Association of Major Adverse Financial Events and Later-Stage Cancer Diagnosis in the United States.

PURPOSE: This study assessed the prevalence of specific major adverse financial events (AFEs)-bankruptcies, liens, and evictions-before a cancer diagnosis and their association with later-stage cancer at diagnosis. METHODS: Patients age 20-69 years diagnosed with cancer during 2014-2015 were identified from the Seattle, Louisiana, and Georgia SEER population-based cancer registries. Registry data were linked with LexisNexis consumer data to identify patients with a history of court-documented AFEs before cancer diagnosis. The association of AFEs and later-stage cancer diagnoses (stages III/IV) was assessed using separate sex-specific multivariable logistic regression. RESULTS: Among 101,649 patients with cancer linked to LexisNexis data, 36,791 (36.2%) had a major AFE reported before diagnosis. The mean and median timing of the AFE closest to diagnosis were 93 and 77 months, respectively. AFEs were most common among non-Hispanic Black, unmarried, and low-income patients. Individuals with previous AFEs were more likely to be diagnosed with later-stage cancer than individuals with no AFE (males-odds ratio [OR], 1.09 [95% CI, 1.03 to 1.14]; P < .001; females-OR, 1.18 [95% CI, 1.13 to 1.24]; P < .0001) after adjusting for age, race, marital status, income, registry, and cancer type. Associations between AFEs prediagnosis and later-stage disease did not vary by AFE timing. CONCLUSION: One third of newly diagnosed patients with cancer had a major AFE before their diagnosis. Patients with AFEs were more likely to have later-stage diagnosis, even accounting for traditional measures of socioeconomic status that influence the stage at diagnosis. The prevalence of prediagnosis AFEs underscores financial vulnerability of patients with cancer before their diagnosis, before any subsequent financial burden associated with cancer treatment.

PubMed4Hh: A Point-of-Care Mobile App for Evidence-Based Clinical Decision Support for Nurse Residents in Maryland.

Evidence-based clinical decision-making is considered a core competency for professional nurses. However, barriers such as lack of time in clinical practice; information overload; restricted access to resources; lack of evidence appraisal skills, awareness, and knowledge; and unreliable resources prevent them from adopting evidence-based practice. This study examined the usefulness of the PubMed4Hh (PubMed for Handhelds) mobile application for clinical decision-making at the point of care among Maryland newly licensed RNs. Using iOS and Android smartphones, 178 newly licensed RNs participated in a 6-month trial from November 2019 to April 2020. Nurses manually entered free-text queries or used voice inputs on the "Patient, Intervention, Comparison, Outcome" or "askMEDLINE" search engines. The results retrieved were presented as journal article abstracts or short summaries called "the bottom line," designed for quick reading at the point of care. Both Patient, Intervention, Comparison, Outcome and askMEDLINE were rated highly for their usefulness, and participants said they would continue using PubMed4Hh and recommend it to others. Newly licensed RNs had a significantly higher perception of the usefulness of PubMed4Hh when the results of "the bottom line" or abstracts confirmed, led, or modified their nursing skills, knowledge, or the patient's care plan.

Evaluation of the Completeness of Managed Care Data to Identify Cancer Diagnoses and Treatments for Patients in the SEER-Medicare Data.

