Patterns of Care and Data Quality in a National Registry of Black and White Patients with Merkel Cell Carcinoma
Abstract
:Simple Summary
Abstract
1. Introduction
2. Methods
2.1. Patient Selection
2.2. Outcomes
2.3. Statistical Analysis
3. Results
3.1. Patient Demographics
3.2. Tumor Characteristics
3.3. Treatment Patterns
3.4. Data Quality
3.5. Overall Survival
3.6. Sensitivity Analysis
4. Discussion
Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Total | White | Black | ||||||
---|---|---|---|---|---|---|---|---|
N | Prop | N | Prop | N | Prop | p-Value | ||
34,503 | 31,947 | 93% | 2556 | 7% | ||||
Age | <0.0001 | |||||||
49 or less | 5439 | 16% | 4239 | 13% | 1200 | 47% | ||
50–59 | 4267 | 12% | 3782 | 12% | 485 | 19% | ||
60–69 | 6729 | 20% | 6313 | 20% | 416 | 16% | ||
70–79 | 8751 | 25% | 8456 | 26% | 295 | 12% | ||
80+ | 9317 | 27% | 9157 | 29% | 160 | 6% | ||
Sex | <0.0001 | |||||||
Male | 20,528 | 59% | 19,350 | 61% | 1178 | 46% | ||
Female | 13,975 | 41% | 12,597 | 39% | 1378 | 54% | ||
Insurance Status | <0.0001 | |||||||
Private Insurance | 11,769 | 35% | 10,772.8 | 34% | 1202.5 | 47% | ||
Not Insured | 763 | 2% | 588.6 | 2% | 198.9 | 8% | ||
Government | 21,427 | 63% | 20,585.6 | 64% | 1154.6 | 45% | ||
Unknown | 544 | |||||||
Analytic Stage | <0.0001 | |||||||
Stage I | 9555 | 49% | 15,752.5 | 49% | 925.9 | 36% | ||
Stage II | 3914 | 20% | 6622 | 21% | 792.2 | 31% | ||
Stage III | 4602 | 24% | 7227.7 | 23% | 543.3 | 21% | ||
Stage IV | 1432 | 7% | 2344.8 | 7% | 294.6 | 12% | ||
Unknown | 15,000 | |||||||
Definitive Resection | 0.3833 | |||||||
No Definitive Resection | 17,450 | 51% | 16,179 | 51% | 1271 | 50% | ||
Definitive Resection | 17,053 | 49% | 15,768 | 49% | 1285 | 50% | ||
Definitive Resection (within first 42 days) | 0.4932 | |||||||
No Definitive Resection | 23,657 | 69% | 21,810 | 68% | 1847 | 72% | ||
Definitive Resection | 10,846 | 31% | 10,137 | 32% | 709 | 28% | ||
Time to Definitive Resection Quartile | <0.0001 | |||||||
Within 21 days | 4765 | 28% | 4431 | 28% | 334 | 26% | ||
22–35 days | 4330 | 25% | 4066 | 26% | 264 | 21% | ||
36–56 days | 4160 | 24% | 3890 | 25% | 270 | 21% | ||
Greater than 57 days | 3798 | 22% | 3381 | 21% | 417 | 32% | ||
No Definitive Resection | 17,450 | 16,179 | 1271 | |||||
Radiation | <0.0001 | |||||||
No Radiation | 23,775 | 69% | 21,583 | 68% | 2192 | 86% | ||
Radiation | 10,728 | 31% | 10,364 | 32% | 364 | 14% | ||
Time to Radiation Quartile | <0.0001 | |||||||
Within 60 days | 2934 | 27% | 2855 | 28% | 79 | 22% | ||
61–80 days | 2402 | 22% | 2341 | 23% | 61 | 17% | ||
81–110 days | 2710 | 25% | 2636 | 25% | 74 | 20% | ||
Greater than 110 days | 2682 | 25% | 2532 | 24% | 150 | 41% | ||
No RT | 23,775 | 21,583 | 2192 | |||||
Chemotherapy | <0.0001 | |||||||
No Chemo | 32,049 | 93% | 29,606 | 93% | 2443 | 96% | ||
Chemotherapy | 2454 | 7% | 2341 | 7% | 113 | 4% | ||
Time to Chemo Quartile | 0.8801 | |||||||
Within 30 days | 520 | 21% | 495 | 21% | 25 | 22% | ||
31–60 days | 701 | 29% | 671 | 29% | 30 | 27% | ||
61–100 days | 625 | 25% | 598 | 26% | 27 | 24% | ||
Greater than 100 days | 608 | 25% | 577 | 25% | 31 | 27% | ||
