Megan Eguchi, MPh Sana karam, md, phd SEER-Medicare: Using healthcare claims to identify treatment and outcomes in Head and Neck Cancer Megan Eguchi, MPh Sana karam, md, phd

Types of Registry Data National Cancer Database: can easily obtain, user- friendly, no tobacco data, no meds, no cause specific mortality, no cost data, no toxicity data SEER Database: similar to NCDB, fewer cases, but has clinical, demographic and cause of death information for persons with cancer SEER MEDICARE Database: longitudinal, with claims for all covered fee-for-service health care from the time of eligibility to death

Why Link the SEER-Medicare data? The linked data can be used for a number of analyses that span the course of cancer control activities Diagnosis/ Tx  Survivorship  Second Occurrence  Terminal Care Rates of second primaries Relationship of second events to initial treatment and ongoing surveillance Patterns of care Peri-operative complications Volume outcomes studies Extent of staging Comorbidities Late effects of treatment Post-diagnostic surveillance Treatment of prevalent cancers Survival Use of hospice services Patterns of care during the last year of life Quality of care, health disparities, and cost of treatment

How to obtain SEER Medicare? Define research questions Get a cost estimate https://healthcaredelivery.cancer.gov/seermedicare/obtain/costcalc.ht ml Submit to IRB, submit to SEER https://healthcaredelivery.cancer.gov/seermedicare/obtain/requests.ht ml#prev_appr Can obtain one free update

SEER-Medicare Overview SEER-Medicare Linked Database Population Health Shared Resource Role Projects

SEER Surveillance, Epidemiology, and End Results (SEER) Population-based cancer registries covering approximately 28% of the U.S. population Cancer incidence data Patient demographics Tumor characteristics at diagnosis First course of treatment Follow-up on vital status Cases diagnosed 1973-2014

Medicare Eligibility Medicare Fee-for-Service (FFS) Age 65 or older Some younger persons with disabilities End-Stage Renal Disease Medicare Fee-for-Service (FFS) Medicare Part A: Hospital Insurance Inpatient hospital stays, skilled nursing facilities, hospice, home health Medicare Part B: Medical Insurance Physician services, outpatient care, medical supplies Medicare Part D: Prescription drug coverage Voluntary supplemental plan initiated in 2006 Medicare Part C (Medicare Advantage) Offered by a private company that contracts with Medicare

SEER-Medicare Linked Database SEER data linked to Medicare FFS claims 93% of SEER patients age 65 and older 67% of Medicare beneficiaries have Medicare FFS Inpatient, outpatient, physician visits, durable medical equipment, home health, hospice claims 71% of Medicare beneficiaries have Part D coverage Prescription drug claims Benefits: Two population-based datasets Detailed data at diagnosis combined with longitudinal claims data De-identified existing dataset Limitations: Medicare FFS population Administrative dataset

SEER-Medicare Measures Patient demographic and socioeconomic characteristics Physician characteristics Hospital characteristics Comorbidity Screening Cancer surgery Radiation therapy Chemotherapy use Complications/toxicity Health care costs

Population Health Shared Resource (PHSR) Facilitate cancer prevention and control research in the clinic, community, and population settings. Aim 1. Provide access to data available through COMPASS, Practice-based Research Networks, & Colorado Cancer Registry, SEER, SEER-Medicare Aim 2. Assist with management of population-based data sets Aim 3. Support growth in prevention and control investigations Collaborate with Cancer Center Members and Shared Resources Research projects initiated by Cancer Center Members Data storage with Biostatistics and Bioinformatics Shared Resource Data processing using SAS and Stata

Head and Neck Cancer Projects Outcomes Between Concurrent Cisplatin vs. Cetuximab in Locally Advanced Oropharyngeal Carcinoma (Amini) Study population: Persons receiving concurrent chemoradiation with Cisplatin vs. Cetuximab Outcome measures: Survival time, toxicity events, costs Survival Impact and Toxicity of Metformin in Head and Neck Cancer (Stokes) Study population: Non-diabetic patients compared to diabetic patients with and without Metformin prescriptions Outcome measures: Survival time, toxicity events Short- and Long-Term Use of Opioids in Head and Neck Cancer Patients Receiving Definitive Treatment (McDermott) Study population: Patients undergoing definitive treatment with at least six months survival time Outcome measures: Time on opioids based on prescription claims

Final Thoughts About Using SEER-Medicare Data Secondary data sources such as SEER-Medicare can be a powerful source of information because of their size and breadth However, these types of data do not offer definitive information about quality- why was treatment not given, what other factors influenced outcomes These data should be used to determine where more in-depth research should be focused.

More Details on the SEER-Medicare data SEER-Medicare WEB site http://appliedresearch.cancer.gov/seermedicare Cancer Center Population Health Shared Resource https://cu.corefacilities.org/service_center/show_external/4444

Thank you Cathy Bradley, PhD Bernard Jones, PhD Arya Amini, MD William Stokes, MD Jessica McDermott, MD