"NONSPECIFIC DIAGNOSES" IN ONCOLOGIC PATHOLOGY: ASSOCIATION WITH CANCER CENTER VOLUME AND FACILITY TYPE AND PATIENT CHARACTERISTICS Open Access
Gansler, Ted (2011)
Abstract
Purpose: Precise characterization of cancers is essential for clinical management and research. Prior studies of cancer care reported associations of process measures and outcomes with cancer center facility type and case volume. However, it is not known whether these facility characteristics are associated with use of nonspecific cancer diagnoses. Methods: This exploratory study of records in the National Cancer Database (NCDB) for patients diagnosed from 1998-2008 used bivariate analyses to identify diagnoses with the greatest variation among cancer center types (Community Center, Comprehensive Community Center, Community Network, Teaching/Research Center, and National Cancer Institute (NCI)-designated Comprehensive Program). Diagnoses from this list that were likely to compromise clinical management were selected for study of the influence of facility characteristics on trends in prevalence over time. Logistic regression was used to determine whether the association of facility type with nonspecific diagnoses was independent of center case volume and patient characteristics. Results: Exploratory review of 14 highest incidence cancer sites identified 10 nonspecific diagnoses from 5 sites were identified as likely to adversely affect patient care and/or research and which were used more often at Community Centers than at NCI-designated Comprehensive Programs. Diagnoses with the greatest prevalence differences included "adenocarcinoma, not otherwise specified (NOS)" of the uterinus (20.4%); "renal cell carcinoma, NOS" (15.0%); "adenocarcinoma, NOS of the ovary (8.2%)", and "malignant non-Hodgkin's lymphoma, NOS (4.9%)". From 1998-2008, the nonspecific diagnosis prevalence gap between Community Centers and NCI-designated Programs decreased for ovarian "papillary adenocarcinoma, NOS"; and uterine "adenocarcinoma, NOS", increased for "renal cell carcinoma, NOS"; "malignant lymphoma, NOS"; and pancreatic "malignant neoplasm, NOS", and remained relatively stable for "non-Hodgkin's lymphoma, NOS"; ovarian "adenocarcinoma, NOS"; ovarian "carcinoma, NOS"; and pancreatic "carcinoma, NOS". Facility type remained significantly associated with nonspecific diagnoses in logistic regression models including facility case volume and regional location, and several patient-level variables. Conclusion: Prevalence of nonspecific cancer diagnoses varies substantially and independently by facility type and may adversely influence patient care and research.
Table of Contents
APPROVED ............................................................................................................ ii INFORMATION FOR BORROWERS ............................................................................. iii CURRICULUM VITA ................................................................................................ v ACKNOWLEDGEMENTS ............................................................................................. xiii TABLE OF CONTENTS .............................................................................................. xiv ABSTRACT............................................................................................................. xvi CHAPTER I: INTRODUCTION.................................................................................... 1 Introduction and rationale ………….............................................................................. 1 Problem statement ................................................................................................ 3 Purpose statement ................................................................................................ 6 Research questions ............................................................................................... 6 Significance statement ........................................................................................... 7 Definition of terms ................................................................................................. 7 CHAPTER II: REVIEW OF LITERATURE.........................................................................11 Introduction .......................................................................................................... 11 Cancer as a public health problem ........................................................................... 11 The National Cancer Database ................................................................................. 12 Facility characteristics and healthcare quality .............................................................. 12 Patient characteristics and healthcare disparities ........................................................ 16 Quality assessment and improvement in oncologic surgical pathology ........................ 16 Use of registries quality assessment and improvement in oncologic surgical pathology, and associations of quality with hospital or laboratory characteristics ............. 18 Gaps in the published literature ............................................................................... 19 Summary of the literature and its gaps ..................................................................... 20 CHAPTER III:METHODOLOGY ................................................................................... 22 Introduction ........................................................................................................... 22 Population, sample, and variables........................................................................... 22 Research design ..................................................................................................... 26 Procedures ............................................................................................................. 26 Algorithm for selection of cancer sites and nonspecific diagnoses .................................. 32 Data analysis ......................................................................................................... 