Determining breast cancer recurrence following completion of active treatment: a novel approach using linked administrative health data

David Preen, Anna Kemp-Casey, Elizabeth Roughead, Derrick Lopez, Max Bulsara, Frances Boyle, Christobel Saunders

Research output: Contribution to journalAbstract/Meeting Abstract

Abstract

Objectives Although outcomes for the majority of women diagnosed with primary breast cancer are good, with five-year survival exceeding 90%, some women will experience cancer recurrence and ultimately die from the disease. It is important for patients, clinicians and health service planners to know the risk of recurrence once initial treatment for primary breast cancer is completed. However, none of Australia’s State or Territory cancer registries routinely report on cancer recurrence which could be used to evaluate this issue. To address this absence of direct reporting, we aimed to determine the incidence of cancer recurrence in Australian clinical practice after completion of treatment for primary breast cancer, using a range of linked health data sources. Approach We performed a retrospective cohort study using linked health data from New South Wales (NSW), Australia. Data were linked from six data collections: i) Cancer Registry, ii) Admitted Patient Data Collection, iii) Pharmaceutical Benefits Scheme claims, iv) Medicare (outpatient) claims, v) Death Registry; and the vi) NSW 45 and Up Study. We identified 2416 women diagnosed with primary invasive breast cancer during 2003-2008 in NSW who had not had a recurrence by 18 months post-diagnosis. Unit-level hospital, pharmacy and outpatient claims were used to identify services indicative of recurrence. Incidence of recurrence was calculated and multivariate Cox regression used to identify baseline and active treatment characteristics predictive of cancer recurrence up to six years post-diagnosis. Results A total of 217 women (9.0%) had a hospital, pharmacy or outpatient claim indicating breast cancer recurrence between 18 months and six years post-diagnosis. Overall annual cumulative incidence of recurrence was 3.3%. Recurrence was significantly higher for women with node-positive (4.8% vs. 2.5% annually, adjHR=1.7, 95%CI=1.3-2.3) or hormone receptor-negative (3.8% vs. 3.1% annually, adjHR=1.3, 95%CI=1.0-1.7) tumours. Women with tumours >2cm at diagnosis were more likely to experience recurrence within six years compared with those with a smaller initial tumour (4.8% vs. 2.7 annually, adjHR=1.5; 95%CI=1.1-2.0). Conclusions Women with breast cancer in this Australian cohort experienced recurrence at 3.3%pa in the years following completion of treatment. Those at greatest risk of recurrence were women with node-positive or hormone-receptor negative tumours, or tumours >2cm at initial diagnosis, consistent with international findings. This method for ascertaining breast cancer recurrence can be used to assess population-level changes over time and to investigate the impact of specific treatments on outcomes in the absence of available Cancer Registry data.
Original languageEnglish
JournalInternational Journal of Population Data Science
Volume1
DOIs
Publication statusPublished - 18 Apr 2017
EventInternational Population Data Linkage Conference - Swansea University Bay Campus, Swansea, United Kingdom
Duration: 24 Aug 201626 Aug 2016
https://www.ipdlnconference2016.org/

Fingerprint

Breast Neoplasms
Recurrence
Health
Neoplasms
Therapeutics
New South Wales
Registries
Outpatients
Incidence
Hormones
South Australia
Hospital Units
Information Storage and Retrieval
Medicare
Health Services
Cohort Studies
Retrospective Studies
Survival