No Chemo | 32,049 | 29,606 | 2443 | |||||
Charlson/Deyo Comorbidity Score | 0.0323 | |||||||
0 | 27,188 | 79% | 25,122 | 79% | 2066 | 81% | ||
1 | 5101 | 15% | 4757 | 15% | 344 | 13% | ||
2 or more | 2214 | 6% | 2068 | 6% | 146 | 6% | ||
Distance to Treatment Center | <0.0001 | |||||||
Less than 10 mi | 13,880 | 45% | 13,560.2 | 42% | 1572.7 | 62% | ||
10–25 mi | 8487 | 27% | 8860.3 | 28% | 574.1 | 22% | ||
25–50 mi | 4210 | 14% | 4575.7 | 14% | 199.9 | 8% | ||
50–100 mi | 2657 | 9% | 2916.7 | 9% | 126.4 | 5% | ||
100 mi or more | 1849 | 6% | 2034.1 | 6% | 82.9 | 3% | ||
Unknown | 3420 | |||||||
Zip Code Income Level | <0.0001 | |||||||
$63,000+ | 11,407 | 37% | 12,120 | 38% | 492.3 | 19% | ||
$48,000–63,000 | 8470 | 27% | 8901.3 | 28% | 527 | 21% | ||
$38,000–48,000 | 6904 | 22% | 7096.2 | 22% | 598 | 23% | ||
$0–38,000 | 4263 | 14% | 3829.5 | 12% | 938.7 | 37% | ||
Unknown | 3459 | |||||||
Diagnosis Year | 0.0705 | |||||||
2006–2008 | 6883 | 20% | 6324 | 20% | 559 | 22% | ||
2009–2011 | 7769 | 23% | 7201 | 23% | 568 | 22% | ||
2012–2014 | 9185 | 27% | 8510 | 27% | 675 | 26% | ||
2015–2017 | 10,666 | 31% | 9912 | 31% | 754 | 29% | ||
Tumor Size | <0.0001 | |||||||
No mass found/Microscopic | 554 | 3% | 1209.3 | 4% | 32.8 | 1% | ||
Less than 2 cm | 11,323 | 56% | 18,606.2 | 58% | 916.7 | 36% | ||
2–5 cm | 6135 | 30% | 9132.6 | 29% | 1001.2 | 39% | ||
Greater than 5 cm | 2221 | 11% | 2998.9 | 9% | 605.3 | 24% | ||
Size unknown | 14,270 | |||||||
Resection Margins | <0.0001 | |||||||
No Residual Tumor | 26,339 | 88% | 25,401.2 | 88% | 2005.2 | 84% | ||
Residual Tumor | 3630 | 12% | 3510.8 | 12% | 373.8 | 16% | ||
No Definitive Resection | 3212 | 3035 | 177 | |||||
Definitive Resection w/unknown margins | 1322 | |||||||
Primary Site | <0.0001 | |||||||
Head/Neck | 14,812 | 43% | 14,199 | 44% | 613 | 24% | ||
Trunk | 7164 | 21% | 6132 | 19% | 1032 | 40% | ||
Limbs | 10,879 | 32% | 10,034 | 31% | 845 | 33% | ||
Other/NOS | 1648 | 5% | 1582 | 5% | 66 | 3% | ||
Immune Suppression | 0.0062 | |||||||
Immunocompetent | 5692 | 89% | 27,386.1 | 86% | 1847.8 | 72% | ||
Immunosuppressed | 680 | 11% | 4560.9 | 14% | 708.2 | 28% | ||
Unknown | 28,077 | |||||||
Positive Lymph Nodes | 0.4507 | |||||||
None positive | 7285 | 62% | 22,584.3 | 71% | 1806.1 | 71% | ||
1–3 positive | 3577 | 30% | 7468.6 | 23% | 626.6 | 25% | ||
4–8 positive | 603 | 5% | 1170 | 4% | 77.3 | 3% | ||
9 or more positive | 378 | 3% | 724.1 | 2% | 46 | 2% | ||
Unknown | 22,660 | |||||||
Facility Type | <0.0001 | |||||||
Academic/Research Program | 15,206 | 48% | 15,451 | 48% | 1409.1 | 55% | ||
Community Cancer Program | 12,759 | 41% | 12,978.6 | 41% | 788 | 31% | ||
Integrated Network Program | 3525 | 11% | 3517.4 | 11% | 358.9 | 14% | ||
Facility Type Suppressed (age < 40) a | 3013 | |||||||
Facility Case Volume | <0.0001 | |||||||
Lowest Third | 11,431 | 33% | 10,548 | 33% | 883 | 35% | ||
Middle Third | 11,470 | 33% | 10,494 | 33% | 976 | 38% | ||
Largest Third | 11,602 | 34% | 10,905 | 34% | 697 | 27% |
Race Effect | Confidence Interval | p-Value | ||
---|---|---|---|---|
Disease Characteristics | ||||
