title: Muddy water? Variation in reporting receipt of breast cancer radiation therapy by population-based tumor registries.
abstract: OBJECTIVE
  To evaluate, in the setting of breast cancer, the accuracy of registry radiation therapy (RT) coding compared with the gold standard of Medicare claims.
  
  
  METHODS
  Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we identified 73,077 patients aged ≥66 years diagnosed with breast cancer in the period 2001-2007. Underascertainment (1 - sensitivity), sensitivity, specificity, κ, and χ(2) were calculated for RT receipt determined by registry data versus claims. Multivariate logistic regression characterized patient, treatment, and geographic factors associated with underascertainment of RT. Findings in the SEER-Medicare registries were compared with three non-SEER registries (Florida, New York, and Texas).
  
  
  RESULTS
  In the SEER-Medicare registries, 41.6% (n=30,386) of patients received RT according to registry coding, versus 49.3% (n=36,047) according to Medicare claims (P<.001). Underascertainment of RT was more likely if patients resided in a newer SEER registry (odds ratio [OR] 1.70, 95% confidence interval [CI] 1.60-1.80; P<.001), rural county (OR 1.34, 95% CI 1.21-1.48; P<.001), or if RT was delayed (OR 1.006/day, 95% CI 1.006-1.007; P<.001). Underascertainment of RT receipt in SEER registries was 18.7% (95% CI 18.6-18.8%), compared with 44.3% (95% CI 44.0-44.5%) in non-SEER registries.
  
  
  CONCLUSIONS
  Population-based tumor registries are highly variable in ascertainment of RT receipt and should be augmented with other data sources when evaluating quality of breast cancer care. Future work should identify opportunities for the radiation oncology community to partner with registries to improve accuracy of treatment data.
authors.affiliation: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
authors.forename: Gary V
authors.initials: GV
authors.lastname: Walker
authors.forename: Sharon H
authors.initials: SH
authors.lastname: Giordano
authors.forename: Melanie
authors.initials: M
authors.lastname: Williams
authors.forename: Jing
authors.initials: J
authors.lastname: Jiang
authors.forename: Jiangong
authors.initials: J
authors.lastname: Niu
authors.forename: Jill
authors.initials: J
authors.lastname: MacKinnon
authors.forename: Patricia
authors.initials: P
authors.lastname: Anderson
authors.forename: Brad
authors.initials: B
authors.lastname: Wohler
authors.forename: Amber H
authors.initials: AH
authors.lastname: Sinclair
authors.forename: Francis P
authors.initials: FP
authors.lastname: Boscoe
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Schymura
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Buchholz
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Smith
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D016009:Chi-Square Distribution; D059019:Clinical Coding / Q000592:standards*; D005260:Female; D005431:Florida; D006801:Humans; D006278:Medicare / Q000592:standards / Q000706:statistics & numerical data; D009518:New York; D012042:Registries / Q000592:standards* / Q000706:statistics & numerical data; D018426:SEER Program / Q000592:standards / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D013781:Texas; D014481:United States