Meeting News CoveragePerspective

Extent of thyroid surgery often miscoded in cancer registries

Registries that include extent of surgical procedure may frequently inaccurately code total thyroidectomy as thyroid lobectomy, according to a retrospective analysis of the Tennessee Cancer Registry presented during the plenary session of the Society for Surgical Oncology’s Annual Cancer Symposium.

Facilities accredited by the Commission on Cancer accounted for most of the inaccurately coded cases, results showed.

Analyses that have evaluated data from the National Cancer Data Base have shown that approximately 20% of patients with thyroid cancer who underwent thyroid lobectomy received radioiodine, which is not standard treatment.

Colleen M. Kiernan, MD, MPH, a resident in the division of surgical oncology and endocrine surgery at Vanderbilt University Medical Center, and colleagues surmised that many thyroid cancer registry abstracts inaccurately coded the extent of the surgical procedure.

To assess their hypothesis, researchers conducted a retrospective review of thyroid cancer cases recorded in the Tennessee Cancer Registry, which receives case information from statewide providers and health care facilities that diagnose and treat patients with cancer.

Certified registrars at the registry reviewed abstracts and/or telephoned reporting facility staff to confirm whether thyroid lobectomy was the performed procedure.

There were 918 thyroid cancer cases in which the definitive surgical procedure was coded as thyroid lobectomy between 2004 and 2011.

Of these cases, 40.2% (n = 369) were incorrectly coded, most of which the researchers changed to total thyroidectomy (65.6%; n = 242).

When researchers classified hospitals in the registry as Commission-on-Cancer–accredited or non-accredited, they found 85% of the 242 cases changed from thyroid lobectomy to total thyroidectomy were reported from Commission-on-Cancer–accredited facilities.

The researchers then performed a subgroup analysis of 184 (20%) records originally coded as thyroid lobectomy with postoperative radioiodine receipt. Of these, 62.5% (n = 115) were inaccurately coded.

Overall, only 7.5% of patients who underwent thyroid lobectomy actually received postoperative radioiodine, which represented a significant difference compared with the recorded 20% in the registry (P < .01 for comparison).

“These Commission on Cancer facilities contribute case information to other large national cancer databases, such as the National Cancer Data Base,” Kiernan and colleagues wrote. “Using text-to-code reabstraction audits and facility contact where needed, these discrepancies can be corrected to improve data quality.” – by Cameron Kelsall

Reference:

Kiernan CM, et al. Abstract 5. Presented at: Society for Surgical Oncology Annual Cancer Symposium; March 2-5, 2016; Boston.

Disclosure: HemOnc Today could not confirm the researchers’ relevant financial disclosures at the time of reporting.

Registries that include extent of surgical procedure may frequently inaccurately code total thyroidectomy as thyroid lobectomy, according to a retrospective analysis of the Tennessee Cancer Registry presented during the plenary session of the Society for Surgical Oncology’s Annual Cancer Symposium.

Facilities accredited by the Commission on Cancer accounted for most of the inaccurately coded cases, results showed.

Analyses that have evaluated data from the National Cancer Data Base have shown that approximately 20% of patients with thyroid cancer who underwent thyroid lobectomy received radioiodine, which is not standard treatment.

Colleen M. Kiernan, MD, MPH, a resident in the division of surgical oncology and endocrine surgery at Vanderbilt University Medical Center, and colleagues surmised that many thyroid cancer registry abstracts inaccurately coded the extent of the surgical procedure.

To assess their hypothesis, researchers conducted a retrospective review of thyroid cancer cases recorded in the Tennessee Cancer Registry, which receives case information from statewide providers and health care facilities that diagnose and treat patients with cancer.

Certified registrars at the registry reviewed abstracts and/or telephoned reporting facility staff to confirm whether thyroid lobectomy was the performed procedure.

There were 918 thyroid cancer cases in which the definitive surgical procedure was coded as thyroid lobectomy between 2004 and 2011.

Of these cases, 40.2% (n = 369) were incorrectly coded, most of which the researchers changed to total thyroidectomy (65.6%; n = 242).

When researchers classified hospitals in the registry as Commission-on-Cancer–accredited or non-accredited, they found 85% of the 242 cases changed from thyroid lobectomy to total thyroidectomy were reported from Commission-on-Cancer–accredited facilities.