Cancer Stage A,1 | 1.41 | 1.25–1.59 | <0.0001 | |
Tumor Size A,1 | 1.99 | 1.77–2.24 | <0.0001 | |
Number of Positive Nodes A,1 | 1.14 | 0.96–1.38 | 0.1561 | |
Subsite B,2 | <0.0001 | |||
Head/Neck | ref | |||
Trunk | 1.87 | 1.66–2.10 | <0.0001 | |
Limbs | 1.24 | 1.10–1.39 | 0.0004 | |
Other/NOS | 0.86 | 0.66–1.13 | 0.2950 | |
Treatment Characteristics | ||||
Facility Volume A,3 | 1.26 | 1.16–1.38 | <0.0001 | |
Definitive Resection (within 42 days) C,4 | 0.85 | 0.77–0.94 | 0.0011 | |
Time to Definitive Resection Quartile A,4,* | 1.22 | 1.09–1.37 | 0.0007 | |
Positive Surgical Margins (DR pts only) C,4 | 1.20 | 0.93–1.53 | 0.1566 | |
Radiation (DR pts only) C,4 | 0.51 | 0.42–0.61 | <0.0001 | |
Time to Radiation Quartile (DR pts only) A,4,* | 1.80 | 1.30–2.50 | 0.0004 | |
Radiation (no DR pts only) C,4 | 0.54 | 0.45–0.64 | <0.0001 | |
Time to Radiation Quartile (no DR pts only) A,4,* | 1.30 | 0.98–1.73 | 0.0645 | |
Chemo (DR only) C,5 | 0.50 | 0.31–0.79 | 0.0031 | |
Time to Chemo Quartile (DR pts only) A,5,* | 2.31 | 0.97–6.14 | 0.0933 | |
Chemo (no DR pts only) C,5 | 0.63 | 0.48–0.85 | 0.0020 | |
Time to Chemo Quartile (no DR pts only) A,5,* | 1.16 | 0.77–1.76 | 0.4723 | |
Data Quality | ||||
Missing Cancer Stage C,6 | 1.69 | 1.52–1.88 | <0.0001 | |
Missing Tumor Size C,6 | 0.87 | 0.79–0.96 | 0.0072 | |
Missing Nodal Information C,6 | 2.10 | 1.84–2.40 | <0.0001 |
Adj HR | 95% CI | p-Values | |||||
---|---|---|---|---|---|---|---|
Race | <0.0001 | ||||||
White | Reference | ||||||
Black | 0.73 | 0.65 | 0.81 | <0.0001 | |||
Age | <0.0001 | ||||||
49 or less | Reference | ||||||
50–59 | 2.93 | 2.54 | 3.37 | <0.0001 | |||
60–69 | 4.42 | 3.87 | 5.05 | <0.0001 | |||
70–79 | 7.16 | 6.26 | 8.19 | <0.0001 | |||
80+ | 14.92 | 13.05 | 17.07 | <0.0001 | |||
Sex | <0.0001 | ||||||
Male | Reference | ||||||
Female | 0.78 | 0.75 | 0.81 | <0.0001 | |||
Insurance Status | <0.0001 | ||||||
Private Insurance | Reference | ||||||
Not Insured | 1.38 | 1.15 | 1.66 | 0.0006 | |||
Government | 1.35 | 1.27 | 1.43 | <0.0001 | |||
Analytic Stage | <0.0001 | ||||||
Stage I | Reference | ||||||
Stage II | 1.19 | 1.10 | 1.30 | <0.0001 | |||
Stage III | 1.29 | 1.10 | 1.51 | 0.0013 | |||
Stage IV | 1.88 | 1.62 | 2.20 | <0.0001 | |||
Procedure (time-varying covariate) | <0.0001 | ||||||
No Procedure | Reference | ||||||
Excision/Biopsy/Other | 0.64 | 0.59 | 0.68 | <0.0001 | |||
Mohs | 0.56 | 0.51 | 0.62 | <0.0001 | |||
Wide Local Excision | 0.61 | 0.57 | 0.65 | <0.0001 | |||
Radiation (time-varying covariate) | 0.0065 | ||||||
No Radiation | Reference | ||||||
Radiation | 1.06 | 1.02 | 1.10 | 0.0065 | |||
Chemotherapy (time-varying covariate) | <0.0001 | ||||||
No Chemo | Reference | ||||||
Chemotherapy | 1.66 | 1.55 | 1.78 | <0.0001 | |||
Charlson/Deyo Comorbidity Score | <0.0001 | ||||||
0 | Reference | ||||||
1 | 1.25 | 1.19 | 1.32 | <0.0001 | |||
2 or more | 1.81 | 1.70 | 1.93 | <0.0001 | |||
Distance to Treatment Center | 0.6678 | ||||||
Less than 10 mi | Reference | ||||||
10–25 mi | 1.01 | 0.96 | 1.06 | 0.7172 | |||
25–50 mi | 0.96 | 0.90 | 1.02 | 0.2219 | |||
50–100 mi | 0.99 | 0.91 | 1.07 | 0.7285 | |||