BACKGROUND: The utility of codes on Medicare Advantage (MA) data to capture cancer diagnoses and treatment for cancer patients is unknown. OBJECTIVE: This study compared cancer diagnoses and treatments on MA encounter data (MA data) with the Surveillance, Epidemiology, and End-Results (SEER) data. SUBJECTS: Subjects were patients enrolled in either MA or Medicare fee-for-service (MFFS) when diagnosed with incident breast, colorectal, prostate, or lung cancer, 2015-2017, in a SEER cancer registry. MEASURES: MA data, from 2 months before to 12 months following SEER diagnosis, were reviewed to identify cancer diagnoses, surgery, chemotherapy, and radiotherapy (RT). MA data were compared with SEER to determine their sensitivity to capture cancer diagnoses and sensitivity/specificity to identify surgeries. The agreement between SEER and Medicare data regarding receipt of chemotherapy and RT was measured by Kappa statistics. A similar comparison to SEER diagnoses/treatments was made using MFFS claims to provide context for the SEER-MA comparison. RESULTS: The study included 186,449 patients, 38% in MA. MA data had 92%+ sensitivity to identify SEER cancer diagnosis and 90%+ sensitivity for cancer surgery. Specificity for surgery was >84%, except for breast cancer (52%). Kappa statistics for agreement between SEER and MA data regarding chemotherapy varied by cancer, 0.61-0.82, and for receipt of RT exceeded 0.75 for all cancers. Results observed for MFFS claims were similar to those in MA data. CONCLUSION: For 4 common cancers, MA data included most cancer diagnoses and general types of cancer treatment reported in the SEER data. More research is needed to assess additional cancers and detailed treatments.

A Statewide Nurse Residency Program Evaluation.

Across the nation, hospitals are answering the call to action for funding and requiring new-to-practice registered nurses to complete a nurse residency program (NRP). In response, all Maryland acute care hospitals successfully funded, adopted, and implemented a 12-month standardized, commercially available (vendored) NRP. However, although the hospitals use the same curriculum, their administrative practices, content, and deliverables vary. A statewide program evaluation was conducted by the Maryland Organization of Nurse Leaders, Inc./Maryland Nurse Residency Collaborative to understand the NRP structure and process variability, including implementation challenges, and what worked and what did not. Findings from 26 semi-structured interviews with Maryland acute care hospital NRP coordinators showed that leadership support and resources, differences in patient populations, number of nurse residents, and organizational requirements best explained programmatic adaptations. Using lessons learned, best practices are shared, including methods to garner leadership support and reduce adaptations. Although program customization is expected, program replicability and scalability are essential to achieving program outcomes. [J Contin Educ Nurs. 2023;54(9):421-429.].

The Association for Nursing Professional Development National Preceptor Practice Analysis Study: An Exploration of Precepting in Perioperative Settings.

Preceptors are an important part of meeting perioperative workforce demands. A secondary analysis of data collected for the 2020 Association for Nursing Professional Development National Preceptor Practice Analysis Study focused on 400 perioperative nurse preceptors and compared their responses to nonperioperative preceptors. Most perioperative respondents had participated in preceptor training; they spent significantly more time orienting experienced nurse preceptees in the perioperative specialty and its diverse settings (eg, orthopedic surgery, open-heart surgery) than preceptors in nonperioperative settings and specialties. Perioperative preceptors spent significantly less time precepting students, suggesting the presence of an opportunity to address the nursing shortage by promoting student exposure to the perioperative setting. To align with the AORN position statements on orientation and nurse residencies, perioperative nurse leaders should ensure that properly educated preceptors are available to assist RNs who are transitioning to perioperative practice. The Ulrich Precepting Model provides an evidence-based framework for preceptor training.

The Impact of Preceptor Education, Experience, and Preparation on the Role.

Findings from the 2020 Association for Nursing Professional Development National Preceptor Practice Analysis study validated the Ulrich precepting model. This secondary data analysis examines the influence of preceptor training, experience, and education on perceptions of the importance of the preceptor roles, domains (knowledge and practice), and required competencies. Preceptor training compared with education and experience best predict nurses' perceived importance of precepting and its seven roles.

Continuum of nursing education and practice: Time to close the chasm between academia and practice.

