Methodology of Conducting the Patterns of Ovarian Cancer Care and Survival in the Midwestern - PowerPoint Presentation

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Methodology of Conducting the Patterns of Ovarian Cancer Care and Survival in the Midwestern Region of the United States

Wilhelmina Ross,

PA, MPH, CTR - WestatJeannette Jackson-Thompson, MSPH, PHD n- Missouri Cancer Registry and Research Center Diane Ng, MPH, Westat Maricarmen Traverso-Ortiz, MPH, CTR - Westat

June 2019

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Background

Involvement of a gynecologic oncologist (GO) in the care of ovarian cancer patients leads to improved outcomes, perhaps related to greater adherence by GOs to guidelines-based procedures.

Standard treatment adherence, mortality and survival outcomes are significantly and consistently greater when GOs are involved in treatment. Being seen by a GO is the most significant predictor of whether a woman with ovarian cancer will receive standard treatment

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BackgroundGuidelines-based treatment consists of:Extensive debulking surgery; also called cytoreductionSpecific surgical staging techniques done during surgery

Chemotherapy with a typical regimen a combination cisplatin and paclitaxelNCCN guidelines specifically recommend that ovarian cancer surgery be performed by

GOs3

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BackgroundThere is an uneven distribution of GOs in the United States.GOs are more likely to be in urban cities.

Region with fewer practicing GOs includes: Iowa, Kansas, Minnesota, Missouri, North Dakota, Nebraska, and South Dakota

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Purpose and ObjectiveThis project pursued investigation of ovarian cancer treatment and survival in the Midwest region where the availability of GOs may be low when compared to other regions of the US. The purpose of the study was

to:Assess patterns of ovarian cancer care, treatment and survival; I

dentify factors associated with receipt of non-guidelines-based treatment. This presentation aims describe and analyze the methodology used throughout the study regarding study design and execution.5

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MethodsRecruitmentThree Midwest central cancer registries (CCRs)

participated in the studyIowa (SEER)Kansas (NPCR)Missouri (NPCR)Subcontract with Westat

Data collected included existing information from each registry’s database as well as additional study-specific data items obtained from reporting facility medical records. CCR staff followed a protocol developed by CDC and Westat.6

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Selection Criteria7

Inclusion

Exclusion

Primary Site: Ovary, C56.9; Fallopian Tube, C57.0; and Primary Peritoneal, C48.1-C48.8

Tumors of low malignant potential (ICD-O codes 8442, 8451, 8462, 8472, and 8473)

Behavior: 3 (Malignant)

Type of Reporting Source: Autopsy only and death certificate only

Histology: 8000-8576 and 8930 – 9110

Synchronous tumors

Year of Diagnosis*: 2011 and 2012

No records available to CCR

Age at Diagnosis:

>

18 and < 90

Resident of state other than where CCR located

Ovarian cancer must be the first primary cancer

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Study SampleRandom selection SAS Program was created by CDC and applied to an extraction of each

participating registry's database to create samples for the studydrew a random sample of 450 cases defined

inclusion and exclusion criteriacreated a file that could be imported into Abstract Pluscreated SAS datasets of the eligible population and a random sample for CDC to review8

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TrainingWebinar on study orientation and training given to each participating registry.CDC, Westat, and registries participated in training.

Abstract Plus demonstration given for data collection tutorial.Participating registries received:Study ProtocolData dictionary

Abstract Plus study specific software with v16 metafile that was modified with study-specific editsFAQs (living document)9

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Data CollectionOccurred between October 2017 and July 2018Abstract Plus data collection tool

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Data Collection11

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Results12

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Results13

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Results14

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Results15

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Results16

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Results17

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ChallengesRecruitment issues timing

funding mechanismsindividual state IRB review processes Customization of collection tool Delayed delivery of Abstract Plus

Reasons for difficulty with abstracting data related to chemotherapy Records had been archived and were difficult to retrieve.Physician offices where patients were seen had since closed.Some facilities had upgraded EHR systems and the records that were from the old EHR system could not be accessed without upper management approval.

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ConclusionThis study’s design, approach, and implementation was suitable overall for describing specific ovarian cancer treatment and survival in the Midwest.

The sample drawn is representative of the population in these states.The

data collection tool yielded high quality data for most items. A very rich data source to evaluate treatment adherence and outcomes now exists and can be used extensively to develop public health interventions to improve ovarian cancer burden. 19

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ConclusionEffectiveness of the data collection instrument

The instrument performed well across many of the elements.

We also learned important improvements that we can make in future similar data collection activities. Findings Provided critical lessons learned that can be applied to future data collection in this area and with regard to surgery, GO involvement and level of involvement, and second and third line chemotherapy can be collected from the medical records by cancer registries.

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ConclusionUncovered key issues with data collection, including incomplete or inadequate information. These data

will allow the CDC to help identify groups of women who are not receiving the benefit of optimal surgery and GO care and provide critical data for improvements we can make in the lives of cancer patients moving forward. 

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FundingThis project was conducted by CDC, Westat and the state cancer registries of Iowa, Kansas, and Missouri, and funded under CDC contract 200-2014-61258. The Iowa Cancer Registry is also funded in part with Federal funds from NIH/NCI contract HHSN261201800012I and cancer center support grant NIH/NCI P30CA086862. The Kansas Cancer Registry is also funded by the Kansas Department of Health and Environment. The Missouri Cancer Registry core activities are supported in part by a cooperative agreement between the Centers for Disease Control and Prevention (CDC) and the Missouri Department of Health and Senior Services (DHSS) (U58DP006299-01/02) and a Surveillance Contract between DHSS and the University of Missouri

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AcknowledgementsWe’d like to acknowledge the work of the Ovarian Cancer Treatment Study Group: Lisa L. Hunter, Charles F. Lynch, Michele M. West (Iowa Cancer Registry); Sue-Min Lai,

Sarma Garimella, John Keighley, Li Huang (Kansas Cancer Registry); Jeannette Jackson-Thompson, Nancy Hunt Rold, Chester L. Schmaltz, Saba

Yemane (Missouri Cancer Registry); Wilhelmina Ross, Diane Ng, Maricarmen Traverso-Ortiz (Westat); Jennifer M. Wike (CDC contractor); Trevor D. Thompson, Sun Hee Rim, Angela Moore, Sherri L. Stewart (CDC)23

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Thank You

Stay tuned for additional papers and presentations regarding the study.

Please contact the following for more information:Wilhelmina Ross, PA, MPH, CTR - WilhelminaRoss@Westat.com Jeannette Thompson-Jackson - jacksonthompsonj@health.missouri.edu Diane Ng, MPH -

DianeNg@Westat.com

Maricarmen Traverso-Ortiz, MPH, CTR -

MaricarmenTraversoOrtiz@Westat.com

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