Surveillance, Epidemiology, and End Results (SEER) - Medicare Linked by mercy2beans107

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									Surveillance, Epidemiology, and End Results
    (SEER) - Medicare Linked Database




           Gerald Riley M.S.P.H.
     Centers for Medicare and Medicaid
                  Services

            Joan Warren Ph.D.
          National Cancer Institute
                    SEER Program


   NCI has contracted with universities and state health
    departments since 1973 to operate population-based
    cancer registries.

   All incident cases are captured, except non-
    melanoma skin cancer and in situ cervical cancer

   Recurrences not reported.

   Since 1992, 12 geographic areas, 14.5% of U.S.
    population; expanded in 2001 to include 25% of U.S.
    population
                               SEER Reporting Areas

                       1992 SEER         2001 SEER


     Seattle/
    Puget Sound
                                                         Metropolitan
                                                         Detroit

                                                                        Connecticut

San Francisco/                                IA                        New Jersey
 Oakland
                          UT
     San Jose/    CA                                    KY
     Monterey
      Los Angeles                  NM                               Atlanta


                                                   LA



                                Hawaii
                       SEER Data

   SEER data have been linked for the entire time each
    registry has participated in the SEER program; some
    registries go back to 1973

   Each individual is assigned a unique case number


   Demographic information
       age at diagnosis
       race/ethnicity, sex, marital status
       year and place of birth
       follow-up vital status w/cause of death
                 SEER Data (cont.)

   For each incident cancer:
        month and year of diagnosis
        site of cancer
        histology
        behavior
        grade
        extent of disease  staging
       surgery and adjuvant radiation given or
        planned during the first course of treatment
                 Medicare data

   Medicare claims (all types) are available from
    1991-2002, except for inpatient hospital data
    that are available back to 1986

   Enrollment data

   Selected information on hospital and provider
    characteristics (POS, HCRIS)

   In addition to Medicare data for persons with
    cancer, the same files are available for a 5%
    random sample of cancer-free individuals
    who reside in the SEER areas.
        Other variables available for
       cancer and non-cancer cases

   Census variables at the census tract and zip
    code level for:
      Median household income
      Median household wealth
      % of population with high school education
      Population density
      Urban, suburban, rural codes


   Health Care Service Area from Area Resource
    File
                          Current update

   Linkage is updated every 3 years
   Current update began Fall 2004
   Preliminary match completed
   Added SEER cases for 2000-2002
   Added data from 4 new registries –
      Louisiana
      Kentucky
      New Jersey
      Greater California
   Data from new registries will be for 2001-2002
   Release date not yet scheduled
                    Matched cases by registry
                     1991 - 2002 (preliminary)

   Total                                 1,647,756
   Los Angeles 1991 - 2002                 290,886
   Detroit 1991 - 2002                    193,141
   Connecticut 1991 - 2002                167,463
   Seattle – Puget Sound 1991 - 2002      157,583
   San Francisco – Oakland 1991 - 2002    156,625
   Iowa 1991 - 2002                       149,034
   Greater California 2001 - 2002         104,227
   Atlanta 1991 - 2002                     71,890
   San Jose – Monterey 1991 - 2002          71,168
   New Jersey 2001 - 2002                   66,151
   New Mexico 1991 - 2002                   58,869
   Utah 1991 - 2002                        52,863
   Kentucky 2001 - 2002                    30,241
   Louisiana 2001 - 2002                   28,850
   Hawaii 1991 - 2002                      44,225
   Rural Georgia 1991 - 2002                4,540
Matched cases by year of diagnosis 1991 –
           2002 (preliminary)

250000

200000

150000

100000

 50000

     0
         1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
    Matched cases by selected cancer sites,
          1991 – 2002 (preliminary)



   Prostate                     302,898
   Breast                       240,426
   Lung and bronchus            224,429
   Colon and rectum             214,826
   Urinary bladder               78,620
   Non-Hodgkins lymphoma         58,996
    Matched cases by selected cancer sites,
          1991 – 2002 (preliminary)