Nurses play a key role in the health of Americans. Unfortunately, the nation is expected to experience an increasing nursing shortage due to nurses retiring or leaving the profession and growing healthcare needs. In this context, it is important to prepare nursing students to be practice-ready graduates. To accomplish this goal, students must learn domain knowledge that is reflective of current nursing practices and have ample experiential learning opportunities, which require close collaboration between academia and practice in nursing education. Traditionally, faculty members who have developed nursing curriculum and the course content are mainly from within academia. The aims of the article are to describe prior efforts in academia-practice collaboration for baccalaureate-level nursing education and to propose the innovative Nursing Education and Practice Continuum model, which expands our team's successful collaborative projects. The model conceptualizes nursing education as a continuum between academia and practice, which constantly interact and evolve, and facilitates co-building and co-implementing nursing education courses for both students and practicing nurses. Nursing practice is also a continuum between experiential learning and practice after graduation. This continuum model can be implemented by aligning baccalaureate-level nursing education with the Nurse Residency Program curriculum. This article also addresses potential challenges and strategies during implementation.

Histological and Immunohistochemical Characteristics for Hereditary Breast Cancer Risk in a Cohort of Brazilian Women / Características histológicas e imunohistoquímicas para risco hereditário de câncer de mama em uma coorte de mulheres brasileiras

Abstract Objective The study aimed to characterize the clinical, histological, and immunohistochemical profile of women with invasive breast cancer, according to the risk for Hereditary Predisposition Breast and Ovarian Cancer Syndrome in a Brazilian population. Methods This is a retrospective study performed from a hospital-based cohort of 522 women, diagnosed with breast cancer treated at an oncology referral center in the Southeast region of Brazil, between 2014 and 2016. Results Among the 430 women diagnosed with invasive breast cancer who composed the study population, 127 (29.5%) were classified as at increased risk for hereditary predisposition to breast and ovarian cancer syndrome. There was a lower level of education in patients at increased risk (34.6%) when compared with those at usual risk (46.0%). Regarding tumor characteristics, women at increased risk had higher percentages of the disease diagnosed at an advanced stage (32.3%), and with tumors > 2cm (63.0%), with increased prevalence for both characteristics, when compared with those at usual risk. Furthermore, we found higher percentages of HG3 (43.3%) and Ki-67 ≥ 25% (64.6%) in women at increased risk, with prevalence being about twice as high in this group. The presence of triple-negative tumors was observed as 25.2% in women at increased risk and 6.0% in women at usual risk, with the prevalence of absence of biomarkers being 2.5 times higher among women in the increased risk group. Conclusion From the clinical criteria routinely used in the diagnosis of breast cancer, the care practice of genetic counseling for patients at increased risk of hereditary breast cancer in contexts such as Brazil is still scarce.

Resumo Objetivo O presente estudo buscou caracterizar o perfil clínico, histológico e imunohistoquímico de mulheres com câncer de mama invasivo segundo o risco para a Síndrome de Predisposição Hereditária ao Câncer de Mama e Ovário em uma população brasileira. Métodos Trata-se de um estudo retrospectivo realizado a partir de uma coorte hospitalar composta por 522 mulheres diagnosticadas com câncer de mama entre 2014 e 2016 assistidas em um centro de referência oncológica localizado na região sudeste brasileira. Resultados Entre as 430 mulheres diagnosticadas com câncer de mama invasivo que compuseram a população de estudo, 127 (29,5%) foram classificadas como de risco aumentado para a síndrome de predisposição hereditária ao câncer de mama e ovário. Verificou-se menor nível de escolaridade nas pacientes com risco aumentado (34,6%) quando comparadas àquelas consideradas como de risco habitual (46,0%). Quanto às características do tumor, as mulheres de risco aumentado apresentaram maiores percentuais de doença diagnosticada em estádio avançado (32,3%) e com tumores > 2cm (63,0%), com prevalência aumentada para ambas as características, quando comparadas àquelas de risco habitual. Ainda nas mulheres de risco aumentado, foram encontrados maiores percentuais de GH3 (43,3%) e Ki-67 ≥ 25% (64,6%), com prevalência cerca de duas vezes maior neste grupo. A presença de tumores triplo-negativos foi observada em 25,2% nas mulheres de risco aumentado e 6,0% nas mulheres de risco habitual, com prevalência de ausência de biomarcadores 2,5 vezes maior entre as mulheres do grupo de risco aumentado. Conclusão A partir dos critérios clínicos rotineiramente utilizados no diagnóstico do câncer de mama, a prática assistencial do aconselhamento genético para as pacientes com risco aumentado de câncer de mama hereditário em contextos como o do Brasil ainda é escarça.