Cite this

@article{26039fba077f4bfb877c659cc642aadd,
title = "Determining breast cancer recurrence following completion of active treatment: a novel approach using linked administrative health data",
abstract = "Objectives Although outcomes for the majority of women diagnosed with primary breast cancer are good, with five-year survival exceeding 90{\%}, some women will experience cancer recurrence and ultimately die from the disease. It is important for patients, clinicians and health service planners to know the risk of recurrence once initial treatment for primary breast cancer is completed. However, none of Australia’s State or Territory cancer registries routinely report on cancer recurrence which could be used to evaluate this issue. To address this absence of direct reporting, we aimed to determine the incidence of cancer recurrence in Australian clinical practice after completion of treatment for primary breast cancer, using a range of linked health data sources. Approach We performed a retrospective cohort study using linked health data from New South Wales (NSW), Australia. Data were linked from six data collections: i) Cancer Registry, ii) Admitted Patient Data Collection, iii) Pharmaceutical Benefits Scheme claims, iv) Medicare (outpatient) claims, v) Death Registry; and the vi) NSW 45 and Up Study. We identified 2416 women diagnosed with primary invasive breast cancer during 2003-2008 in NSW who had not had a recurrence by 18 months post-diagnosis. Unit-level hospital, pharmacy and outpatient claims were used to identify services indicative of recurrence. Incidence of recurrence was calculated and multivariate Cox regression used to identify baseline and active treatment characteristics predictive of cancer recurrence up to six years post-diagnosis. Results A total of 217 women (9.0{\%}) had a hospital, pharmacy or outpatient claim indicating breast cancer recurrence between 18 months and six years post-diagnosis. Overall annual cumulative incidence of recurrence was 3.3{\%}. Recurrence was significantly higher for women with node-positive (4.8{\%} vs. 2.5{\%} annually, adjHR=1.7, 95{\%}CI=1.3-2.3) or hormone receptor-negative (3.8{\%} vs. 3.1{\%} annually, adjHR=1.3, 95{\%}CI=1.0-1.7) tumours. Women with tumours >2cm at diagnosis were more likely to experience recurrence within six years compared with those with a smaller initial tumour (4.8{\%} vs. 2.7 annually, adjHR=1.5; 95{\%}CI=1.1-2.0). Conclusions Women with breast cancer in this Australian cohort experienced recurrence at 3.3{\%}pa in the years following completion of treatment. Those at greatest risk of recurrence were women with node-positive or hormone-receptor negative tumours, or tumours >2cm at initial diagnosis, consistent with international findings. This method for ascertaining breast cancer recurrence can be used to assess population-level changes over time and to investigate the impact of specific treatments on outcomes in the absence of available Cancer Registry data.",
author = "David Preen and Anna Kemp-Casey and Elizabeth Roughead and Derrick Lopez and Max Bulsara and Frances Boyle and Christobel Saunders",
year = "2017",
month = "4",
day = "18",
doi = "10.23889/ijpds.v1i1.210",
language = "English",
volume = "1",
journal = "International Journal of Population Data Science",
issn = "2399-4908",
publisher = "Swansea University",

}

TY - JOUR

T1 - Determining breast cancer recurrence following completion of active treatment

