title: Are hospital cancer caseloads related to the validity of staging data reported? A lesson from National Cancer Registry in Taiwan.
abstract: OBJECTIVE
  Data from the National Taiwan Cancer Registry have been widely used since 2002 to assess quality of health, but its quality of coding in cancer staging data has not been discussed. This study assessed the agreement rate for staging by site visit at medical institutes.
  
  
  METHODS
  In this retrospective chart review study, 392 cancer patients in year 2013 were randomly selected from 14 hospitals; the senior cancer registrar reviewers had compared each original chart with data from the Taiwan Cancer Registry to assess agreement rate for staging. The hospitals were classified into two groups on the basis of the number of cancer patients. The kappa (κ) statistic method and multiple regression analysis were used to compare among the medical institutes and qualified cancer registrars.
  
  
  RESULTS
  The agreement rate was high in pharynx, esophageal, rectal, breast and prostate cancers, and low in ovarian and other cancers for clinical and pathological staging. After adjustment for the experience of the qualified cancer registrar, low-caseload hospitals had a significantly lower clinical staging agreement rate than that of high-caseload hospitals. After controlling the hospital cancer caseloads the cancer registrar background becomes one of significant factor. That is long duration between a basic license to an advanced license exceeded 5 years, having lower agreement rate.
  
  
  CONCLUSIONS
  The reliability of staging data in the Taiwan Cancer Registry is affected not only by the cancer type but also by the number of patients treated in hospital. Moreover, the experience of cancer registrar strongly influences agreement rate, especially in clinical staging.
authors.affiliation: Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei d97846001@ntu.edu.tw.|Department of Cancer Centre, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City.
authors.forename: Chin-Ying
authors.initials: CY
authors.lastname: Cheng
authors.affiliation: Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei.|Taiwan Cancer Registry, Taipei.
authors.forename: Chun-Ju
authors.initials: CJ
authors.lastname: Chiang
authors.affiliation: Department of Diagnostic Radiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
authors.forename: Jong-Kai
authors.initials: JK
authors.lastname: Hsiao
authors.affiliation: Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei.|Taiwan Cancer Registry, Taipei.
authors.forename: Mei-Shu
authors.initials: MS
authors.lastname: Lai
mesh_terms: D000368:Aged; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009369:Neoplasms / Q000175:diagnosis / Q000473:pathology*; D012042:Registries; D012044:Regression Analysis; D012189:Retrospective Studies; D013624:Taiwan
keywords: cancer registry data; cancer stages; chart review; validity