Descriptive characteristics of 3957 patients of study population within the Surveillance, Epidemiology, and End Results (SEER) Medicare-linked database and 272 propensity score-matched patients.

Comparison of preexisting medical conditions among ICC cases, ECC cases, and controls, SEER-Medicare 2000–20111.

Adjusted1 logistic regression analysis examining the association between selected medical conditions and ICC or ECC, SEER-Medicare 2000–2011.

Demographic characteristics of the study participants, SEER-Medicare 2000–2011.

Characteristics of individuals with hepatocellular carcinoma, by hepatitis B virus (HBV) and hepatitis C virus (HCV) infection status, SEER-Medicare, 2007–2017.

BackgroundThere are inconsistent and limited data regarding the risk of myeloid neoplasms (MN) among breast cancer survivors who received radiotherapy (RT) in the absence of chemotherapy. Concern about subsequent MN might influence the decision to use adjuvant RT for women with localized disease. As patients with therapy-related MN have generally poor outcomes, the presumption of subsequent MN being therapy-related could affect treatment recommendations.MethodsWe used the Surveillance, Epidemiology, and End Results (SEER)–Medicare linked database to study older women with in-situ or stage 1–3 breast cancer diagnosed 2001–2009 who received surgery. Chemotherapy and RT were ascertained using Medicare claims, and new MN diagnoses were captured using both SEER registry and Medicare claims. We excluded women who received chemotherapy for initial treatment, and censored at receipt of subsequent chemotherapy. Competing-risk survival analysis was used to assess the association between RT and risk of subsequent MN adjusting for relevant characteristics.ResultsMedian follow-up for 60,426 eligible patients was 68 months (interquartile range, 46 to 92 months), with 47.6% receiving RT. In total, 316 patients (0.52%) were diagnosed with MN; the cumulative incidence per 10,000 person-years was 10.6 vs 9.0 among RT-treated vs non-RT-treated women, respectively (p = .004); the increased risk of subsequent MN persisted in the adjusted analysis (hazard ratio = 1.36, 95% confidence interval: 1.03–1.80). The results were consistent in multiple sensitivity analyses.ConclusionsOur data suggest that RT is associated with a significant risk of subsequent MN among older breast cancer survivors, though the absolute risk increase is very small. These findings suggest the benefits of RT outweigh the risks of development of subsequent MN.

International Classification of Diseases, ninth edition codes for preexisting medical conditions and risk factors for cholangiocarcinoma.

These are peer-reviewed supplementary materials for the article 'Economic burden of early-stage non-small-cell lung cancer: an assessment of healthcare resource utilization and medical costs' published in the Journal of Comparative Effectiveness Research.Supplemental Table 1: ICD-O-3 codes for identification of NSCLCSupplemental Table 2: Procedure codes used to identify lung cancer-related surgerySupplemental Table 3: Pharmaceutical costs (2021 USD) during the observation period by disease stage at diagnosis and therapy typeSupplemental Table 4: Medical costs (2021 USD) during the observation period by type of surgery each patient receivedSupplemental Table 5: Healthcare resource utilization (HRU) and costs (2021 USD) during the observation period by phase of careAim: To quantify the economic burden of early-stage non-small-cell lung cancer (NSCLC) among patients with and without adjuvant therapy. Methods: All-cause and NSCLC-related healthcare resource utilization and medical costs were assessed among patients with resected stage IB–IIIA NSCLC in the SEER–Medicare database (1 January 2011–31 December 2019), from NSCLC diagnosis to death, end of continuous enrollment, or end of data availability (whichever occurred first). Results: Patients receiving adjuvant therapy had the lowest mean NSCLC-related medical costs (adjuvant [n = 1776]: $3738; neoadjuvant [n = 56]: $5793; both [n = 47]: $4818; surgery alone [n = 3478]: $4892, per-person-per-month), driven by lower NSCLC-related hospitalization rates. Conclusion: Post-surgical management of early-stage NSCLC was associated with high economic burden. Adjuvant therapy was associated with numerically lower medical costs over surgical resection alone.

