Measuring Disease-Free Survival and Cancer Relapse Using Medicare Claims From CALGB Breast Cancer Trial Participants (Companion to 9344)

To determine the accuracy with which Medicare claims data measure disease-free survival in elderly Medicare beneficiaries with cancer, we performed a criterion validation study. We merged gold-standard clinical trial data of 45 elderly patients with node-positive breast cancer who were treated on the Cancer and Leukemia Group B (CAL-GB) adjuvant breast trial 9344 with Centers for Medicare and Medicaid Services (CMS) data files and compared the results of a CMS-based algorithm with the CALGB disease-free survival information to determine sensitivity and specificity. For 5-year disease-free survival, the sensitivity of the CMS-based algorithm was 100% (95% confidence interval [CI] = 81% to 100%), the specificity was 97% (95% CI = 83% to 100%), and the area under the receiver operator curve was 97% (95% CI = 90% to 100%). For 2-year disease-free survival, the test characteristics were less favorable: sensitivity was 83% (95% CI = 36% to 100%), specificity was 95% (95% CI = 83% to 100%), and area under the receiver operator curve was 84% (95% CI = 66% to 100%)

Evaluation of the WMO Solid Precipitation Intercomparison Experiment (SPICE) transfer functions for adjusting the wind bias in solid precipitation measurements

The World Meteorological Organization (WMO) Solid Precipitation Intercomparison Experiment (SPICE) involved extensive field intercomparisons of automated instruments for measuring snow during the 2013/2014 and 2014/2015 winter seasons. A key outcome of SPICE was the development of transfer functions for the wind bias adjustment of solid precipitation measurements using various precipitation gauge and wind shield configurations. Due to the short intercomparison period, the data set was not sufficiently large to develop and evaluate transfer functions using independent precipitation measurements, although on average the adjustments were effective at reducing the bias in unshielded gauges from −33.4 % to 1.1 %. The present analysis uses data collected at eight SPICE sites over the 2015/2016 and 2016/2017 winter periods, comparing 30 min adjusted and unadjusted measurements from Geonor T-200B3 and OTT Pluvio2 precipitation gauges in different shield configurations to the WMO Double Fence Automated Reference (DFAR) for the evaluation of the transfer function. Performance is assessed in terms of relative total catch (RTC), root mean square error (RMSE), Pearson correlation (r), and percentage of events (PEs) within 0.1 mm of the DFAR. Metrics are reported for combined precipitation types and for snow only. The evaluation shows that the performance varies substantially by site. Adjusted RTC varies from 54 % to 123 %, RMSE from 0.07 to 0.38 mm, r from 0.28 to 0.94, and PEs from 37 % to 84 %, depending on precipitation phase, site, and gauge configuration (gauge and wind screen type). Generally, windier sites, such as Haukeliseter (Norway) and Bratt's Lake (Canada), exhibit a net under-adjustment (RTC of 54 % to 83 %), while the less windy sites, such as Sodankylä (Finland) and Caribou Creek (Canada), exhibit a net over-adjustment (RTC of 102 % to 123 %). Although the application of transfer functions is necessary to mitigate wind bias in solid precipitation measurements, especially at windy sites and for unshielded gauges, the variability in the performance metrics among sites suggests that the functions be applied with caution

Lung cancer treatment costs, including patient responsibility, by disease stage and treatment modality, 1992 to 2003

