The accuracy and characteristics of gastric cancer treatment information in the national data of the hospital-based cancer registry.

OBJECTIVE: The hospital-based cancer registry is used extensively for research to support cancer control activities by providing an overview of how cancer treatments are provided nationwide. This study aimed to shed light on the quality and characteristics of treatment data in the hospital-based cancer registry using the linked dataset on gastric cancer. METHODS: Using the nationally linked data of the hospital-based cancer registry and the health services utilization data, the treatment data in the hospital-based cancer registry for patients who were newly diagnosed with gastric cancer in 2016 and 2017 and received the first course of treatment at their own institutions were examined. The agreement rates between registry data and utilization data were analyzed by stage, treatment, age, period from the date of diagnosis to the date of treatment and hospital type. RESULTS: The sensitivity of open surgery, laparoscopic surgery and endoscopic treatment tended to decrease in advanced stages, whereas the sensitivity of chemotherapy and radiation therapy increased. Specificity was high for all treatments and stages, at ˃90%. Sensitivity by age was slightly different for chemotherapy and radiation therapy, but specificities did not differ.For all treatments, the longer the time from diagnosis to treatment implementation, the higher the coverage rate. CONCLUSIONS: The hospital-based cancer registry recorded the treatment performed appropriately. It is necessary to interpret the data from the hospital-based cancer registry whilst keeping in mind that, chemotherapy and radiation therapy are registered less frequently than surgical treatments administered.

Quality of care measurement for patients with ovarian cancer in Japan.

AIM: Quality of care is important to reduce disease progression, and improve both survival and quality of life. The Japan Society of Gynecologic Oncology has published treatment guidelines to promote standardized high-quality care for ovarian cancer in Japan. We developed quality indicators based on the guideline recommendations and used them on large datasets of health service use to examine the quality of ovarian cancer care. METHODS: A panel of experts developed the indicators using a modified Delphi method. Adherence to each indicator was evaluated using data from a hospital-based cancer registry of patients diagnosed in 2018. All patients receiving first-line treatment at participating facilities were included. The adherence rates were returned to participating hospitals, and reasons for nonadherence were collected. A total of 580 hospitals participated, and the study examined the care received by 6611 patients with ovarian cancer and 1879 with borderline tumors using 11 measurable quality indicators. RESULTS: The adherence rate ranged from 22.6% for "Estrogen replacement within 6 months of operation" to 93.5% for "Bleomycin, etoposide, and cisplatin for germ cell tumor more than Stage II." Of 580 hospitals, 184 submitted the reasons for nonadherence. CONCLUSIONS: The quality of ovarian cancer care should be continuously assessed to encourage the use of best practices. These indicators may be a useful tool for this purpose.

Time to Treatment Initiation for Six Cancer Types: An Analysis of Data from a Nationwide Registry in Japan.

BACKGROUND: Delay in the time to treatment initiation (TTI) may adversely affect the survival of patients, but its current status in Japan is unknown. This study aims to describe the TTI for six cancer types: lung, breast, colorectal, stomach, head and neck (H&N), and cervical. Data for this study were derived from a nationwide registry in Japan. METHODS: This observational study employed the national database of hospital-based cancer registries (HBCRs) and health services utilization data. Using HBCR data, we identified all patients with cancer who started their cancer therapy at the same hospitals between January 1 and December 31, 2017. We calculated the TTI for each cancer type and treatment option, stratifying the results by age group and geographical region. RESULTS: The overall median TTI was 33 days, with shorter TTIs for colorectal and H&N cancers and chemotherapy. The TTI was the shortest for younger patients and the longest for the elderly, especially for lung cancer. When categorized by eight Japanese geographical regions, Tohoku and Kanto had the longest TTI. The result remained the same even after adjusting cancer type, treatment, age, and stage information. CONCLUSION: For colorectal and H&N cancers, in which a longer TTI is associated with a poorer prognosis, TTI was found to be particularly shorter. Although we could not discuss our results in light of the patient survival in this study, future research should explore the best balance between thorough evaluation before treatment and necessary time for that.

How are new drugs disseminated in Japan? Analysis using the National Database of Health Insurance Claims of Japan.

