title: Preliminary Development and Evaluation of an Algorithm to Identify Breast Cancer Chemotherapy Toxicities Using Electronic Medical Records and Administrative Data.
abstract: Breast cancer chemotherapy toxicity is not well documented outside of randomized trials. We developed and conducted preliminary evaluation of an algorithm to detect grade 3 and 4 toxicities using electronic data from a large integrated managed care organization.
  
  
  
  The algorithm used administrative, pharmacy, and electronic data from outpatient, emergency room, and inpatient records of 99 women diagnosed with breast cancer from 2006 to 2009 who underwent chemotherapy. Data were abstracted for 12 months post-treatment initiation (24 months for trastuzumab recipients). An oncology nurse independently blindly reviewed records; these results were the "gold standard." Sensitivity and specificity were calculated for overall toxicity, categories of toxicities, and toxicity by age or regimen. The algorithm was applied to an independent sample of 1,575 patients with breast cancer diagnosed during the study period to estimate prevalence rates.
  
  
  
  The overall sensitivity for detecting chemotherapy-related toxicity was 89% (95% CI, 77% to 95%). The highest sensitivity was for identification of hematologic toxicities (97%; 95% CI, 84% to 99%). There were good sensitivities for infectious toxicity, but rates dropped for GI and neurological toxicities. Specificity was high within each category (89% to 99%), but when combined to measure any toxicity, it was lower (70%; 95% CI, 57% to 81%). When applied to an independent chemotherapy sample, the algorithm estimates a 26% rate of hematologic toxicity; rates were higher among patients age ≥ 65 years versus less than 65 years.
  
  
  
  If validated in other samples and health care settings, algorithms to capture toxicity could be useful in comparative and cost-effectiveness evaluations of community practice-delivered treatment.
authors.affiliation: Georgetown University Medical Center; Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Kaiser Permanente Medical Group, Oakland, CA; and Columbia Presbyterian Medical Center, New York, NY Mandelbj@georgetown.edu.
authors.forename: Jeanne S
authors.initials: JS
authors.lastname: Mandelblatt
authors.affiliation: Georgetown University Medical Center; Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Kaiser Permanente Medical Group, Oakland, CA; and Columbia Presbyterian Medical Center, New York, NY.
authors.forename: Karl
authors.initials: K
authors.lastname: Huang
authors.affiliation: Georgetown University Medical Center; Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Kaiser Permanente Medical Group, Oakland, CA; and Columbia Presbyterian Medical Center, New York, NY.
authors.forename: Solomon B
authors.initials: SB
authors.lastname: Makgoeng
authors.affiliation: Georgetown University Medical Center; Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Kaiser Permanente Medical Group, Oakland, CA; and Columbia Presbyterian Medical Center, New York, NY.
authors.forename: Gheorghe
authors.initials: G
authors.lastname: Luta
authors.affiliation: Georgetown University Medical Center; Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Kaiser Permanente Medical Group, Oakland, CA; and Columbia Presbyterian Medical Center, New York, NY.
authors.forename: Jun X
authors.initials: JX
authors.lastname: Song
authors.affiliation: Georgetown University Medical Center; Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Kaiser Permanente Medical Group, Oakland, CA; and Columbia Presbyterian Medical Center, New York, NY.
authors.forename: Michelle
authors.initials: M
authors.lastname: Tallarico
authors.affiliation: Georgetown University Medical Center; Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Kaiser Permanente Medical Group, Oakland, CA; and Columbia Presbyterian Medical Center, New York, NY.
authors.forename: Janise M
authors.initials: JM
authors.lastname: Roh
authors.affiliation: Georgetown University Medical Center; Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Kaiser Permanente Medical Group, Oakland, CA; and Columbia Presbyterian Medical Center, New York, NY.
authors.forename: Julie R
authors.initials: JR
authors.lastname: Munneke
authors.affiliation: Georgetown University Medical Center; Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Kaiser Permanente Medical Group, Oakland, CA; and Columbia Presbyterian Medical Center, New York, NY.
authors.forename: Cathie A
authors.initials: CA
authors.lastname: Houlston
authors.affiliation: Georgetown University Medical Center; Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Kaiser Permanente Medical Group, Oakland, CA; and Columbia Presbyterian Medical Center, New York, NY.
authors.forename: Meghan E
authors.initials: ME
authors.lastname: McGuckin
authors.affiliation: Georgetown University Medical Center; Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Kaiser Permanente Medical Group, Oakland, CA; and Columbia Presbyterian Medical Center, New York, NY.
authors.forename: Ling
authors.initials: L
authors.lastname: Cai
authors.affiliation: Georgetown University Medical Center; Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Kaiser Permanente Medical Group, Oakland, CA; and Columbia Presbyterian Medical Center, New York, NY.
authors.forename: Grace
authors.initials: G
authors.lastname: Clarke Hillyer
authors.affiliation: Georgetown University Medical Center; Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Kaiser Permanente Medical Group, Oakland, CA; and Columbia Presbyterian Medical Center, New York, NY.
authors.forename: Dawn L
authors.initials: DL
authors.lastname: Hershman
authors.affiliation: Georgetown University Medical Center; Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Kaiser Permanente Medical Group, Oakland, CA; and Columbia Presbyterian Medical Center, New York, NY.
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
authors.affiliation: Georgetown University Medical Center; Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Kaiser Permanente Medical Group, Oakland, CA; and Columbia Presbyterian Medical Center, New York, NY.
authors.forename: Claudine
authors.initials: C
authors.lastname: Isaacs
authors.affiliation: Georgetown University Medical Center; Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC; Kaiser Permanente Medical Group, Oakland, CA; and Columbia Presbyterian Medical Center, New York, NY.
authors.forename: Larry
authors.initials: L
authors.lastname: Kushi
mesh_terms: D000368:Aged; D000465:Algorithms; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy*; D002140:California; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008329:Managed Care Programs / Q000706:statistics & numerical data; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity