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Evaluating Factors Associated with Unknown SEER Summary Stage 2000 Derived from Collaborative Stage
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    J Registry Manag. 39(3):101-106.
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  • Alternative Title:
    J Registry Manag
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    Background Information on cancer stage is critical for guiding treatment and assessing disease prognosis. The Percentage of unknown staged cancer cases varies considerably across state cancer registries; factors contributing to the variations in unknown stage have not been reported in the literature before. The purpose of this study was to examine whether these variations are influenced by demographic and clinical factors as well as type of reporting facilities. Methods Invasive colorectal, lung, female breast, and prostate cancers diagnosed in 2004–2007 and staged (derived Summary Stage 2000) according to Collaborative Stage Version 1 were obtained from the North American Association of Central Cancer Registries (NAACCR); 47 population-based cancer registries in the United States were included. Relative importance analysis was used to identify variables that were relatively important in predicting unknown stage. We used multiple linear regression to evaluate factors associated with percentage of unknown stage by cancer site using state central cancer registries as analytic units; potential outlier registries with high percentage of unstaged cases were identified using boxplots and standardized residuals. Results Overall, lung cancer had the highest percentage of unknown stage (8.3%) and prostate cancer had the largest variation of unknown stage among registries (0.6%–18.1%). The percentages of neoplasm Not Otherwise Specified (NOS) histology, non-microscopically confirmation, and non-hospital reporting source were positively associated (p<0.05) with percentage of unknown stage for all studied cancer sites before adjustment. Variables that retained a positive association with unknown stage after adjusted for demographic variables, clinical variables, year of diagnosis, and type of reporting source were black race, metropolitan area < 1 million population, histologies of neoplasm NOS or epithelial neoplasm NOS, diagnosis year 2005, and non-hospital reporting source for colorectal cancer; metropolitan area < 1 million population, neoplasm NOS histology, and non-hospital reporting source for female breast; and diagnosis year 2005 and non-hospital reporting source for prostate. After adjustment, none of the predictors were significant for lung cancer. We observed one potential outlier registry each for colorectal, lung, and female cancers. Conclusions Factors associated with unknown stage differ by cancer site; however, type of reporting source is an important predictor of unknown stage for all cancers except lung after adjustment. Cancer registries with high percentage of unknown stage should be made aware of their data quality issue(s). As a result, these registries can investigate those factors and provide training to registrars to improve their cancer data quality.
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