Drug lag refers to the difference in the time of a new drug's approval in different countries; the dissemination of the new drug after approval within the countries is another problem. We examined the nationwide dissemination of 11 cancer drugs approved in Japan between 2011 and 2015 using the National Database of Health Insurance Claims data. We extracted data on the number of cancer drug prescriptions from 47 prefectures and associated demographic information, such as age and sex. Eight diabetes drugs were also examined for comparison. We observed a lag between the marketing approval date of the drugs and their first use. To further explore the rise and pattern of each drug's dissemination, we analyzed the trend of the cumulative number and total of new prescriptions for each prefecture. The results showed that the first month of new cancer drug prescriptions varied across prefectures. On average, they lagged by up to 2 months in the slowest prefectures, whereas the variation was almost nonexistent for diabetes drugs. The patterns of dissemination varied more among cancer drugs across the seven Japanese geographical regions. After the initial prescription, the number of prescriptions showed a steep rise for most cancer drugs, whereas the increase was gradual for diabetes drugs. In conclusion, the dissemination of cancer drugs had a greater lag time than that of diabetes drugs. Further research is needed to explore the causative factors to ensure that all effective drugs are equally accessible for those who need them.

Experiences of patients with cancer at health care facilities in Japan: results from a nationwide survey.

BACKGROUND: To elucidate the experience of patients with cancer from diagnosis to early survivorship in Japan using a nationwide questionnaire survey, and to inform the current progress of the cancer control programs. METHODS: The survey was sent to a representative sample of adult patients with cancer identified from the national database of hospital-based cancer registries. The patients' responses were compared across three groups: patients with rare cancers, patients aged < 40 years, and patients with non-rare cancers aged ≥40 years. RESULTS: Of 20,488 patients invited to participate in the survey, 8935 (43.6%) responded. Respondents reported an average score of 7.9 out of 10 on global ratings of care. Patients with rare cancers experienced a longer time to diagnosis but the shortest time from diagnosis to first treatment (p < 0.05). Patients aged < 40 years rated worse for the majority of the survey items, especially on items that related to communication with medical staff and items referring to early survivorship. CONCLUSION: The care experienced by patients with cancer in Japan varies on the basis of age group and cancer type. Efforts should be directed to ensuring prompt access to diagnostic facilities for patients with rare cancers and providing sufficient support to younger patients.

Baseline cardiac function checkup in patients with gastric or breast cancer receiving trastuzumab or anthracyclines.

BACKGROUND: Although trastuzumab and anthracyclines are frequently used to treat breast cancer (BC) and gastric cancer (GC), cardiotoxicity is a serious concern. The cardiac function assessment is recommended at baseline before initiating treatment. However, the prevalence rates of baseline cardiac checkups are unknown. METHODS: The national database of hospital-based cancer registries linked to the health services-utilization data was used to study patients with newly diagnosed stage IV BC and GC (n = 6271) who received trastuzumab (n = 4324, 69.0%) or anthracyclines between January 2012 and December 2015. The baseline ultrasound echocardiogram (UCG) performance rate and factors related to adequate UCG performance for all patients and those receiving trastuzumab were analyzed. RESULTS: The adequate baseline UCG checkup rate was higher in patients treated with trastuzumab than in those treated with anthracyclines (71.8% vs 44.1%, respectively). Additionally, patients with GC were less likely to receive an adequate baseline UCG performance than those with BC (70.4% vs 75.0%, respectively). After adjusting for potential confounders, patients with anthracycline-treated BC and GC were less likely to receive adequate baseline UCG performance than those with trastuzumab-treated BC (odds ratio [OR]: 0.24, 95% confidence interval [CI]: 0.20-0.28, and OR: 0.07, 95% CI: 0.03-0.16, respectively). Furthermore, patients with trastuzumab-treated GC were less likely to receive adequate baseline UCG performance than those with BC (OR: 0.65, 95% CI: 0.50-0.84). CONCLUSIONS: The baseline UCG was less likely to be performed in patients receiving anthracyclines than in those receiving trastuzumab, as well as in patients with GC than in those with BC.

Differences in the performance of adjuvant chemotherapy between hemodialysis and nonhemodialysis patients.

BACKGROUND: The survival of hemodialysis (HD) patients with cancer is poor, which may be caused by undertreatment due to renal dysfunction. Particularly, adjuvant chemotherapy after surgery may be considered optional because of its preventive nature. This study investigated the current frequency of administration of adjuvant chemotherapy to HD patients compared with non-HD patients in Japan. METHODS: We used data from the Hospital-Based Cancer Registries national database linked to health services utilization data to analyze cases of newly diagnosed colon cancer, gastric cancer, breast cancer, and non-small cell lung cancer (NSCLC) at the stages where adjuvant chemotherapy is generally required. We compared the performance rate of adjuvant chemotherapy and the adjuvant chemotherapy regimens between HD and non-HD patients from October 2011 to December 2017. RESULTS: Of the 99,761 patients who underwent curative surgery, 1207 (1%) were HD patients. HD patients received adjuvant chemotherapy less frequently than non-HD patients (24% vs. 63%, p < 0.001). After adjusting for potential confounders, HD remained negatively related to adjuvant chemotherapy administration for all four cancer types. Among all patients who received adjuvant chemotherapy 0(N = 61,873), HD patients were less likely to receive standard regimens and chemotherapy requiring dose adjustment than non-HD patients (88% vs. 95%, p < 0.001 and 92% vs. 98%, p < 0.001, respectively). This trend was particularly pronounced among patients with gastric cancer. CONCLUSIONS: HD patients were less likely to receive adjuvant chemotherapy with standard regimens than non-HD patients.