These are peer-reviewed supplementary figures and tables for the article 'Treatment patterns and economic burden of bacterial vaginosis among commercially insured women in the USA' published in the Journal of Comparative Effectiveness Research.Supplementary Figure 1: Timing of events for the treated and untreated subgroupsSupplementary Figure 2: The covariate balance between the treated and untreated subgroupsSupplementary Table 1: Procedure and NDC codes for CLL treatmentsSupplementary Table 2: Diagnosis codes for SPMsAim: Improved management of chronic lymphocytic leukemia (CLL) has resulted in a growing populationof CLL survivors; these patients have a higher risk of developing second primary malignancies (SPMs) versusthe general population. This retrospective cohort study aims to assess the timing, frequency, incidence andtypes of SPMs in treated and untreated patients with CLL in the USA, using the Surveillance, Epidemiology,and End Results (SEER) Medicare database, which links a nationally representative cancer registry withMedicare claims data. Patients & methods: Patients aged ≥66 years with newly diagnosed CLL between1 January 2010 and 31 December 2016, who were enrolled in Parts A and B of Medicare for ≥12 monthspre-diagnosis of CLL were selected from the database. Patients were assessed for ≥36 months until the endof continuous enrollment in Medicare Parts A, B and D, a switch to a health maintenance organization,death, or end of the study period (December 2019). Results: Of 3053 patients included in the analyses,620 (20.3%) were treated and 2433 (79.7%) were untreated within 36 months of diagnosis. Overall,638 (20.9%) patients developed a SPM, 26.8% of patients in the treated cohort and 19.4% of patientsin the untreated cohort. The most common SPMs for both cohorts were squamous cell carcinoma andacute myeloid leukemia. Among the 166 treated patients who developed a SPM, a greater proportiondeveloped their first SPM after treatment initiation versus those who developed their first SPM priorto treatment initiation (p < 0.001). A significantly lower percentage of patients who received targetedtherapy developed a SPM (p < 0.05) versus patients treated with anti-CD20 + chemotherapy. Conclusion:Findings indicate that treatment type and timing can affect SPM development in patients with CLL.Combined with previous findings, this can help inform best practices in monitoring for SPM in patientswith CLL.

BackgroundTreatment selection for elderly patients with lung cancer must balance the benefits of curative/life-prolonging therapy and the risks of increased mortality due to comorbidities. Lung cancer trials generally exclude patients with comorbidities and current treatment guidelines do not specifically consider comorbidities, so treatment decisions are usually made on subjective individual-case basis.MethodsImpacts of surgery, radiation, and chemotherapy mono-treatment as well as combined chemo/radiation on one-year overall survival (compared to no-treatment) are studied for stage-specific lung cancer in 65+ y.o. patients. Methods of causal inference such as propensity score with inverse probability weighting (IPW) for time-independent and marginal structural model (MSM) for time-dependent treatments are applied to SEER-Medicare data considering the presence of comorbid diseases.Results122,822 patients with stage I (26.8%), II (4.5%), IIIa (11.5%), IIIb (19.9%), and IV (37.4%) lung cancer were selected. Younger age, smaller tumor size, and fewer baseline comorbidities predict better survival. Impacts of radio- and chemotherapy increased and impact of surgery decreased with more advanced cancer stages. The effects of all therapies became weaker after adjustment for selection bias, however, the changes in the effects were minor likely due to the weak selection bias or incompleteness of the list of predictors that impacted treatment choice. MSM provides more realistic estimates of treatment effects than the IPW approach for time-independent treatment.ConclusionsCausal inference methods provide substantive results on treatment choice and survival of older lung cancer patients with realistic expectations of potential benefits of specific treatments. Applications of these models to specific subsets of patients can aid in the development of practical guidelines that help optimize lung cancer treatment based on individual patient characteristics.

