance and Audit Program (NPCR-TAA). In addition, the NPCR Annual Program Evaluation Instrument (NPCR-APEI) provides information about NPCR-supported central cancer registries (CCRs). The current report includes a unique, national-level analysis of NPCR-TAA results linked with NPCR-APEI data and other covariates. METHODS: NPCR-TAA results for 34 CCRs were aggregated across diagnosis years 1998 to 2001 for analysis of average CC rates and site-specific data accuracy (DA) rates by covariates obtained from the NPCR-APEI, United States Cancer Statistics (USCS) publications, and the North American Association of Central Cancer Registries (NAACCR) Web site. Site-specific DA rates were calculated for the 13 data elements examined in the audit program. Small-sample Student t tests were used to determine statistically significant differences in covariates (alpha = .05). RESULTS: Overall, the average CC and DA rates were 96.4% and 95%, respectively. Both site- and data element-specific DA issues were highlighted. Higher CC and DA rates were observed for CCRs that were staffed with more certified tumor registrars, had supplementary sources reporting, and met USCS publication standards and/or achieved NAACCR certification. CONCLUSIONS: Study findings underscored the importance of CCRs having adequate, well-trained staff, procuring supplemental reporting sources, and attaining compliance with national data standards. The study results also demonstrated the overall high completeness and quality of NPCR-CSS data and provided guidance to users of the data.