Skip to main content

Advertisement

SpringerLink
Log in

Validation of self-reported comorbidity status of breast cancer patients with medical records: the California Breast Cancer Survivorship Consortium (CBCSC)

  • Original paper
  • Published:
Cancer Causes & Control Aims and scope Submit manuscript

Abstract

Purpose

To compare information from self-report and electronic medical records for four common comorbidities (diabetes, hypertension, myocardial infarction, and other heart diseases).

Methods

We pooled data from two multiethnic studies (one case–control and one survivor cohort) enrolling 1,936 women diagnosed with breast cancer, who were members of Kaiser Permanente Northern California.

Results

Concordance varied by comorbidity; kappa values ranged from 0.50 for other heart diseases to 0.87 for diabetes. Sensitivities for comorbidities from self-report versus medical record were similar for racial/ethnic minorities and non-Hispanic Whites, and did not vary by age, neighborhood socioeconomic status, or education. Women with a longer history of comorbidity or who took medications for the comorbidity were more likely to report the condition. Hazard ratios for all-cause mortality were not consistently affected by source of comorbidity information; the hazard ratio was lower for diabetes, but higher for the other comorbidities when medical record versus self-report was used. Model fit was better when the medical record versus self-reported data were used.

Conclusions

Comorbidities are increasingly recognized to influence the survival of patients with breast or other cancers. Potential effects of misclassification of comorbidity status should be considered in the interpretation of research results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

AIC:

Akaike information criterion

AJCC:

American Joint Committee on Cancer

CBCSC:

California Breast Cancer Survivorship Consortium

CCR:

California Cancer Registry

CI:

Confidence interval

EMR:

Electronic medical record

ER:

Estrogen receptor

HR:

Hazard ratio

KPMR:

Kaiser Permanente medical record

KPNC:

Kaiser Permanente Northern California

LACE:

Life After Cancer Epidemiology

MI:

Myocardial infarction

PR:

Progesterone receptor

SES:

Socioeconomic status

SFBCS:

San Francisco Bay Area Breast Cancer Study

References

  1. Patnaik JL, Byers T, DiGuiseppi C, Denberg TD, Dabelea D (2011) The influence of comorbidities on overall survival among older women diagnosed with breast cancer. J Natl Cancer Inst 103(14):1101–1111

    Article  PubMed Central  PubMed  Google Scholar 

  2. Land LH, Dalton SO, Jorgensen TL, Ewertz M (2012) Comorbidity and survival after early breast cancer. A review. Crit Rev Oncol Hematol 81(2):196–205

    Article  PubMed  Google Scholar 

  3. Tammemagi CM, Nerenz D, Neslund-Dudas C, Feldkamp C, Nathanson D (2005) Comorbidity and survival disparities among black and white patients with breast cancer. JAMA 294(14):1765–1772

    Article  CAS  PubMed  Google Scholar 

  4. Braithwaite D, Tammemagi CM, Moore DH, Ozanne EM, Hiatt RA, Belkora J, West DW, Satariano WA, Liebman M, Esserman L (2009) Hypertension is an independent predictor of survival disparity between African-American and white breast cancer patients. Int J Cancer 124(5):1213–1219

    Article  CAS  PubMed  Google Scholar 

  5. Du W, Simon MS (2005) Racial disparities in treatment and survival of women with stage I–III breast cancer at a large academic medical center in metropolitan Detroit. Breast Cancer Res Treat 91(3):243–248

    Article  PubMed  Google Scholar 

  6. Lipscombe LL, Goodwin PJ, Zinman B, McLaughlin JR, Hux JE (2008) The impact of diabetes on survival following breast cancer. Breast Cancer Res Treat 109(2):389–395

    Article  PubMed  Google Scholar 

  7. Louwman WJ, Janssen-Heijnen ML, Houterman S, Voogd AC, van der Sangen MJ, Nieuwenhuijzen GA, Coebergh JW (2005) Less extensive treatment and inferior prognosis for breast cancer patient with comorbidity: a population-based study. Eur J Cancer 41(5):779–785

    Article  CAS  PubMed  Google Scholar 

  8. Yancik R, Wesley MN, Ries LA, Havlik RJ, Edwards BK, Yates JW (2001) Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older. JAMA 285(7):885–892

    Article  CAS  PubMed  Google Scholar 

  9. Patterson RE, Flatt SW, Saquib N, Rock CL, Caan BJ, Parker BA, Laughlin GA, Erickson K, Thomson CA, Bardwell WA, Hajek RA, Pierce JP (2010) Medical comorbidities predict mortality in women with a history of early stage breast cancer. Breast Cancer Res Treat 122(3):859–865

    Article  PubMed Central  PubMed  Google Scholar 

  10. Patnaik JL, Byers T, DiGuiseppi C, Dabelea D, Denberg TD (2011) Cardiovascular disease competes with breast cancer as the leading cause of death for older females diagnosed with breast cancer: a retrospective cohort study. Breast Cancer Res 13(3):R64