   Pancreas                     38,031
   Ovary                        24,236
   Larynx                       15,193
   Esophagus                    15,060
   Brain                        13,797
   Liver                        13,609
Examples of Studies Using
  SEER-Medicare Data
        Example of a Study of Post-diagnostic Surveillance
    using the SEER-Medicare Data: Frequency of Cystoscopy
       Following a Diagnosis of Superficial Bladder Cancer


   Patients diagnosed with superficial bladder cancer who have
    not undergone total cystectomy are at high risk for recurrence

   Bladder surveillance with cystoscopy is recommended for
    such patients every 3-6 months

   Investigators used the SEER-Medicare data to examine the
    frequency with which these patients underwent cystoscopy
    during each of five contiguous 6-month intervals from
     month 7 to month 36 following diagnosis
                         Surveillance among Medicare Eligible Patients with
                         Superficial Bladder Cancer over a 30-month interval
                                  following diagnosis, by Age Group

                         100
                         90
  % Receiving Followup




                         80
                         70
                         60
                         50
                         40                                                                 65-69
                         30                                                                 70-74
                         20
                                                                                            75-79
                                                                                            80-84
                         10                                                                 85+
                          0
                               1+      2+           3+            4+         5
                                            Number of Followups



Source: Schrag D et al. Adherence to surveillance among patients with superficial bladder cancer.
J Natl Cancer Inst. 2003 Apr 16;95(8):588-97.
                   Results/Conclusion


   Only 40% of the entire cohort had an examination during
    all five intervals

   Exams were significantly lower for old olds, blacks and
    persons living in rural areas

   The actual practice of surveillance for patients with
    superficial bladder cancer differs substantially from the
    standards recommended in clinical guidelines
    Example of a Volume-Outcome Study Using the SEER-
      Medicare data: Hospital and Surgeon Volume and
             Outcomes following Prostatectomy

   Studies of outcomes of cancer surgery have
    demonstrated variations among hospitals and
    among surgeons by procedure volume

   Investigators used SEER-Medicare data to
    examine variations in morbidity after radical
    prostatectomy, focusing on hospital and
    surgeon volume
  Percentage of Patients Experiencing Late Complications
  (stricture or fistula) Within One Year of Radical
  Prostatectomy, by Volume of Procedures

               35

               30

               25

                                                                                             Hospitals
     Percent




               20

               15                                                                            Physicians

               10

                5

                0
                    Low              Medium               High             Very High
                                        Volume of procedures

Source: Begg CB et al. Variations in morbidity after radical prostatectomy. N Engl J Med. 2002 Apr
11;346(15):1138-44.
                  Results/Conclusion


   For men undergoing prostatectomy, the rates of
    postoperative and late urinary complications are
    significantly reduced if the procedure is performed in a
    high-volume hospital and by a surgeon who performs a
    high number of such procedures

   However, even with high-volume surgeons, there was
    substantial variation in outcome among individual
    surgeons after adjustment for hospital volume and case
    mix
    Limitations of SEER-Medicare data

   Does not include claims for care provided to persons in HMOs
    (about 22% in SEER areas)

   Non-covered services excluded - prescription drugs, nursing
    home care, free screenings

   Under 65 population includes only the disabled/ESRD

   Reasons for tests are not known; this raises challenges with
    identifying screening

   Results of tests not available
       How to obtain SEER-Medicare data

   SEER-Medicare are de-identified. Because of the
    remote possibility of re-identification, these data are not
    available as public use files.

   Researchers must submit to NCI a proposal or copy of
    grant submission that describes
      Use of the data
      How data will be protected
      Investigators using the data
      SEER-Medicare data use agreement
      Support for SEER-Medicare data users

   SEER-Medicare WEB site:
    http://healthservices.cancer.gov/seermedicare/

   Medical Care Vol. 40, no. 8 August 2002
    Supplement

   SEER web site: http://seer.cancer.gov
    Publications, Manuals, Cancer Statistics,
    Scientific Systems: SEER*Stat, DEVCAN, etc.

   RESDAC support for Medicare data users
    http://www.resdac.umn.edu/
                    Funding Opportunities

   NCI Program Announcement

       http://appliedresearch.cancer.gov/funding.html

            Note: Cancer Surveillance Using Health Claims-Based
             Data System


            Note: Economic Studies in Cancer Prevention,
             Screening, and Care

								
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