Overcoming the Disruption of Clinical Nursing Education: A Statewide Hospital-Academic Initiative.

Havoc of the COVID-19 pandemic on prelicensure nursing programs caused students to lose precious onsite clinical opportunities to gain competency in basic fundamental skills. A statewide task force of faculty and hospital leaders developed the Transition to Nurse Residency Program to develop new nurses' skills and behaviors routinely learned during onsite clinical experiences. This article describes the program contents and shares its contents for use by nursing professional development practitioners.

A History of Health Economics and Healthcare Delivery Research at the National Cancer Institute.

With increased attention to the financing and structure of healthcare, dramatic increases in the cost of diagnosing and treating cancer, and corresponding disparities in access, the study of healthcare economics and delivery has become increasingly important. The Healthcare Delivery Research Program (HDRP) in the Division of Cancer Control and Population Sciences at the National Cancer Institute (NCI) was formed in 2015 to provide a hub for cancer-related healthcare delivery and economics research. However, the roots of this program trace back much farther, at least to the formation of the NCI Division of Cancer Prevention and Control in 1983. The creation of a division focused on understanding and explaining trends in cancer morbidity and mortality was instrumental in setting the direction of cancer-related healthcare delivery and health economics research over the subsequent decades. In this commentary, we provide a brief history of health economics and healthcare delivery research at NCI, describing the organizational structure and highlighting key initiatives developed by the division, and also briefly discuss future directions. HDRP and its predecessors have supported the growth and evolution of these fields through the funding of grants and contracts; the development of data, tools, and other research resources; and thought leadership including stimulation of research on previously understudied topics. As the availability of new data, methods, and computing capacity to evaluate cancer-related healthcare delivery and economics expand, HDRP aims to continue to support this growth and evolution.

Histological and Immunohistochemical Characteristics for Hereditary Breast Cancer Risk in a Cohort of Brazilian Women.

OBJECTIVE: The study aimed to characterize the clinical, histological, and immunohistochemical profile of women with invasive breast cancer, according to the risk for Hereditary Predisposition Breast and Ovarian Cancer Syndrome in a Brazilian population. METHODS: This is a retrospective study performed from a hospital-based cohort of 522 women, diagnosed with breast cancer treated at an oncology referral center in the Southeast region of Brazil, between 2014 and 2016. RESULTS: Among the 430 women diagnosed with invasive breast cancer who composed the study population, 127 (29.5%) were classified as at increased risk for hereditary predisposition to breast and ovarian cancer syndrome. There was a lower level of education in patients at increased risk (34.6%) when compared with those at usual risk (46.0%). Regarding tumor characteristics, women at increased risk had higher percentages of the disease diagnosed at an advanced stage (32.3%), and with tumors > 2cm (63.0%), with increased prevalence for both characteristics, when compared with those at usual risk. Furthermore, we found higher percentages of HG3 (43.3%) and Ki-67 ≥ 25% (64.6%) in women at increased risk, with prevalence being about twice as high in this group. The presence of triple-negative tumors was observed as 25.2% in women at increased risk and 6.0% in women at usual risk, with the prevalence of absence of biomarkers being 2.5 times higher among women in the increased risk group. CONCLUSION: From the clinical criteria routinely used in the diagnosis of breast cancer, the care practice of genetic counseling for patients at increased risk of hereditary breast cancer in contexts such as Brazil is still scarce.

