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