Cancer Surveillance in Ontario

Enhancing our Information and Methods

- the example of SEER*Stat and related tools -Eric Holowaty

Senior Consultant,Division of Preventive Oncology,

Cancer Care Ontario.16 October 2006.

OutlineSome definitions

Emerging user requirements

SEER*Stat – the cornerstone of a powerful suite of analytic tools

Surveillanceon-going, systematic and timely collection, analysis and dissemination of information on past, present and future disease occurrence, survival, QoL, mortality and costs - DIRECT MEASURES

also, data on social and individual determinants of ill-health incl. knowledge, attitudes and behaviours of public and providers re. practices which prevent ill-health, facilitate screening, extend survival and improve quality of life - INDIRECT MEASURES

for the purpose of more effectively planning, implementing and evaluating health promotion and disease control programs and activities

in order to measurably reduce the burden of ill-health in our population

Definitions

Surveillance System a network of information systems

spanning the pop’n

Administrative systems (incl. patient care, population censuses, etc) - CIHI, OHIP, CCACs, ODB, OMDB integrated in modern data warehouse environment

Registries - population-based and center-specific

Periodic sample surveys - CCHS, CTUMS, RRFSS, CAMH, pt/prov. surveys

Analytic studies i.e. new knowledge

Ontario Cancer RegistryOntario’s first data warehouse?

PATHICPs/PMH

DCCIHIData Sources :

Editing

Record Linkage

Summarization

Master IncidenceFile

Integrated Information Systems:Schematic Example

HOSP

Ontario Cancer Patient

Knowledge Base

OBSP OHIP Epidemiologicsurveillance &

research

Health Services Planning and

Ev’n

Operations & QA

Clinical Care & RCTs

RCC/PMHLABS RG Death

Register all invasive neoplasms: ICD9 sites 140 - 208, excluding 173

OCR Current Operations

1.35 M incident cases1964 - 2003

55,330 incident cases in 2003

Data Products

Incidence and mortality frequencies and rates

Projections/forecasts

Prevalence

Treatment patterns

Survival estimates

Data Products : Incidence and Mortality

Mini-Monographs - 2-3 X per yearMonthly Cancer Facts - 12 X per yearWeb-based Site-specific Trends and Regional Patterns -24 cancer sites; updated q2-3 yrsCanadian Cancer Statistics - once per yearCancer Incidence/Mortality in North America - yearlyCancer Incidence in Five Continents - q 5 yrsCanQuery - interactive website for rates and freqOntario SEER*Stat CDCancer Surveillance Data Mart – i-PortRapid Inquiry Facility – for spatial surveillance

Death Rates Falling Rapidly for CVDboth sexes combined

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CVD

Cancer Death Rates Now Dropping in Ontario Men and Women!

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Stakeholders - Wants/NeedsComprehensive network/warehouse of data from registries, surveys, & admin. DB supporting the planning, delivery and ev’n of cost-effective and equitable strategies for prevention and control of cancer– reporting on provincial, regional and local trends (past and

future) and sub-group variations in cancer burden.– provide data for setting and monitoring goals and targets of

cancer control– enable the study of differential rates of cancer among

disadvantaged groups– provide data for the evaluation of preventive, screening,

treatment and palliative care programs and activities– provide timely data for use in planning and managing cancer

care services provincially and locally

Emerging Tools to Support Comparative Analysis

Desirable characteristics

user friendly GUI interfacecomprehensive help systemeasy selection/exclusion of cases, with more complex selection/subset statements with full Boolean logicmulti-dimensional matrices for reporting resultseasy copying and pasting of output into spreadsheet, graphics or statistical analysis packagesexporting records and statistics to a generic text datafile for easy input into other statistical systems e.g. Joinpoint; SASprint preview

Cancer statistics available through SEER*Stat

Ontario SEER*Stat Version 6.2.4

Aggregated frequencies - incl. row/column percentages; estimates of temporal trend (PC; APC)Rates - crude (non-adjusted) with SE and CLs; age-adjusted with SE and CLs - a dozen std. populations; temporal trends (comparison of APCs with zero and comparison of two APCs with each other)Survival statistics - observed survival; net survival (rel. surv; cause-specific); comparison of pairs of survival curves; conditional survival; period survival.Limited duration prevalence statistics - counts; crude percents; age-adjusted percentsMultiple primaries - SIR statistics; compared with general pop’n

Ontario Version of SEER*StatSystem requirements

Pentium-based PC32-bit Microsoft Windows (95, 98, NT, 2000, XP)32 MBs Application RAM6 MB disc spaceHigh Speed Internet connection for client-server configuration

Data Use Agreementsfor Ontario data, and SEER*Stat : check CCO’s website

http://www.cancercare.on.ca/index_statistics.htm#anfor SEER data, and other software

http://seer.cancer.gov/seerstat/mandatory small cell suppression <5.

SEER*Stat and Related Software

http://www.seer.cancer.gov/seerstat/related.html

Related software

Joinpoint Version 3.0Analysis of trends in rates using joinpoint models

fits simplest joinpointmodel to trend data

statistical comparison of whether more joinpointsare statistically significant

Related software

DevCan Version 6.1.1lifetime risk of developing, or dying from, cancer- age-conditional risk, CLs, sensitivity anal.

Head-Bang: Non-paramet.smoothing software

SaTScan: i,.e., scan stat.

ESTAT: ExploratorySpatio-Temporal Analysis(under dev’t)

Related software

CanSurv Version 1.0 : Cancer Survival Analysis Software

Fits standard survival models (e.g. Cox PH) and mixture-cure models

prognostic and demo. variables as covariates

ComPrev Version 1.0.0Complete prevalence of cancer, based on limited duration prevalence – uses incidence and survival models to estimate a completeness index

ProjPrev Version 1.0.1

CanQuery Interactive Website(being enhanced)

Ontario incidence and mortality - frequencies, rates, trends, projections

Cancer prevalence

Probability of developing or dying of cancer

Cancer survival

New CanQuery Application

Cancer Incidence and Mortalityin Ontario

Ontario Incidence Statistics

North American Portal

And now, some examplesCancer Control PLANET

See: http://cancercontrolplanet.cancer.gov/

SEER*Stat DemoAnd now, some examples

That’s It For Now !