Accuracy of Time to Treatment Initiation Data in Musculoskeletal Soft Tissue Sarcoma

Abstract

Background: Time to treatment initiation (TTI) is a quality metric in cancer care. The purpose of this study is to determine the accuracy of TTI data from a single cancer center registry that reports to the National Cancer Database (NCDB) for sarcoma diagnoses.

Methods: A retrospective analysis of a single Commission on Cancer (CoC)-accredited cancer center's tumor registry between 2006 and 2016 identified 402 patients who underwent treatment of a musculoskeletal soft tissue sarcoma and had TTI data available. Registry-reported TTI was extracted from the tumor registry. Effective TTI was manually calculated by medical record review as the number of days from the date of tissue diagnosis to initiation of first effective treatment. Effective treatment was defined as oncologic surgical excision or initiation of radiation therapy or chemotherapy. Registry-reported TTI and effective TTI values were compared for concordance in all patients.

Results: In the entire cohort, 25% (99/402) of patients had TTI data discordance, all related to surgical treatment definition. For patients with a registry-reported value of TTI = 0 days, 74% (87/118) had a diagnostic surgical procedure coded as their first treatment event, with 73 unplanned incomplete excision procedures and 14 incisional biopsies. In these patients, effective TTI was on average 59 days (P < 0.001). For patients with a registry-reported value of TTI >0 days, only 4% (12/284) had discordant TTI values.

Conclusions: Nearly three-fourths of patients with a registry-reported value of TTI = 0 days in a large, CoC-accredited cancer center registry had a diagnostic procedure coded as their first treatment event, though their effective treatment had not yet started. These data suggest that TTI is likely longer than what is reported to the NCDB. Redefinition of what constitutes surgical treatment should be considered to improve the accuracy of data used in measuring TTI in sarcoma.

Figure 1

Patient inclusion and exclusion criteria.

Figure 2

Registry-reported versus effective time to treatment initiation (TTI) by year of diagnosis. Overall difference between groups, P < 0.001; difference between registry-reported (gray) and effective TTI (orange) in all patients, P < 0.001; difference between registry-reported TTI in all patients (gray) and effective TTI in the original TTI = 0 cohort (blue), P < 0.001; difference between effective TTI in all patients (orange) and effective TTI in the original TTI = 0 cohort (blue), P=0.02. The mean TTI from 2006 to 2016 is listed next to the associated curve (44 days, 35 days, and 22 days).