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• 11929

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  P2.22 - Poster Session 2 - Epidemiology, Etiology (ID 167)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Prevention & Epidemiology
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11938

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    P2.22-009 - Quality in lung cancer care: The development of a population based lung cancer registry (ID 2536)

    09:30 - 09:30  |  Author(s): S. Evans
    • Abstract

    Background
    Lung cancer is the fourth most common cancer in Victoria and the leading cause of cancer mortality. Little local knowledge exists of the factors which influence outcome in lung cancer. A pressing need exists to describe regional structure, process and outcome in lung cancer care to improve quality of care and to inform translational research and health care planning. We aim to develop and pilot a population-based lung cancer clinical quality registry to describe clinical assessment, diagnosis, staging, management and outcomes in lung cancer in Victoria.

    Methods
    The establishment of the Victorian Lung Cancer Registry Pilot Project commenced with the appointment of a Steering Committee to provide project governance. Review of current literature and evidence-based national and international clinical practice guidelines was undertaken by an expert working group. Included data items were epidemiologically sound, reproducible and valid. The data set enables the capture of identified quality indicators designed to describe the structural quality, process quality and indicators of outcome in lung cancer management. Case ascertainment is derived from institutional ICD-10 coding of small and non-small cell lung cancer. Consent to recruitment to the registry occurs via an “opt-off” system. Follow up and outcome measures are collected 6 and 12 months after initial diagnosis capturing survival, treatment and quality of life assessments. Survival will be reconfirmed at 2 and 5 years post diagnosis. Institutional recruitment was designed to sample from metropolitan public, metropolitan private and regional hospitals. A quantitative, case finding audit was employed to evaluate the case ascertainment methodology at a major metropolitan hospital.

    Results
    Ethics approval was received for 8 pilot sites and a mechanism for rapid case ascertainment and secure data transfer has been established. A web enabled data collection tool has been developed and data has been collected on 576 eligible and consenting patients. Evidence of distress screening was available for 13.02% of subjects. Diagnosis was confirmed < 28 days from referral in 56-86% of cases across institutions. A statement of ECOG status was available in 52.51% of cases and clinical T staging in 48.43% prior to treatment. A record of multidisciplinary team meeting presentation was available in 48.43% of cases. Curative surgery was provided for 27.78% of subjects, curative chemotherapy <5% and curative radiotherapy < 5%. Curative surgery was provided < 14 days from diagnosis in 82-100% of cases. 30 day post curative surgery mortality was 3.12% following 160 curative surgical procedures.

    Conclusion
    Cancer registries have proven capacity for improving process in the delivery of cancer care and the ensuing outcomes. The development of rapid case ascertainment and “opt off” recruitment strategies appear viable and should ensure broad recruitment from eligible patients diagnosed with lung cancer in Victoria. For registries to inform quality of care and benchmark performance, high quality data is needed on all eligible cases. Our study has identified significant gaps in the documentation of this information in the patient’s medical record. Efforts to improve documentation are required to ensure that registries can perform their important function.

• 12837

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  P3.22 - Poster Session 3 - Epidemiology, Etiology (ID 168)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Prevention & Epidemiology
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12844

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    P3.22-007 - Determining completeness of case ascertainment to a lung cancer registry:<br /> A single institutional study. (ID 2585)

    09:30 - 09:30  |  Author(s): S. Evans
    • Abstract

    Background
    The Victorian Lung Cancer Registry (VLCR) pilot project was established in January 2011 and aims to recruit all newly diagnosed lung cancer cases across participating sites in Victoria. Case ascertainment for the registry is derived from institutional ICD-10 coding with subsequent assessment against inclusion criteria. Incomplete case ascertainment threatens data validity and several methods have been proposed for estimating this in cancer registries.

    Methods
    A quantitative, case finding audit was employed to evaluate the VLCR’s case ascertainment methodology at a major metropolitan hospital between 01/07/2011 and 30/06/2012. ICD-codes determined that 125 new cases were registered at the hospital. Lists of patients recorded or suspected to have a diagnosis of lung cancer were requested from the following institutional and external departments: Radiotherapy, Day Procedure Unit, Oncology Lung Multidisciplinary Team Meeting (MDM), Cardiothoracic Surgery (CTS), Victorian Cancer Registry (VCR) and Pathology. Comparisons were made between patients included in the registry and departmental lists provided. Medical records were then assessed to check eligibility of outstanding patients for inclusion in the registry.

    Results
    Six patient lists were compared with the VLCR. Excluding duplications and exclusions a total of 10 eligible patients had not been recruited by the registry. Investigations indicated that the underreporting of these cases was largely attributed to the use of the ICD10 R91 Code. This code is not a primary lung malignancy code and is assigned by clinical coders for abnormal findings on diagnostic imaging of the lung where lung cancer is suspected but not confirmed. Of the 10 patients eligible for inclusion in the registry, 7 were discharged with the R91 code and pending clinical confirmation were later included in the registry. The remaining 3 patients were not included in hospital data extracts as they were non admitted day patients and therefore not coded. A capture – recapture methodology is used to evaluate ascertainment completeness.

    Conclusion
    The completeness of cancer registry data – the extent to which all of the incident cancers occurring in the population are included in the registry database – is an extremely important attribute of a cancer registry. Only a high degree of completeness in case-finding procedures will ensure cancer incidence rates and survival proportions are close to their true value.[i] It was identified that a possible 7.5% of total lung cancer patients were not being captured by the VLCR recruitment method. The inclusion of the R Code in hospital ICD code extracts will increase the VLCR ascertainment rate. [i] Parkin, D. M. and F. Bray (2009). "Evaluation of data quality in the cancer registry: Principles and methods Part II. Completeness." European Journal of Cancer 45(5): 756-764.