T2 - a novel approach using linked administrative health data

AU - Preen, David

AU - Kemp-Casey, Anna

AU - Roughead, Elizabeth

AU - Lopez, Derrick

AU - Bulsara, Max

AU - Boyle, Frances

AU - Saunders, Christobel

PY - 2017/4/18

Y1 - 2017/4/18

N2 - Objectives Although outcomes for the majority of women diagnosed with primary breast cancer are good, with five-year survival exceeding 90%, some women will experience cancer recurrence and ultimately die from the disease. It is important for patients, clinicians and health service planners to know the risk of recurrence once initial treatment for primary breast cancer is completed. However, none of Australia’s State or Territory cancer registries routinely report on cancer recurrence which could be used to evaluate this issue. To address this absence of direct reporting, we aimed to determine the incidence of cancer recurrence in Australian clinical practice after completion of treatment for primary breast cancer, using a range of linked health data sources. Approach We performed a retrospective cohort study using linked health data from New South Wales (NSW), Australia. Data were linked from six data collections: i) Cancer Registry, ii) Admitted Patient Data Collection, iii) Pharmaceutical Benefits Scheme claims, iv) Medicare (outpatient) claims, v) Death Registry; and the vi) NSW 45 and Up Study. We identified 2416 women diagnosed with primary invasive breast cancer during 2003-2008 in NSW who had not had a recurrence by 18 months post-diagnosis. Unit-level hospital, pharmacy and outpatient claims were used to identify services indicative of recurrence. Incidence of recurrence was calculated and multivariate Cox regression used to identify baseline and active treatment characteristics predictive of cancer recurrence up to six years post-diagnosis. Results A total of 217 women (9.0%) had a hospital, pharmacy or outpatient claim indicating breast cancer recurrence between 18 months and six years post-diagnosis. Overall annual cumulative incidence of recurrence was 3.3%. Recurrence was significantly higher for women with node-positive (4.8% vs. 2.5% annually, adjHR=1.7, 95%CI=1.3-2.3) or hormone receptor-negative (3.8% vs. 3.1% annually, adjHR=1.3, 95%CI=1.0-1.7) tumours. Women with tumours >2cm at diagnosis were more likely to experience recurrence within six years compared with those with a smaller initial tumour (4.8% vs. 2.7 annually, adjHR=1.5; 95%CI=1.1-2.0). Conclusions Women with breast cancer in this Australian cohort experienced recurrence at 3.3%pa in the years following completion of treatment. Those at greatest risk of recurrence were women with node-positive or hormone-receptor negative tumours, or tumours >2cm at initial diagnosis, consistent with international findings. This method for ascertaining breast cancer recurrence can be used to assess population-level changes over time and to investigate the impact of specific treatments on outcomes in the absence of available Cancer Registry data.

AB - Objectives Although outcomes for the majority of women diagnosed with primary breast cancer are good, with five-year survival exceeding 90%, some women will experience cancer recurrence and ultimately die from the disease. It is important for patients, clinicians and health service planners to know the risk of recurrence once initial treatment for primary breast cancer is completed. However, none of Australia’s State or Territory cancer registries routinely report on cancer recurrence which could be used to evaluate this issue. To address this absence of direct reporting, we aimed to determine the incidence of cancer recurrence in Australian clinical practice after completion of treatment for primary breast cancer, using a range of linked health data sources. Approach We performed a retrospective cohort study using linked health data from New South Wales (NSW), Australia. Data were linked from six data collections: i) Cancer Registry, ii) Admitted Patient Data Collection, iii) Pharmaceutical Benefits Scheme claims, iv) Medicare (outpatient) claims, v) Death Registry; and the vi) NSW 45 and Up Study. We identified 2416 women diagnosed with primary invasive breast cancer during 2003-2008 in NSW who had not had a recurrence by 18 months post-diagnosis. Unit-level hospital, pharmacy and outpatient claims were used to identify services indicative of recurrence. Incidence of recurrence was calculated and multivariate Cox regression used to identify baseline and active treatment characteristics predictive of cancer recurrence up to six years post-diagnosis. Results A total of 217 women (9.0%) had a hospital, pharmacy or outpatient claim indicating breast cancer recurrence between 18 months and six years post-diagnosis. Overall annual cumulative incidence of recurrence was 3.3%. Recurrence was significantly higher for women with node-positive (4.8% vs. 2.5% annually, adjHR=1.7, 95%CI=1.3-2.3) or hormone receptor-negative (3.8% vs. 3.1% annually, adjHR=1.3, 95%CI=1.0-1.7) tumours. Women with tumours >2cm at diagnosis were more likely to experience recurrence within six years compared with those with a smaller initial tumour (4.8% vs. 2.7 annually, adjHR=1.5; 95%CI=1.1-2.0). Conclusions Women with breast cancer in this Australian cohort experienced recurrence at 3.3%pa in the years following completion of treatment. Those at greatest risk of recurrence were women with node-positive or hormone-receptor negative tumours, or tumours >2cm at initial diagnosis, consistent with international findings. This method for ascertaining breast cancer recurrence can be used to assess population-level changes over time and to investigate the impact of specific treatments on outcomes in the absence of available Cancer Registry data.

U2 - 10.23889/ijpds.v1i1.210

DO - 10.23889/ijpds.v1i1.210

M3 - Abstract/Meeting Abstract

VL - 1

JO - International Journal of Population Data Science

JF - International Journal of Population Data Science

SN - 2399-4908

ER -