    Article  PubMed Central  PubMed  Google Scholar 

  11. Nechuta S, Lu W, Zheng Y, Cai H, Bao PP, Gu K, Zheng W, Shu XO (2013) Comorbidities and breast cancer survival: a report from the Shanghai Breast Cancer Survival Study. Breast Cancer Res Treat 139(1):227–235

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  12. Wu AH, Kurian AW, Kwan ML, John EM, Lu Y, Keegan TH, Gomez SL, Cheng I, Shariff-Marco S, Caan BJ, Lee VS, Sullivan-Halley J, Tseng CC, Bernstein L, Sposto R, Vigen C (2015) Diabetes and other comorbidities in breast cancer survival by race/ethnicity: the California Breast Cancer Survivorship Consortium (CBCSC). Cancer Epidemiol Biomarkers Prev 24(2):361–368

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Sangha O, Stucki G, Liang MH, Fossel AH, Katz JN (2003) The self-administered comorbidity questionnaire: a new method to assess comorbidity for clinical and health services research. Arthritis Care Res 49(2):156–163

    Article  Google Scholar 

  14. Martin LM, Leff M, Calonge N, Garrett C, Nelson DE (2000) Validation of self-reported chronic conditions and health services in a managed care population. Am J Prev Med 18(3):215–218

    Article  CAS  PubMed  Google Scholar 

  15. Okura Y, Urban LH, Mahoney DW, Jacobsen SJ, Rodeheffer RJ (2004) Agreement between self-report questionnaires and medical record data was substantial for diabetes, hypertension, myocardial infarction and stroke but not for heart failure. J Clin Epidemiol 57(10):1096–1103

    Article  PubMed  Google Scholar 

  16. Baena-Díez JM, Alzamora-Sas MT, Grau M, Subirana I, Vila J, Torán P, García-Navarro Y, Bermúdez-Chillida N, Alegre-Basagaña J, Viozquez-Meia M (2009) Validity of the MONICA cardiovascular questionnaire compared with clinical records. Gac Sanit 23(6):519–525

    Article  PubMed  Google Scholar 

  17. Merkin SS, Cavanaugh K, Longenecker JC, Fink NE, Levey AS, Powe NR (2007) Agreement of self-reported comorbid conditions with medical and physician reports varied by disease among end-stage renal disease patients. J Clin Epidemiol 60(6):634–642

    Article  PubMed Central  PubMed  Google Scholar 

  18. Haapanen N, Miilunpalo S, Pasanen M, Oja P, Vuori I (1997) Agreement between questionnaire data and medical records of chronic diseases in middle-aged and elderly Finnish men and women. Am J Epidemiol 45(8):762–769

    Article  Google Scholar 

  19. Corser W, Sikorskii A, Olomu A, Stommel M, Proden C, Holmes-Rovner M (2008) Concordance between comorbidity data from patient self-report interviews and medical record documentation. BMC Health Serv Res 8(1):85

    Article  PubMed Central  PubMed  Google Scholar 

  20. Eze-Nliam C, Cain K, Bond K, Forlenza K, Jankowski R, Magyar-Russell G, Yenokyan G, Ziegelstein RC (2012) Discrepancies between the medical record and the reports of patients with acute coronary syndrome regarding important aspects of the medical history. BMC Health Serv Res 12(1):78

    Article  PubMed Central  PubMed  Google Scholar 

  21. Midthjell K, Holmen J, Bjorndal A, Lund-Larsen G (1992) Is questionnaire information valid in the study of a chronic disease such as diabetes? The Nord-Trondelag diabetes study. J Epidemiol Commun Health 46(5):537–542

    Article  CAS  Google Scholar 

  22. Skinner KM, Miller DR, Lincoln E, Lee A, Kazis LE (2005) Concordance between respondent self-reports and medical records for chronic conditions: experience from the Veterans Health Study. J Ambulat Care Manag 28(2):102–110

    Article  Google Scholar 

  23. Walker AM, Lanes SF (1991) Misclassification of covariates. Stat Med 10(8):1181–1196

    Article  CAS  PubMed  Google Scholar 

  24. Kwan ML, John EM, Caan BJ, Lee VS, Bernstein L, Cheng I, Gomez SL, Henderson BE, Keegan TH, Kurian AW, Lu Y, Monroe KR, Roh JM, Shariff-Marco S, Sposto R, Vigen C, Wu AH (2014) Obesity and mortality after breast cancer by race/ethnicity: the California Breast Cancer Survivorship Consortium. Am J Epidemiol 179(1):95–111

    Article  PubMed Central  PubMed  Google Scholar 

  25. Lu Y, John EM, Sullivan-Halley J, Vigen C, Gomez SL, Kwan ML, Caan BJ, Lee VS, Roh JM, Shariff-Marco S, Keegan TH, Kurian AW, Monroe KR, Cheng I, Sposto R, Wu AH, Bernstein L (2015) History of recreational physical activity and survival after breast cancer: the California Breast Cancer Survivorship Consortium. Am J Epidemiol 181(12):944–955