The researchers then performed a subgroup analysis of 184 (20%) records originally coded as thyroid lobectomy with postoperative radioiodine receipt. Of these, 62.5% (n = 115) were inaccurately coded.

Overall, only 7.5% of patients who underwent thyroid lobectomy actually received postoperative radioiodine, which represented a significant difference compared with the recorded 20% in the registry (P < .01 for comparison).

“These Commission on Cancer facilities contribute case information to other large national cancer databases, such as the National Cancer Data Base,” Kiernan and colleagues wrote. “Using text-to-code reabstraction audits and facility contact where needed, these discrepancies can be corrected to improve data quality.” – by Cameron Kelsall

Reference:

Kiernan CM, et al. Abstract 5. Presented at: Society for Surgical Oncology Annual Cancer Symposium; March 2-5, 2016; Boston.

Disclosure: HemOnc Today could not confirm the researchers’ relevant financial disclosures at the time of reporting.

    Perspective
    Saral Mehra

    Saral Mehra

    This study highlights important issues regarding the quality of data in hospital and state cancer registries, finding that in one state’s cancer registry, over 40% of thyroid cancer cases were incorrectly coded as thyroid lobectomy. In fact, 66% of those cases actually received a total thyroidectomy. The implication is that such coding errors may extend to other states and cancer diagnoses, and also undermine the interpretation of registry research studies.
    Our previous publications on database and registry research on thyroid cancer summarize the advantages and disadvantages of various types of cancer registries used in the United States, and this study highlights one such disadvantage: quality control. Numerous studies have shown that cancer statistics and research conclusions can be greatly impacted by the quality of data used in registry research. In one of our publications, we present the advantages of a patient-centric, cloud-based disease management tool — the Thyroid Cancer Care Collaborative — integrated into physician workflow to improve the quality of thyroid cancer data used in research.
    Although at first glance this may seem like a study arguing for limited use of any registry data for large-scale research, it is actually the contrary. Researchers must continue to use the wealth of information available in cancer registries — unmatched by any other disease process in the United States — while controlling for quality concerns in study design, and show cancer registrars that their daily work is useful and has meaning.
    Further, hospitals should give tumor registries the resources needed to collect and report meaningful high-quality data — data that can be used by the hospitals themselves for internal quality control and process improvement. From 2000 to 2011, the number of new thyroid cancer cases per year reported to the National Cancer Data Base increased from 15,000 to over 35,000. Was there a related increase in resources devoted to tumor registries?

    References:
    Mehra S, et al. Thyroid. 2014;doi:10.1089/thy.2013.0441.
    Urken ML, et al. Head Neck. 2012;doi:10.1002/hed.23615.
    • Saral Mehra, MD, MBA
    • Yale University School of Medicine Smilow Cancer Hospital

    Disclosures: Mehra reports no relevant financial disclosures.

    Perspective
    Miriam N. Lango, MD, FACS

    Miriam N. Lango, MD, FACS

    Efforts to improve the quality of health care critically depend on the accuracy of documentation that measure the effectiveness of quality improvement initiatives. Prior reviews of large databases have found substantial and pervasive deviations from standards of care in clinical practice.

    Kiernan and colleagues hypothesized that some observed deviations were a result of documentation errors. As part of their study, researchers reviewed 918 thyroid cancer cases from the Tennessee Cancer Registry from 2004 to 2011. They found that of these cases, 369 were incorrectly coded, and most errors (85%) were attributable to facilities accredited by the American College of Surgeons’ Commission on Cancer (COC). This is an unexpected finding, since COC-accredited institutions are distinguished by their commitment to quality cancer care.

    In reviewing the errors in documentation, the researchers found that, in fact, the correct procedures were done most of the time. Thus, there were errors in reporting, and not in practice. Facilities with COC accreditation were more likely to commit documentation errors that would reflect poorly on the quality of care delivered at their facilities. Although it is reassuring that documentation errors may be more common than deviations from the medical standard of care, this study highlights the need for quality assurance in data collection, as well as the substantial burden that such documentation requirements may represent for some institutions. We can wonder if billing records are subject to the same kinds of errors.

    • Miriam N. Lango, MD, FACS
    • Fox Chase Cancer Center

    Disclosures: Lango reports no relevant financial disclosures.