A retrospective study of sentinel lymph node biopsy for skin cancer in Japan: Comparison with breast cancer and evaluation of factors related to its use.

BACKGROUND: Sentinel lymph node biopsy (SLNB) underuse has been reported for skin cancers; however, actual performance rates have not been compared. The objective of this study was to investigate the SLNB performance rate in skin cancers covered by health insurance in Japan and compare it with that in breast cancer. METHODS: This was a retrospective study of the SLNB performance rate in SLNB-eligible patients with breast or skin cancer from 2018 to 2019, utilizing a database linked to the Hospital-Based Cancer Registry and Diagnosis Procedure Combination survey. Demographic and tumor characteristics were analyzed using logistic regression. RESULTS: A total of 71,652 patients were included in this study. SLNB was performed in 86.4% (57,904/67,036) of the patients with breast cancer, 44.7% (694/1552) with melanomas, 3.1% (89/2849) with squamous cell carcinomas (SCCs), and 13.5% (29/215) with Merkel cell carcinomas (MCCs). The performance rate of SLNB was significantly lower for skin cancers than for breast cancers (odds ratio [OR], 0.03; p < 0.001). In addition, the performance rates of SLNB were significantly lower for SCCs and MCCs than for melanomas (SCC: OR, 0.04; p < 0.001; MCC: OR, 0.19; p < 0.001). Factors associated with SLNB performance included age, sex, year of incidence, primary tumor site, T stage, and number of hospital beds. CONCLUSIONS: SLNB is underutilized for skin cancer. Further investigation is required to explore the reasons for its underutilization so that it may be implemented more universally.

Cardiac Function Checkup During Trastuzumab Therapy Among Patients With Breast Cancer.

BACKGROUND: Appropriate cardiac function evaluation before trastuzumab therapy is recommended. However, there are no data that show the current practice of appropriate cardiac evaluation for patients receiving postsurgical adjuvant trastuzumab (adjuvant group) and patients with metastatic disease (metastatic group). MATERIALS AND METHODS: We assessed patients with newly diagnosed breast cancer who received trastuzumab between October 2011 and December 2016 using the national database of the Hospital-Based Cancer Registry. We defined appropriate cardiac function checkup as having ultrasound echocardiogram (UCG) before the start of trastuzumab as well as within 6 months after trastuzumab initiation for the adjuvant group, and having UCG before trastuzumab for the metastatic group. RESULTS: In the adjuvant group (14,501 patients), 34.7% of patients received appropriate UCG checkup. Factors related to appropriate UCG were 65 years or older (OR 1.54, 95% CI 1.41-1.69), advanced stage (stage II OR 1.18, 95% CI 1.07-1.30, stage III OR 1.08, 95% CI 0.96-1.23 compared to stage I), and surgical department (OR 0.57, 95% CI 0.47-0.70). In the metastatic group (1734 patients), appropriate UCG checkup was performed in 72.1% of the patients. Factors associated with appropriate UCG included 65 years or older (OR 1.45, 95% CI 1.10-1.91) and anthracycline use before trastuzumab (OR 0.59, 95% CI 0.44-0.80). UCG checkup rate improved from 2012 to 2015 in both the adjuvant and metastatic groups. CONCLUSION: Although many patients still received suboptimal UCG checkup, it has been improving over time. The level of appropriate UCG checkup was different between physicians with different specialties.

Association between diabetes and adjuvant chemotherapy implementation in patients with stage III colorectal cancer.

AIMS/INTRODUCTION: Among colorectal cancer (CRC) patients, pre-existing diabetes is suggested to influence poor prognosis, but the impact on adjuvant chemotherapy implementation is largely unknown. We aimed to compare the implementation rate of adjuvant chemotherapy between CRC patients with and without pre-existing diabetes in a retrospective cohort study. MATERIALS AND METHODS: Colorectal cancer diagnosis information was obtained from the hospital-based cancer registry of patients with stage III CRC who underwent curative surgery in 2013 in Japan (n = 6,344). Health claims data were used to identify diabetes and chemotherapy. We examined the association between diabetes and the implementation rate of adjuvant chemotherapy using a generalized linear model adjusted for age, sex, updated Charlson Comorbidity Index, hospital type and prefecture. Furthermore, we applied a mediation analysis to examine the extent to which postoperative complications mediated the association. RESULTS: Of the 6,344 patients, 1,266 (20.0%) had diabetes. The mean ages were 68.2 and 71.3 years for patients without and with diabetes, respectively. Compared with those without diabetes, patients with diabetes were less likely to receive adjuvant chemotherapy (crude rate 58.9 and 49.8%; adjusted percentage point difference 4.6; 95% confidence interval 1.7-7.5). The difference was evident for patients aged <80 years, and larger for platinum-containing regimens than others. Mediation analysis showed that postoperative complications explained 9.1% of the inverse association between diabetes and adjuvant chemotherapy implementation. CONCLUSIONS: We observed that patients with stage III CRC and diabetes are less likely to receive adjuvant chemotherapy than those without diabetes, and postoperative complications might partially account for the association.