OBJETIVO: O presente estudo buscou caracterizar o perfil clínico, histológico e imunohistoquímico de mulheres com câncer de mama invasivo segundo o risco para a Síndrome de Predisposição Hereditária ao Câncer de Mama e Ovário em uma população brasileira. MéTODOS: Trata-se de um estudo retrospectivo realizado a partir de uma coorte hospitalar composta por 522 mulheres diagnosticadas com câncer de mama entre 2014 e 2016 assistidas em um centro de referência oncológica localizado na região sudeste brasileira. RESULTADOS: Entre as 430 mulheres diagnosticadas com câncer de mama invasivo que compuseram a população de estudo, 127 (29,5%) foram classificadas como de risco aumentado para a síndrome de predisposição hereditária ao câncer de mama e ovário. Verificou-se menor nível de escolaridade nas pacientes com risco aumentado (34,6%) quando comparadas àquelas consideradas como de risco habitual (46,0%). Quanto às características do tumor, as mulheres de risco aumentado apresentaram maiores percentuais de doença diagnosticada em estádio avançado (32,3%) e com tumores > 2cm (63,0%), com prevalência aumentada para ambas as características, quando comparadas àquelas de risco habitual. Ainda nas mulheres de risco aumentado, foram encontrados maiores percentuais de GH3 (43,3%) e Ki-67 ≥ 25% (64,6%), com prevalência cerca de duas vezes maior neste grupo. A presença de tumores triplo-negativos foi observada em 25,2% nas mulheres de risco aumentado e 6,0% nas mulheres de risco habitual, com prevalência de ausência de biomarcadores 2,5 vezes maior entre as mulheres do grupo de risco aumentado. CONCLUSãO: A partir dos critérios clínicos rotineiramente utilizados no diagnóstico do câncer de mama, a prática assistencial do aconselhamento genético para as pacientes com risco aumentado de câncer de mama hereditário em contextos como o do Brasil ainda é escarça.

Role of Medicaid in Early Detection of Screening-Amenable Cancers.

BACKGROUND: This study examines the association between Medicaid enrollment, including through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), and distant stage for three screening-amenable cancers: breast, cervical, and colorectal. METHODS: We use the Surveillance, Epidemiology, and End Results Cancer Registry linked with Medicaid enrollment data to compare patients who were Medicaid insured with patients who were not Medicaid insured. We estimate the likelihood of distant stage at diagnosis using logistic regression. RESULTS: Medicaid enrollment following diagnosis was associated with the highest likelihood of distant stage. Medicaid enrollment through NBCCEDP did not mitigate the likelihood of distant stage disease relative to Medicaid enrollment prior to diagnosis. Non-Hispanic Black patients had a greater likelihood of distant stage breast and colorectal cancer. Residing in higher socioeconomic areas was associated with a lower likelihood of distant stage breast cancer. CONCLUSIONS: Medicaid enrollment prior to diagnosis is associated with a lower likelihood of distant stage in screen amenable cancers but does not fully ameliorate disparities. IMPACT: Our study highlights the importance of health insurance coverage prior to diagnosis and demonstrates that while targeted programs such as the NBCCEDP provide critical access to screening, they are not a substitute for comprehensive insurance coverage.

The Utility of Pathology Reports to Identify Persons With Cancer Recurrence.

BACKGROUND: Cancer recurrence is an important measure of the impact of cancer treatment. However, no population-based data on recurrence are available. Pathology reports could potentially identify cancer recurrences. Their utility to capture recurrences is unknown. OBJECTIVE: This analysis assesses the sensitivity of pathology reports to identify patients with cancer recurrence and the stage at recurrence. SUBJECTS: The study includes patients with recurrent breast (n=214) or colorectal (n=203) cancers. RESEARCH DESIGN: This retrospective analysis included patients from a population-based cancer registry who were part of the Patient-Centered Outcomes Research (PCOR) Study, a project that followed cancer patients in-depth for 5 years after diagnosis to identify recurrences. MEASURES: Information abstracted from pathology reports for patients with recurrence was compared with their PCOR data (gold standard) to determine what percent had a pathology report at the time of recurrence, the sensitivity of text in the report to identify recurrence, and if the stage at recurrence could be determined from the pathology report. RESULTS: One half of cancer patients had a pathology report near the time of recurrence. For patients with a pathology report, the report's sensitivity to identify recurrence was 98.1% for breast cancer cases and 95.7% for colorectal cancer cases. The specific stage at recurrence from the pathology report had a moderate agreement with gold-standard data. CONCLUSIONS: Pathology reports alone cannot measure population-based recurrence of solid cancers but can identify specific cohorts of recurrent cancer patients. As electronic submission of pathology reports increases, these reports may identify specific recurrent patients in near real-time.