AbstractObjectivesThe objective of this analysis was to estimate costs for lung cancer care and evaluate trends in the share of treatment costs that are the responsibility of Medicare beneficiaries.MethodsThe Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 1991–2003 for 60,231 patients with lung cancer were used to estimate monthly and patient-liability costs for clinical phases of lung cancer (prediagnosis, staging, initial, continuing, and terminal), stratified by treatment, stage, and non-small- versus small-cell lung cancer. Lung cancer-attributable costs were estimated by subtracting each patient's own prediagnosis costs. Costs were estimated as the sum of Medicare reimbursements (payments from Medicare to the service provider), co-insurance reimbursements, and patient-liability costs (deductibles and “co-payments” that are the patient's responsibility). Costs and patient-liability costs were fit with regression models to compare trends by calendar year, adjusting for age at diagnosis.ResultsThe monthly treatment costs for a 72-year-old patient, diagnosed with lung cancer in 2000, in the first 6 months ranged from $2687 (no active treatment) to$9360 (chemo-radiotherapy); costs varied by stage at diagnosis and histologic type. Patient liability represented up to 21.6% of care costs and increased over the period 1992–2003 for most stage and treatment categories, even when care costs decreased or remained unchanged. The greatest monthly patient liability was incurred by chemo-radiotherapy patients, which ranged from $1617 to$2004 per month across cancer stages.ConclusionsCosts for lung cancer care are substantial, and Medicare is paying a smaller proportion of the total cost over time

Assessment of snowfall accumulation underestimation by tipping bucket gauges in the Spanish operational network

Within the framework of the World Meteorological Organization Solid Precipitation Intercomparison Experiment (WMO-SPICE), the Thies tipping bucket precipitation gauge was assessed against the SPICE reference configuration at the Formigal–Sarrios test site located in the Pyrenees mountain range of Spain. The Thies gauge is the most widely used precipitation gauge by the Spanish Meteorological State Agency (AEMET) for the measurement of all precipitation types including snow. It is therefore critical that its performance is characterized. The first objective of this study is to derive transfer functions based on the relationships between catch ratio and wind speed and temperature. Multiple linear regression was applied to 1 and 3 h accumulation periods, confirming that wind is the most dominant environmental variable affecting the gauge catch efficiency, especially during snowfall events. At wind speeds of 1.5 m s−1 the tipping bucket recorded only 70 % of the reference precipitation. At 3 m s−1, the amount of measured precipitation decreased to 50 % of the reference, was even lower for temperatures colder than −2 °C and decreased to 20 % or less for higher wind speeds

Estimates and predictors of health care costs of esophageal adenocarcinoma : A population-based cohort study

Background: Esophageal adenocarcinoma (EAC) incidence is increasing rapidly. Esophageal cancer has the second lowest 5-year survival rate of people diagnosed with cancer in Canada. Given the poor survival and the potential for further increases in incidence, phase-specific cost estimates constitute an important input for economic evaluation of prevention, screening, and treatment interventions. The study aims to estimate phase-specific net direct medical costs of care attributable to EAC, costs stratified by cancer stage and treatment, and predictors of total net costs of care for EAC. Methods: A population-based retrospective cohort study was conducted using Ontario Cancer Registry-linked administrative health data from 2003 to 2011. The mean net costs of EAC care per 30 patient-days (2016 CAD) were estimated from the payer perspective using phase of care approach and generalized estimating equations. Predictors of net cost by phase of care were based on a generalized estimating equations model with a logarithmic link and gamma distribution adjusting for sociodemographic and clinical factors. Results: The mean net costs of EAC care per 30 patient-days were $1016 (95$955-$1078) in the initial phase,$669 (95% CI, $594-$743) in the continuing care phase, and $8678 (95$8217-$9139) in the terminal phase. Overall, stage IV at diagnosis and surgery plus radiotherapy for EAC incurred the highest cost, particularly in the terminal phase. Strong predictors of higher net costs were receipt of chemotherapy plus radiotherapy, surgery plus chemotherapy, radiotherapy alone, surgery alone, and chemotherapy alone in the initial and continuing care phases, stage III-IV disease and patients diagnosed with EAC later in a calendar year (2007-2011) in the initial and terminal phases, comorbidity in the continuing care phase, and older age at diagnosis (70-74 years), and geographic region in the terminal phase. Conclusions: Costs of care vary by phase of care, stage at diagnosis, and type of treatment for EAC. These cost estimates provide information to guide future resource allocation decisions, and clinical and policy interventions to reduce the burden of EAC