    Article  PubMed  Google Scholar 

  26. Wu AH, Gomez SL, Vigen C, Kwan ML, Keegan TH, Lu Y, Shariff-Marco S, Monroe KR, Kurian AW, Cheng I, Caan BJ, Lee VS, Roh JM, Sullivan-Halley J, Henderson BE, Bernstein L, John EM, Sposto R (2013) The California Breast Cancer Survivorship Consortium (CBCSC): prognostic factors associated with racial/ethnic differences in breast cancer survival. Cancer Causes Control 24(10):1821–1836

    Article  PubMed Central  PubMed  Google Scholar 

  27. John EM, Phipps AI, Davis A, Koo J (2005) Migration history, acculturation, and breast cancer risk in Hispanic women. Cancer Epidemiol Biomark Prev 14(12):2905–2913

    Article  Google Scholar 

  28. Caan B, Sternfeld B, Gunderson E, Coates A, Quesenberry C, Slattery ML (2005) Life After Cancer Epidemiology (LACE) Study: a cohort of early stage breast cancer survivors (United States). Cancer Causes Control 16(5):545–556

    Article  PubMed  Google Scholar 

  29. Ross M, Tyler R, Ng M, Jeffrey S, Mark C, Hart M, John F (2014) The HMO research network virtual data warehouse: a public data model to support collaboration. eGEMs 2(1):2

    Google Scholar 

  30. Viera AJ, Garrett JM (2005) Understanding interobserver agreement: the kappa statistic. Fam Med 37(5):360–363

    PubMed  Google Scholar 

  31. Yost K, Perkins C, Cohen R, Morris C, Wright W (2001) Socioeconomic status and breast cancer incidence in California for different race/ethnic groups. Cancer Causes Control 12(8):703–711

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by the California Breast Cancer Research Program (CBCRP) (Grants 16ZB-8001 to AHW, 16ZB-8002 to SLG, 16ZB-8003 to LB, 16ZB-8004 to MLK, 16ZB-8005 to KRM). The Asian American Breast Cancer Study was supported by CBCRP Grants 1RB-0287, 3 PB-0120, and 5 PB-0018. The San Francisco Bay Area Breast Cancer Study was supported by National Cancer Institute Grants R01 CA63446 and R01 CA77305; by the US Department of Defense (DOD) Grant DAMD17-96-1-6071; and by the CBCRP Grants 4JB-1106 and 7 PB-0068. The Women’s CARE Study was funded by the National Institute of Child Health and Human Development (NICHD), through a contract with USC (N01-HD-3-3175), and the California Teachers Study was funded by the California Breast Cancer Act of 1993; National Cancer Institute grants (R01 CA77398 and K05 CA136967 to LB); and the California Breast Cancer Research Fund (contract 97-10500). The Multiethnic Cohort Study was supported by National Cancer Institute Grants R01 CA54281, R37CA54281, and UM1 CA164973. The Life After Cancer Epidemiology Study is supported by National Cancer Institute Grant R01 CA129059. Clinical and tumor characteristics and mortality data were obtained from the California Cancer Registry. The collection of cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Sect. 103885; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under Contract HHSN261201000140C awarded to the Cancer Prevention Institute of California, Contract HHSN261201000035C awarded to the University of Southern California, and Contract HHSN261201000034C awarded to the Public Health Institute; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under Agreement U58DP003862-01 awarded to the California Department of Public Health. The ideas and opinions expressed herein are those of the author(s), and endorsement by the State of California, Department of Public Health the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors is not intended nor should be inferred.

Author information

Authors and Affiliations

  1. University of Southern California, 1540 Alcazar St. CHP-133, Los Angeles, CA, 90089-9003, USA

    Cheryl Vigen & Kristine R. Monroe

  2. Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA

    Marilyn L. Kwan, Bette J. Caan, Valerie S. Lee & Janise M. Roh

  3. Cancer Prevention Institute of California, 2201 Walnut Ave #300, Fremont, CA, 94538, USA

    Esther M. John, Scarlett Lin Gomez, Theresa H. M. Keegan, Salma Shariff-Marco & Iona Cheng

  4. Beckman Research Institute of the City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA

    Yani Lu & Leslie Bernstein

  5. Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA

    Allison W. Kurian

  6. University of Southern California, Health Sciences Campus, 4650 Sunset Blvd, SRT 600A, MS#54, Los Angeles, CA, 90027-6016, USA

    Richard Sposto

  7. University of Southern California, Health Sciences Campus, NOR 4443, Mail Code:9175, Los Angeles, CA, 90089-9175, USA

    Anna H. Wu

Authors
  1. Cheryl Vigen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marilyn L. Kwan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Esther M. John
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Scarlett Lin Gomez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Theresa H. M. Keegan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yani Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Salma Shariff-Marco
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kristine R. Monroe
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Allison W. Kurian
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Iona Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Bette J. Caan
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Valerie S. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Janise M. Roh
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Leslie Bernstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Richard Sposto
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Anna H. Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cheryl Vigen.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional and/or National Research Committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vigen, C., Kwan, M.L., John, E.M. et al. Validation of self-reported comorbidity status of breast cancer patients with medical records: the California Breast Cancer Survivorship Consortium (CBCSC). Cancer Causes Control 27, 391–401 (2016). https://doi.org/10.1007/s10552-016-0715-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10552-016-0715-8

Keywords

Search

Navigation