Preceptor Practice: Initial Results of a National Association for Nursing Professional Development Study.

In 2020, the Association for Nursing Professional Development commissioned a national preceptor practice analysis study using the Ulrich Precepting Model to identify the roles, knowledge, and activities essential to preceptor practice. In a survey of 3,623 preceptors, the model's seven preceptor roles and their associated domains of knowledge and practice were validated. Findings indicate that nursing professional development practitioners should provide preceptors with initial role preparation in addition to ongoing education.

Stage and mortality of low-income patients with cancer: Evidence from SEER-Medicaid.

BACKGROUND: A national data source for identifying patients with cancer enrolled in Medicaid is needed to evaluate cancer care for low-income, publicly insured patients. In this study, a population-based data set of patients diagnosed with cancer and enrolled in Medicaid was created and evaluated. The objective was to compare the characteristics of patients with cancer identified in Surveillance, Epidemiology, and End Results (SEER) data and linked to the Medicaid Analytic eXtract (MAX) Personal Summary files with the characteristics of patients who were not linked to the MAX file. METHODS: All persons in 14 SEER registries diagnosed with cancer from 2006 to 2013 who were or were not linked to the 2006-2013 nationwide MAX files were selected, and patient demographic characteristics were compared for 3 age groups. Common cancer sites and the timing of Medicaid enrollment with respect to patients' cancer diagnoses were reported, and the stage at diagnosis and 4-year mortality were compared by 3 categories of Medicaid enrollment. RESULTS: Approximately 18% of the sample was enrolled in Medicaid within 25 months of diagnosis. Enrollees had a greater proportion of racial/ethnic minorities in comparison with patients who were not enrolled. A late-stage diagnosis was more common among Medicaid patients and particularly among those who enrolled after their diagnosis. For every common cancer site, mortality was highest in the sample of Medicaid patients who enrolled after their diagnosis. CONCLUSIONS: The Medicaid enrollment data newly added to SEER records enhance researchers' ability to investigate research questions related to Medicaid policies and care delivery. For patients enrolled before their diagnosis, Medicaid appears to offer protection against late-stage disease and mortality.

Cancer-Attributable Medical Costs for Colorectal Cancer Patients by Phases of Care: What Is the Effect of a Prior Cancer History?

Medical care costing studies have excluded patients with a prior cancer history. This study aims to update methods for estimating medical care costs attributable to cancer and to evaluate the effect of a prior history of cancer on costs for colorectal cancer (CRC) patients. We used Surveillance, Epidemiology, and End Results (SEER)-Medicare data and matched cancer patients to controls without cancer to estimate cancer-attributable costs by phases of care using Medicare 2007-2013 claims. CRC annualized average cancer-attributable costs were $56.0 K, $5.3 K, $92.5 K, and $24.3 K in the initial, continuing, and end-of-life cancer and noncancer death phases, respectively, in 2014 dollars. Costs were higher for patients diagnosed with more advanced stage, younger ages, and nonwhite races. Costs for patients with prior cancers were consistently higher than patients without prior cancers, especially in the continuing (4.9 K vs 7.2 K) and end-of-life noncancer death (22.7 K vs 30.0 K). Our CRC costs improve previous estimates by using more recent data and updated methods.

Estimating Chemotherapy Use Among Patients With a Prior Primary Cancer Diagnosis Using SEER-Medicare Data.

