Overview of All SEER-Medicare Publications

Outcomes Insights, Inc.

Mark D. Danese, MHS, PhDClaire Cangialose

March 23, 2016

Overview

● Information was extracted from the National Cancer Institute (NCI) online reference database for "SEER-Medicare" publications

○ http://healthcaredelivery.cancer.gov/seermedicare/overview/pubsearch.html ○ Data accessed January 18, 2016 - articles published in 2015 and 2016 may be

underrepresented due to reporting lag○ 1363 citations retrieved○ NCI classified all publications according to the following:

● 19 tumor types (e.g., colorectal, leukemia, etc.)● 28 topic areas (e.g., outcomes (all), health disparities, etc.)

● Summary measures were calculated by year, tumor site, topic area, journal, and author● Exploratory analyses were conducted to assess publication frequency relative to cancer incidence,

prevalence, and deaths● All analyses were conducted using R version 3.2.3 (2015-12-10)● All data were extracted from internet-based sources on January 18, 2016 using the rvest package

(version 0.3.1)● Figures were created using the ggplot2 package (version 2.1.0)● This report was generated using the ReporteRs package (version 0.8.6)

SEER-Medicare Publications Search

Tumor Sites:1. Breast2. Prostate3. Colorectal4. Lung5. All Sites or No Specific Site6. Other7. Urinary Bladder8. Head and Neck9. Pancreas10. Ovary11. Renal12. Lymphoma13. Liver14. Esophagus15. Corpus Uteri16. Leukemia17. Gastric18. Brain & Other Nervous System19. Cervical

Topic Areas:1. Outcomes (All)2. Treatment3. Palliative & End-of-Life Care4. Health Care Systems5. Health Disparities6. Economics of Cancer7. Economics of Cancer - Health Care

Costs8. Risk Factors9. Research Methodology10. None11. Survivorship12. Economics of Cancer - Cost of

Illness13. Screening14. Clinical Outcomes15. Prevention16. Surveillance17. Preventive & Screening Services18. Quality of Care19. Tobacco20. Health Behaviors & Survivorship21. Policy22. Methods for Assessing Risk

Factors23. Epidemiologic, Experimental, &

Methodological Studies24. Epidemiology Studies & Related

Methods25. Guidance & Policy Research26. Decision-Making27. Health-Related Quality of Life28. Outcomes Research Measures &

Methods

Summary of Publications

Exploratory Analyses: Publications Relative to Population Size

Methodology● Publication counts were plotted against tumor types● Counts of incident and prevalent patients, as well as deaths from cancer, were taken from SEER

published estimates● Ratios of publications to these patient counts were estimated

○ Publications divided by incidence (1,000 patients)○ Publications divided by prevalence (10,000 patients)○ Publications divided by deaths (1,000 deaths)○ Higher numbers reflect more publications per patient○ The median publication ratio across all tumors was used as an index for establishing high

versus low ratios

Publications per patient according to incidence, prevalence, and death

Bre

ast

Pros

tate

Col

orec

tal

Lung

Urin

ary

Bla

dder

Hea

d an

d N

eck

Panc

reas

Ova

ry

Ren

al

Lym

phom

a

Live

r

Esop

hagu

s

Cor

pus U

teri

Leuk

emia

Gas

tric

Bra

in &

Oth

er N

ervo

us S

yste

m

Cer

vica

l

Total Publication

s

318 314 299 188 60 59 53 50 50 42 33 28 21 19 18 11 9

% incide

nt patients 65 years

or older (2008

-2012)

43% 57% 60% 68% 73% 42% 66% 47% 49% 52% 46% 58% 42% 55% 61% 37% 20%

Pub/Incide

nce ratio per

1,000 (2015

)

1.4 1.4 2.3 0.8 0.8 1.3 1.1 2.3 0.8 0.5 0.9 1.6 0.4 0.4 0.7 0.5 0.7

Pub/Prevalence

1.1 1.1 2.6 4.6 1.0 2.0 11.6 2.6 1.3 0.6 6.5 7.8 0.3 0.6 2.3 0.7 0.4

Publications per patient according to incidence, prevalence, and death

Bre

ast

Pros

tate

Col

orec

tal

Lung

Urin

ary

Bla

dder

Hea

d an

d N

eck

Panc

reas

Ova

ry

Ren

al

Lym

phom

a

Live

r

Esop

hagu

s

Cor

pus U

teri

Leuk

emia

Gas

tric

Bra

in &

Oth

er N

ervo

us S

yste

m

Cer

vica

l

ratio per

10,000

(2012)

