Validating billing/encounter codes as indicators of lung, colorectal, breast, and prostate cancer recurrence using 2 large contemporary cohorts

Abstract

Background: A substantial proportion of cancer-related mortality is attributable to recurrent, not de novo metastatic disease, yet we know relatively little about these patients. To fill this gap, investigators often use administrative codes for secondary malignant neoplasm or chemotherapy to identify recurrent cases in population-based datasets. However, these algorithms have not been validated in large, contemporary, routine care cohorts.

Objective: To evaluate the validity of secondary malignant neoplasm and chemotherapy codes as indicators of recurrence after definitive local therapy for stage I-III lung, colorectal, breast, and prostate cancer.

Research design, subjects, and measures: We assessed the sensitivity, specificity, and positive predictive value (PPV) of these codes 14 and 60 months after diagnosis using 2 administrative datasets linked with gold-standard recurrence status information: CanCORS/Medicare (diagnoses 2003-2005) and HMO/Cancer Research Network (diagnoses 2000-2005).

Results: We identified 929 CanCORS/Medicare patients and 5298 HMO/CRN patients. Sensitivity, specificity, and PPV ranged widely depending on which codes were included and the type of cancer. For patients with lung, colorectal, and breast cancer, the combination of secondary malignant neoplasm and chemotherapy codes was the most sensitive (75%-85%); no code-set was highly sensitive and highly specific. For prostate cancer, no code-set offered even moderate sensitivity (≤ 19%).

Conclusions: Secondary malignant neoplasm and chemotherapy codes could not identify recurrent cancer without some risk of misclassification. Findings based on existing algorithms should be interpreted with caution. More work is needed to develop a valid algorithm that can be used to characterize outcomes and define patient cohorts for comparative effectiveness research studies.

Figure 1. Sensitivity and Specificity of Administrative Codes for Recurrent Lung, Colorectal, and Breast Cancer

Left Panel: Comparing the core set of secondary malignant neoplasm codes with the core set plus the addition of codes for lymph nodes and non-specific sites. Right Panel: Stage stratified results for the combination of either secondary malignant neoplasm or chemotherapy codes. The CanCORS dataset did not include breast cancer patients, so these columns are noted as not applicable (NA). Prostate cancer results were substantially lower and varied little by type of code or stage, so are not displayed.

Figure 2. Positive Predictive Values for the HMO/CRN Sample

Positive predictive values (PPV's) at 14- and 60-months using secondary malignancy codes, chemotherapy codes, or the combination (either secondary malignancy or chemotherapy).