1. 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

2. 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

3. 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

4. How to obtain SEER Medicare?
Define research questions
Get a cost estimate ml
Submit to IRB, submit to SEER
ml#prev_appr
Can obtain one free update

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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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.

13. More Details on the SEER-Medicare data
SEER-Medicare WEB site
Cancer Center Population Health Shared Resource

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