33 Limitations and delimitations .................................................................................... 34 CHAPTER IV: RESULTS.............................................................................................. 37 Introduction ........................................................................................................... 37 Findings ................................................................................................................. 37 Differences in prevalence of diagnoses by facility type ................................................. 37 Time trends in prevalence of diagnoses by facility type and volume group ..................... 45 Multivariable logistic regression models ..................................................................... 47 Summary ............................................................................................................... 49 CHAPTER V: DISCUSSION ..........................................................................................50 Introduction ............................................................................................................ 50 Summary of Study ................................................................................................... 50 Conclusion .............................................................................................................. 55 Implications ............................................................................................................ 56 REFERENCES............................................................................................................. 58 APPENDIX A: TABLES ................................................................................................ 62 Table 1. Breast cancer diagnoses by facility type ......................................................... 62 Table 2. Colorectal cancer diagnoses by facility type .................................................. 63 Table 3. Kidney and renal pelvis cancer diagnoses by facility type ................................. 64 Table 4. Leukemia diagnoses by facility type .............................................................. 65 Table 5. Lung cancer diagnoses by facility type ........................................................... 66 Table 6. Melanoma diagnoses by facility type ............................................................. 67 Table 7. Non-Hodgkin lymphoma diagnoses by facility type........................................... 68 Table 8. Oral and pharyngeal cancer diagnoses by facility type .................................... .69 Table 9. Ovarian cancer diagnoses by facility type ...................................................... 70 Table 10. Pancreatic cancer diagnoses by facility type ................................................ 71 Table 11. Prostate cancer diagnoses by facility type .................................................... 72 Table 12. Thyroid cancer diagnoses by facility type ..................................................... 73 Table 13. Urinary bladder cancer diagnoses by facility type .......................................... 74 Table 14. Uterine corpus cancer diagnoses by facility type ........................................... 75 Table 15. Multivariable logistic regression of nonspecific diagnoses for 5 cancer sites ..................................................................................................................... 76 APPENDIX B: FIGURES ............................................................................................. 80 Figure 1. Site: kidney and renal pelvis. Prevalence of "renal cell carcinoma" (8312) by facility type and volume group ............................................................................. 80 Figure 2A. Site/type: non-Hodgkin lymphoma. Prevalence of "non-Hodgkin lymphoma, NOS" (9591) by facility type and volume group .......................................... 81 Figure 2B. Site/type: non-Hodgkin lymphoma. Prevalence of "follicular lymphoma, NOS" (9690) by facility type and volume group ......................................... 82 Figure 2C. Site/type: non-Hodgkin lymphoma. Prevalence of "malignant lymphoma, NOS" (9590) by facility type and volume group ........................................................... 83 Figure 2D. Site/type: non-Hodgkin lymphoma. Prevalence of "3 nonspecific diagnoses" (9590, 9591, 9690) by facility type and volume group ................................ 84 Figure 3A. Site/type: ovary. Prevalence of "adenocarcinoma, NOS" (8140) by facility type and volume group ................................................................................. 85 Figure 3B. Site/type: ovary. Prevalence of "carcinoma, NOS" (8010) by facility type and volume group ........................................................................................... 86 Figure 3C. Site/type: ovary. Prevalence of "papillary adenocarcinoma, NOS" (8260) by facility type and volume group ................................................................... 87 Figure 3D. Site/type: ovary. Prevalence of "3 nonspecific diagnoses" (8140, 8010, 8260) by facility type and volume group .................................................................... 88 Figure 4A. Site/type: pancreas. Prevalence of "carcinoma, NOS" (8010) by facility type and volume group .................................................................................................. 89 Figure 4B. Site/type: pancreas. Prevalence of "malignant neoplasm, NOS" (8000) by facility type and volume group ............................................................................. 90 Figure 4C. Site/type: pancreas. Prevalence of "2 nonspecific diagnoses" (8010, 8000) by facility type and volume group .................................................................... 91 Figure 5. Site/type: uterine corpus. Prevalence of "adenocarcinoma, NOS" (8140) by facility type and volume group ............................................................................. 92
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