Cancer treatment studies commonly exclude patients with prior primary cancers due to difficulties in ascertaining for which site treatment is intended. Surveillance, Epidemiology, and End Results-Medicare patients 65 years and older diagnosed with an index colon or rectal cancer (CRC) or female breast cancer (BC) between 2004 and 2013 were included. Chemotherapy, defined as "any chemotherapy" and more restrictively as "chemotherapy with confirmatory diagnoses," was ascertained based on claims data within 6 months of index cancer diagnosis by prior cancer history. Any chemotherapy use was slightly lower among patients with a prior cancer (CRC: no prior = 17.4%, prior = 16.1%; BC: no prior = 12.9%, prior = 12.0%). With confirmatory diagnoses required, estimates were lower, especially among patients with a prior cancer (CRC: no prior = 16.8%, prior = 13.6%; BC: no prior = 12.6%, prior = 11.0%). These findings suggest that patients with prior cancers can be included in studies of chemotherapy use; requiring confirmatory diagnoses can increase treatment assignment confidence.

Home Health Use Following a Cancer Diagnosis Among Patients Enrolled in Medicare Advantage and Traditional Medicare: Findings From the Newly Linked SEER-Medicare and Home Health OASIS Data.

BACKGROUND: This article describes characteristics of patients receiving home health following an initial cancer diagnosis, comparing those enrolled in Medicare Advantage (MA) and Traditional Medicare (TM), using the newly linked 2010-2014 National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER)-Medicare and home health Outcome and Assessment Information Set (OASIS) data. METHODS: We identified SEER-Medicare beneficiaries with at least one OASIS assessment within 3 months of cancer diagnosis in 2010-2014, and summarized their demographic and clinical characteristics. Demographic and diagnostic data were obtained from the SEER-Medicare data, while further details about cognitive status, mood, function, and medical history were obtained from OASIS. We assessed differences between MA and TM beneficiaries using chi-square tests for independence, t-tests, and Kruskal-Wallis tests. RESUTLS: We identified 104 023 patients who received home health within 3 months of cancer diagnosis: 81 587 enrolled in TM and 22 436 enrolled in MA. TM cancer patients had higher unadjusted rates of home health use than MA patients (16.3% vs 10.3%, P < .001). TM cancer patients receiving home health had more limitations in their cognitive function than their MA counterparts and longer lengths of service (mean = 42.2 days vs 39.4 days, P < .001; median = 27 vs 26 days, interquartile range = 42). CONCLUSION: This study demonstrates the large number of cancer patients in the SEER-Medicare-OASIS data and describes characteristics for TM and MA patients. These newly linked data can be used to assess home health care among older patients with cancer.

Comparison of Physician Data in Two Data Files Available for Cancer Health Services Research.

INTRODUCTION: Physicians are vital to health-care delivery, but assessing their impact on care can be challenging given limited data. Historically, health services researchers have obtained physician characteristics data from the American Medical Association (AMA) Physician Masterfile. The Center for Medicare and Medicaid Services' Medicare Data on Provider Practice and Specialty (MD-PPAS) file was assessed, as an alternative source of physician data, particularly in the context of cancer health services research. METHODS: We used physician National Provider Identifiers in the MD-PPAS data (2008-2014) to identify physicians in the AMA data current as of July 18, 2016. Within each source, we grouped physicians into six broad specialty groups. Percent agreement and Cohen's kappa coefficient (k) were calculated for age, sex, specialty, and practice state. RESULTS: Among the 698 202 included physicians, there was excellent agreement for age (percent agreement = 97.7%, k = 0.97) and sex (99.4%, k = 0.99) and good agreement for specialty (86.1%, k = 0.80). Within specialty, using AMA as the reference, agreement was lowest for oncologists (77%). Approximately 85.9% of physicians reported the same practice state in both data sets. CONCLUSION: Although AMA data have been commonly used to account for physician-level factors in health services research, MD-PPAS data provide researchers with an alternative option depending on study needs. MD-PPAS data may be optimal if nonphysicians, provider utilization, practice characteristics, and/or temporal changes are of interest. In contrast, the AMA data may be optimal if more granular specialty, physician training, and/or a broader inclusion of physicians is of interest.