First-Year Healthcare Resource Utilization Costs of Five Major Cancers in Japan.

Reports on the expenditure of cancer treatments per patient using comprehensive data remain unavailable in Japan. This study aimed to use Japan's cancer registry data and health service utilization data for evaluating the disease-specific, per-patient costs of five major cancers-stomach, lung, colorectal, liver, and breast cancers. We used a database linking the 2017 data from a hospital-based cancer registry and the health service utilization data from the Diagnosis Procedure Combination survey. All patients who started their first treatment course at each hospital were included. The costs were calculated using the total volume of the health services provided and the unit fee information included in the data. We analyzed 304,698 patients. Lung cancer had the highest healthcare cost per-patient for the first year of diagnosis and the longest median hospitalization duration. Conversely, breast cancer showed the lowest cost and the shortest median hospitalization duration. However, in the first month after diagnosis, colorectal cancer showed the highest cost. Subsequently, the gaps between the costs of the five common cancers drastically diminished. The cancer type having the longest hospitalization duration had the highest overall healthcare resource utilization costs. This information is essential for care planning and research studies.

Epidemiology and practice patterns for male breast cancer compared with female breast cancer in Japan.

BACKGROUND: The incidence of male breast cancer (MBC), although rare, has shown an increase. However, the current epidemiology of and practice patterns for MBC remain unclear. This study evaluated the characteristics and care patterns for MBC compared with female breast cancer (FBC) in Japan. METHODS: Using the National Database of Hospital-Based Cancer Registries (HBCR) linked to the Diagnosis Procedure Combination data, we analyzed newly diagnosed breast cancer cases between January 2012 and December 2015 at participating hospitals in a large quality-of-care monitoring project. We employed logistic regression models to assess cancer treatment differences between MBC and FBC in patients who were indicated for adjuvant radiation therapy and neo-adjuvant/adjuvant chemotherapy. RESULTS: Of 142,636 breast cancer patients, 870 (0.61%) were MBC patients. At diagnosis, the mean age of MBC patients was 10 years older than FBC patients (70 vs 60 years; P < .001). Advanced-stage cancer was more frequently observed in MBC than in FBC (stage III/IV 18.9%/6.1% vs 10.6%/5.2%). Despite this, MBC patients were less likely to receive adjuvant radiation therapy and neo-adjuvant/adjuvant chemotherapy. Gender was an independent treatment determinant factor for chemotherapy decisions. CONCLUSION: MBC patients were older and had higher stages of cancer than FBC patients at diagnosis, but received suboptimal treatment.

Quality indicators for cervical cancer care in Japan.

OBJECTIVE: We aimed to propose a set of quality indicators (QIs) based on the clinical guidelines for cervical cancer treatment published by The Japan Society of Gynecologic Oncology, and to assess adherence to standard-of-care as an index of the quality of care for cervical cancer in Japan. METHODS: A panel of clinical experts devised the QIs using a modified Delphi method. Adherence to each QI was evaluated using data from a hospital-based cancer registry of patients diagnosed in 2013, and linked with insurance claims data, between October 1, 2012, and December 31, 2014. All patients who received first-line treatment at the participating facility were included. The QI scores were communicated to participating hospitals, and additional data about the reasons for non-adherence were collected. RESULTS: In total, 297 hospitals participated, and the care provided to 15,163 cervical cancer patients was examined using 10 measurable QIs. The adherence rate ranged from 50.0% for 'cystoscope or proctoscope for stage IVA' to 98.8% for 'chemotherapy using platinum for stage IVB'. Despite the variation in care, hospitals reported clinically valid reasons for more than half of the non-adherent cases. Clinically valid reasons accounted for 75%, 90.9%, 73.4%, 44.5%, and 88.1% of presented non-adherent cases respectively. CONCLUSION: Our study revealed variations in pattern of care as well as an adherence to standards-of-care across Japan. Further assessment of the causes of variation and non-adherence can help identify areas where improvements are needed in patient care.