100 mi or more | 0.97 | 0.89 | 1.07 | 0.5535 | |||
Zip Code Income Level | <0.0001 | ||||||
$63,000+ | Reference | ||||||
$48,000–63,000 | 1.04 | 0.99 | 1.10 | 0.0955 | |||
$38,000–48,000 | 1.11 | 1.05 | 1.16 | 0.0002 | |||
$0–38,000 | 1.15 | 1.07 | 1.22 | <0.0001 | |||
Diagnosis Year | <0.0001 | ||||||
2006–2008 | Reference | <0.0001 | |||||
2009–2011 | 1.03 | 0.97 | 1.08 | 0.3151 | |||
2012–2014 | 0.98 | 0.93 | 1.03 | 0.4569 | |||
2015–2016 | 0.86 | 0.81 | 0.92 | <0.0001 | |||
Tumor Size | <0.0001 | ||||||
No mass found/Microscopic | Reference | Reference | |||||
Less than 2 cm | 1.30 | 1.10 | 1.53 | 0.0025 | |||
2–5 cm | 1.37 | 1.16 | 1.63 | 0.0003 | |||
Greater than 5 cm | 1.60 | 1.33 | 1.92 | <0.0001 | |||
Resection Margins | <0.0001 | ||||||
No Residual Tumor | Reference | Reference | |||||
Residual Tumor | 1.35 | 1.27 | 1.43 | <0.0001 | |||
Primary Site | <0.0001 | ||||||
Head/Neck | Reference | ||||||
Trunk | 0.84 | 0.79 | 0.89 | <0.0001 | |||
Limbs | 0.86 | 0.82 | 0.90 | <0.0001 | |||
Other/NOS | 0.84 | 0.74 | 0.96 | 0.0103 | |||
Immune Suppression | 0.0001 | ||||||
Immunocompetent | Reference | ||||||
Immunosuppressed | 1.15 | 1.07 | 1.23 | 0.0001 | |||
Positive Lymph Nodes | 0.0080 | ||||||
None positive | Reference | ||||||
1–3 positive | 1.11 | 0.95 | 1.31 | 0.1841 | |||
4–8 positive | 1.25 | 1.01 | 1.54 | 0.0382 | |||
9 or more positive | 1.53 | 1.20 | 1.96 | <0.0001 | |||
Facility Type | 0.1433 | ||||||
Academic/Research Program | Reference | ||||||
Community Cancer Program | 1.06 | 1.00 | 1.12 | 0.0489 | |||
Integrated Network Program | 1.04 | 0.97 | 1.11 | 0.3267 | |||
Facility Case Volume | <0.0001 | ||||||
Lowest Third | Reference | ||||||
Middle Third | 0.96 | 0.91 | 1.01 | 0.0882 | |||
Largest Third | 0.86 | 0.80 | 0.92 | <0.0001 |
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Rattani, A.; Gaskins, J.; McKenzie, G.; Scharf, V.K.; Broman, K.; Pisu, M.; Holder, A.; Dunlap, N.; Schwartz, D.; Yusuf, M.B. Patterns of Care and Data Quality in a National Registry of Black and White Patients with Merkel Cell Carcinoma. Cancers 2022, 14, 5059. https://doi.org/10.3390/cancers14205059
Rattani A, Gaskins J, McKenzie G, Scharf VK, Broman K, Pisu M, Holder A, Dunlap N, Schwartz D, Yusuf MB. Patterns of Care and Data Quality in a National Registry of Black and White Patients with Merkel Cell Carcinoma. Cancers. 2022; 14(20):5059. https://doi.org/10.3390/cancers14205059
Chicago/Turabian StyleRattani, Abbas, Jeremy Gaskins, Grant McKenzie, Virginia Kate Scharf, Kristy Broman, Maria Pisu, Ashley Holder, Neal Dunlap, David Schwartz, and Mehran B. Yusuf. 2022. "Patterns of Care and Data Quality in a National Registry of Black and White Patients with Merkel Cell Carcinoma" Cancers 14, no. 20: 5059. https://doi.org/10.3390/cancers14205059
APA StyleRattani, A., Gaskins, J., McKenzie, G., Scharf, V. K., Broman, K., Pisu, M., Holder, A., Dunlap, N., Schwartz, D., & Yusuf, M. B. (2022). Patterns of Care and Data Quality in a National Registry of Black and White Patients with Merkel Cell Carcinoma. Cancers, 14(20), 5059. https://doi.org/10.3390/cancers14205059