The effect on survival of continuing chemotherapy to near death

<p>Abstract</p> <p>Background</p> <p>Overuse of anti-cancer therapy is an important quality-of-care issue. An aggressive approach to treatment can have negative effects on quality of life and cost, but its effect on survival is not well-defined.</p> <p>Methods</p> <p>Using the Surveillance, Epidemiology, and End Results-Medicare database, we identified 7,879 Medicare-enrolled patients aged 65 or older who died after having survived at least 3 months after diagnosis of advanced non-small cell lung cancer (NSCLC) between 1991 and 1999. We used Cox proportional hazards regression analysis, propensity scores, and instrumental variable analysis (IVA) to compare survival among patients who never received chemotherapy (n = 4,345), those who received standard chemotherapy but not within two weeks prior to death (n = 3,235), and those who were still receiving chemotherapy within 14 days of death (n = 299). Geographic variation in the application of chemotherapy was used as the instrument for IVA.</p> <p>Results</p> <p>Receipt of chemotherapy was associated with a 2-month improvement in overall survival. However, based on three different statistical approaches, no additional survival benefit was evident from continuing chemotherapy within 14 days of death. Moreover, patients receiving chemotherapy near the end of life were much less likely to enter hospice (81% versus 51% with no chemotherapy and 52% with standard chemotherapy, P < 0.001), or were more likely to be admitted within only 3 days of death.</p> <p>Conclusions</p> <p>Continuing chemotherapy for advanced NSCLC until very near death is associated with a decreased likelihood of receiving hospice care but not prolonged survival. Oncologists should strive to discontinue chemotherapy as death approaches and encourage patients to enroll in hospice for better end-of-life palliative care.</p

Referrals for suspected hematologic malignancy: A survey of primary care physicians

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/91356/1/23172_ftp.pd

Applications of the WMO Solid Precipitation Intercomparison Experiment (WMO-SPICE) results for nowcasting activities

Presentación realizada en la 3rd European Nowcasting Conference, celebrada en la sede central de AEMET en Madrid del 24 al 26 de abril de 2019

The potential for uncertainty in Numerical Weather Prediction model verification when using solidprecipitation observations

Precipitation forecasts made by Numerical Weather Prediction (NWP) models are typically verified using precipitation gauge observations that are often prone to the wind‐induced undercatch of solid precipitation. Therefore, apparent model biases in solid precipitation forecasts may be due in part to the measurements and not the model. To reduce solid precipitation measurement biases, adjustments in the form of transfer functions were derived within the framework of the World Meteorological Organization Solid Precipitation Inter‐Comparison Experiment (WMO‐SPICE). These transfer functions were applied to single‐Alter shielded gauge measurements at selected SPICE sites during two winter seasons (2015–2016 and 2016–2017). Along with measurements from the WMO automated field reference configuration at each of these SPICE sites, the adjusted and unadjusted gauge observations were used to analyze the bias in a Global NWP model precipitation forecast. The verification of NWP winter precipitation using operational gauges may be subject to verification uncertainty, the magnitude and sign of which varies with the gauge‐shield configuration and the relation between model and site‐specific local climatologies. The application of a transfer function to alter‐shielded gauge measurements increases the amount of solid precipitation reported by the gauge and therefore reduces the NWP precipitation bias at sites where the model tends to overestimate precipitation, and increases the bias at sites where the model underestimates the precipitation. This complicates model verification when only operational (non‐reference) gauge observations are available. Modelers, forecasters, and climatologists must consider this when comparing modeled and observed precipitation

A preliminary assessment of the biases between forecasted by ECMWF Numerical Weather Prediction model precipitation and the adjusted observed snowfall precipitation in different SPICE sites

Comunicación presentada en: TECO-2018 (Technical Conference on Meteorological and Environmental Instruments and Methods of Observation) celebrada en Amsterdam, del 8 al 11 de octubre de 2018