Demographic and clinical characteristics of patients with HCC

Background and objectiveEarly detection methods for pancreatic cancer are lacking. We aimed to develop a prediction model for pancreatic cancer based on changes in health captured by healthcare claims data.MethodsWe conducted a case-control study on 29,646 Medicare-enrolled patients aged 68 years and above with pancreatic ductal adenocarcinoma (PDAC) reported to the Surveillance Epidemiology an End Results (SEER) tumor registries program in 2004–2011 and 88,938 age and sex-matched controls. We developed a prediction model using multivariable logistic regression on Medicare claims for 16 risk factors and pre-diagnostic symptoms of PDAC present within 15 months prior to PDAC diagnosis. Claims within 3 months of PDAC diagnosis were excluded in sensitivity analyses. We evaluated the discriminatory power of the model with the area under the receiver operating curve (AUC) and performed cross-validation by bootstrapping.ResultsThe prediction model on all cases and controls reached AUC of 0.68. Excluding the final 3 months of claims lowered the AUC to 0.58. Among new-onset diabetes patients, the prediction model reached AUC of 0.73, which decreased to 0.63 when claims from the final 3 months were excluded. Performance measures of the prediction models was confirmed by internal validation using the bootstrap method.ConclusionModels based on healthcare claims for clinical risk factors, symptoms and signs of pancreatic cancer are limited in classifying those who go on to diagnosis of pancreatic cancer and those who do not, especially when excluding claims that immediately precede the diagnosis of PDAC.

Survival probabilities of patients with HCC by imaging group after adjustment for lead- and length-time bias

BackgroundEsophagectomy for esophageal cancer carries high morbidity and mortality, particularly in older patients. Transthoracic esophagectomy allows formal lymphadenectomy, but leads to greater perioperative morbidity and pain than transhiatal esophagectomy. Epidural analgesia may attenuate the stress response and be less immunosuppressive than opioids, potentially affecting long-term outcomes. These potential benefits may be more pronounced for transthoracic esophagectomy due to its greater physiologic impact. We evaluated the impact of epidural analgesia on survival and recurrence after transthoracic versus transhiatal esophagectomy.MethodsA retrospective cohort study was performed using the linked Surveillance, Epidemiology and End Results (SEER)-Medicare database. Patients aged ≥66 years with locoregional esophageal cancer diagnosed 1994–2009 who underwent esophagectomy were identified, with follow-up through December 31, 2013. Epidural receipt and surgical approach were identified from Medicare claims. Survival analyses adjusting for hospital esophagectomy volume, surgical approach, and epidural use were performed. A subgroup analysis restricted to esophageal adenocarcinoma patients was performed.ResultsAmong 1,921 patients, 38% underwent transhiatal esophagectomy (n = 730) and 62% underwent transthoracic esophagectomy (n = 1,191). 61% (n = 1,169) received epidurals and 39% (n = 752) did not. Epidural analgesia was associated with transthoracic approach and higher volume hospitals. Patients with epidural analgesia had better 90-day survival. Five-year survival was higher with transhiatal esophagectomy (37.2%) than transthoracic esophagectomy (31.0%, p = 0.006). Among transthoracic esophagectomy patients, epidural analgesia was associated with improved 5-year survival (33.5% epidural versus 26.5% non-epidural, p = 0.012; hazard ratio 0.81, 95% confidence interval [0.70, 0.93]). Among the subgroup of esophageal adenocarcinoma patients undergoing transthoracic esophagectomy, epidural analgesia remained associated with improved 5-year survival (hazard ratio 0.81, 95% confidence interval [0.67, 0.96]); this survival benefit persisted in sensitivity analyses adjusting for propensity to receive an epidural.ConclusionAmong patients undergoing transthoracic esophagectomy, including a subgroup restricted to esophageal adenocarcinoma, epidural analgesia was associated with improved survival even after adjusting for other factors.

Association of screening/surveillance colonoscopy or flexible sigmoidoscopy with colorectal cancer incidence overall and stratified by selected variables, SEER-Medicare*.

