Quality of diagnostic staging in patients with bladder cancer: a process-outcomes link.

BACKGROUND: Muscle sampling is often used as a surrogate for staging quality in patients with bladder cancer. The association of staging quality at diagnosis and survival was examined among patients with bladder cancer. METHODS: The clinical records of all individuals within the Los Angeles Surveillance, Epidemiology, and End Results registry with an incident diagnosis of non-muscle-invasive bladder cancer in 2004-2005 were reviewed. Patient demographics, tumor characteristics, staging quality (presence of muscle in the specimen and mention of muscle in the pathology report), and vital status were recorded. With mixed-effects and competing-risks regression analyses, the association of patient and tumor characteristics with staging quality and cancer-specific survival was quantified. RESULTS: The sample included 1865 patients, 335 urologists, and 27 pathologists. Muscle was reported to be present in 972 (52.1%), was reported to be absent in 564 (30.2%), and was not mentioned in 329 (17.7%) of the initial pathology reports. The presence of muscle did not differ according to the grade or depth of invasion. Mortality was associated with staging quality (P < .05). Among patients with high-grade disease, the 5-year cancer-specific mortality rates were 7.6%, 12.1%, and 18.8% when muscle was present, absent, and not mentioned, respectively. CONCLUSIONS: The omission of muscle in the specimen or its mention in the pathology report in nearly half of all diagnostic resections was associated with increased mortality, particularly in patients with high-grade disease. Because urologists cannot reliably discern between high- and low-grade or Ta and T1 disease, it is contended that patients with bladder cancer should undergo adequate muscle sampling at the time of endoscopic resection.

External validation of a claims-based algorithm for classifying kidney-cancer surgeries.

BACKGROUND: Unlike other malignancies, there is no literature supporting the accuracy of medical claims data for identifying surgical treatments among patients with kidney cancer. We sought to validate externally a previously published Medicare-claims-based algorithm for classifying surgical treatments among patients with early-stage kidney cancer. To achieve this aim, we compared procedure assignments based on Medicare claims with the type of surgery specified in SEER registry data and clinical operative reports. METHODS: Using linked SEER-Medicare data, we calculated the agreement between Medicare claims and SEER data for identification of cancer-directed surgery among 6,515 patients diagnosed with early-stage kidney cancer. Next, for a subset of 120 cases, we determined the agreement between the claims algorithm and the medical record. Finally, using the medical record as the reference-standard, we calculated the sensitivity, specificity, and positive and negative predictive values of the claims algorithm. RESULTS: Among 6,515 cases, Medicare claims and SEER data identified 5,483 (84.1%) and 5,774 (88.6%) patients, respectively, who underwent cancer-directed surgery (observed agreement = 93%, kappa = 0.69, 95% CI 0.66 - 0.71). The two data sources demonstrated 97% agreement for classification of partial versus radical nephrectomy (kappa = 0.83, 95% CI 0.81 - 0.86). We observed 97% agreement between the claims algorithm and clinical operative reports; the positive predictive value of the claims algorithm exceeded 90% for identification of both partial nephrectomy and laparoscopic surgery. CONCLUSION: Medicare claims represent an accurate data source for ascertainment of population-based patterns of surgical care among patients with early-stage kidney cancer.

Latinas and breast cancer outcomes: population-based sampling, ethnic identity, and acculturation assessment.

PURPOSE: Latinas and African-Americans with breast cancer, especially those of lower socioeconomic status and acculturation, have been underrepresented in studies assessing treatment satisfaction, decision-making, and quality of life. A study was designed to recruit a large and representative sample of these subgroups. MATERIALS AND METHODS: Incident cases were selected by rapid case ascertainment (RCA) in the Los Angeles Surveillance, Epidemiology, and End Results Registry from 2005 to 2006, with oversampling of Latinas and African-Americans. Patients were mailed a questionnaire and $10 incentive 5 to 6 months after diagnosis; nonrespondents were contacted by telephone. Multivariate analysis was used to assess possible response bias. The RCA definition of Hispanic origin was validated by self-reports. The Short Acculturation Scale for Hispanics index for Latina respondents was used. RESULTS: One thousand six hundred and ninety-eight eligible breast cancer cases were selected and 1,223 participated, for a response rate of 72.0%, which varied little by race/ethnicity. Age, race/ethnicity, and clinical factors were not associated with response; however, respondents were slightly more likely to be married and from higher socioeconomic status census tracts than nonrespondents. The RCA definition of Hispanic identity was highly sensitive (94.6%) and specific (90.0%). Lower acculturation was associated with lower education and literacy among Latinas. DISCUSSION: High response rates among all subgroups were achieved due to the use of RCA, an incentive, extensive telephone follow-up, a native Spanish-speaking interviewer, and a focused questionnaire. The low acculturation index category identified a highly vulnerable subgroup. This large sample representing subgroups with greater problems will provide a basis for developing better interventions to assist these women.