Pub/Deaths ratio

per 1,000 (2015

)

7.9 11.4 6.0 1.2 3.8 6.8 1.3 3.5 3.6 2.0 1.3 1.8 2.1 0.8 1.7 0.7 2.2

Notes: Higher numbers indicate more publications per patient (see table for comparisons to the median ratios)

Publications per patient according to incidence, prevalence, and death, standardized to the median ratio

Bre

ast

Pros

tate

Col

orec

tal

Lung

Urin

ary

Bla

dder

Hea

d an

d N

eck

Panc

reas

Ova

ry

Ren

al

Lym

phom

a

Live

r

Esop

hagu

s

Cor

pus U

teri

Leuk

emia

Gas

tric

Bra

in &

Oth

er N

ervo

us S

yste

m

Cer

vica

l

Total Publication

s

318 314 299 188 60 59 53 50 50 42 33 28 21 19 18 11 9

% incide

nt patients 65 years

or older (2008

-2012)

43% 57% 60% 68% 73% 42% 66% 47% 49% 52% 46% 58% 42% 55% 61% 37% 20%

Pub/Incide

nce ratio per

1,000 (2015

)

1.6 1.7 2.7 1.0 1.0 1.5 1.3 2.8 1.0 0.6 1.1 1.9 0.5 0.4 0.9 0.6 0.8

Pub/Prevalence

0.8 0.8 1.9 3.5 0.8 1.5 8.7 2.0 1.0 0.4 4.9 5.9 0.3 0.4 1.8 0.6 0.3

Publications per patient according to incidence, prevalence, and death, standardized to the median ratio

Bre

ast

Pros

tate

Col

orec

tal

Lung

Urin

ary

Bla

dder

Hea

d an

d N

eck

Panc

reas

Ova

ry

Ren

al

Lym

phom

a

Live

r

Esop

hagu

s

Cor

pus U

teri

Leuk

emia

Gas

tric

Bra

in &

Oth

er N

ervo

us S

yste

m

Cer

vica

l

ratio per

10,000

(2012)

Pub/Deaths ratio

per 1,000 (2015

)

3.8 5.5 2.9 0.6 1.8 3.3 0.6 1.7 1.7 1.0 0.7 0.9 1.0 0.4 0.8 0.3 1.1

Notes: Ratios reflect the tumor-specific publication ratio relative to median publication ratio (see table for non-standardized ratios) - values above 1.0 indicate ratios higher than the median, and values below 1.0 indicate ratios below the median (shaded orange)

Conclusions

● There has been steady growth in the number of publications over time using the SEER-Medicare data

● Breast, prostate, colorectal, and lung are the tumor sites with the highest number of publications○ This corresponds well with estimates of incidence and prevalence in the United States

population● The number of publications appears to align better with incidence and prevalence than with death,

particularly for more common cancers● Leukemia, lymphoma, lung, and renal might be under-represented in terms of the absolute number

of publications

Data Sources

● Incidence (2015), Prevalence (2012), and Deaths (2015)○ Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu

M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2012, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2012/, based on November 2014 SEER data submission, posted to the SEER web site, April 2015.

● Proportion of patients age 65 or older at diagnosis (2008-2012)○ U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2012

Incidence and Mortality Web-based Report. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; 2015. Available at: www.cdc.gov/uscs.

● All Site and Morphology classifications were aligned among all data sources with a few exceptions:

○ Head and Neck was defined using SEER/CDC category: Oral Cavity and Pharynx○ Corpus Uteri was defined using SEER/CDC category: Endometrial Cancer

Acknowledgements

Thanks to Marc Halperin and Ryan Duryea who helped to automate this and previous versions of this report

Contact Information

Mark D. DaneseOutcomes Insights, Inc.2801 Townsgate Road, Suite #330Westlake Village, CA 91361805-498-0034mark@outins.comwww.outins.com