*Results in the table refer to the following analyses: 1) original analysis; 2) Inclusion of patients with polyps detected and removed at (procto-) sigmoidoscopy; 3) Single inclusion of individuals in the cohort of their first colonoscopy with polypectomy between 1998 and 2003; 4) Limiting the definition of a surveillance event to a colonoscopy; 5) Including people from the SEER-Medicare data with a cancer diagnosis.Probability of first surveillance event and first polypectomy event within 5 years after baseline colonoscopy with polypectomy among Medicare beneficiaries, stratified by cohort based on date of baseline colonoscopy with polypectomy – results of sensitivity analyses (estimated using the Kaplan-Meier method).

Endoscopist characteristics in relation to the magnitude of the association of CRC incidence and screening endoscopy history, SEER-Medicare*.

Mean one-year direct medical expenditure by SEER registry.

IntroductionThe treatment landscape of small cell lung cancer (SCLC) is evolving. Evidence generated from administrative claims is needed to characterize real-world SCLC patients. However, the current ICD-10 coding system cannot distinguish SCLC from non-small cell lung cancer (NSCLC). We developed and estimated the accuracy of an algorithm to identify SCLC in claims-only databases.MethodsWe performed a cross-sectional study of lung cancer patients diagnosed from 2016-2017 using the Surveillance, Epidemiology and End Results (SEER), linked with Medicare database. The analysis included two phases – data exploration (utilizing a 25% random sample) and data validation (remaining 75% sample). The SEER definition of SCLC and NSCLC were used as the gold standard. Claims-based algorithms were identified and evaluated for their sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).ResultsThe eligible cohort included 31,912 lung cancer patients. The mean age was 76.3 years, 44.6% were male, with 9.4% having SCLC and 90.6% identified as NSCLC using SEER. The exploration analysis identified potential algorithms based on treatment data. In the validation analysis of 7,438 lung cancer patients who received systemic treatment in the outpatient setting, an etoposide-based algorithm (etoposide use in 180 days following lung cancer diagnosis) to identify SCLC showed: sensitivity 95%, specificity 95%, PPV 82% and NPV 99%.DiscussionAn etoposide treatment-based algorithm showed good accuracy in identifying SCLC patients. Such algorithms can facilitate analyses of treatment patterns, outcomes, healthcare resource and costs among treated SCLC patients, thereby bolstering the evidence-base for best patient care.

BackgroundFlexible sigmoidoscopy and colonoscopy are both recommended colorectal cancer screening options, but their relative effectiveness needs clarification. The aim of this study was to compare the effectiveness of colonoscopy and flexible sigmoidoscopy for reduction of colorectal cancer incidence.MethodsWe conducted a case-control study within the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Cases were subjects age 70–85 years in the SEER-Medicare database diagnosed with CRC during 2004–2013. Up to 3 controls were matched to each case by birth year, sex, race, and SEER region. Receipt of screening colonoscopy or flexible sigmoidoscopy was ascertained from Medicare claims. Conditional logistic regression models were developed to estimate the odds ratios (ORs) and 95% confidence intervals (CI) for a history of screening in cases vs. controls. We conducted secondary analyses by sex, race, endoscopist characteristics, and with varying timing and duration of the look-back period.ResultsReceipt of screening colonoscopy and sigmoidoscopy was associated with a 59% (OR 0.41, 95%CI 0.39, 0.43) and 22% reduction (OR 0.78, 95%CI 0.67, 0.92) in colorectal cancer incidence, respectively. Colonoscopy was associated with greater reduction in the distal colorectal cancer incidence (OR 0.22, 95%CI 0.20, 0.24) than proximal colorectal cancer incidence (OR 0.62, 95%CI 0.59, 0.66). Sigmoidoscopy was associated with a 52% reduction in distal colorectal cancer incidence (OR 0.48, 95%CI 0.37, 0.63), but with no reduction in proximal colorectal cancer incidence. These associations were stronger in men than in women. No differences by race or endoscopist characteristics were observed.ConclusionBoth screening colonoscopy and sigmoidoscopy were associated with reductions in overall colorectal cancer incidence, with a greater magnitude of reduction observed with colonoscopy.