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Development and Validation of Case-Finding Algorithms to Identify Pancreatic Cancer in the Veterans Health Administration

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Abstract

Background

Survival in pancreatic ductal adenocarcinoma (PDAC) remains poor due to late diagnosis. Electronic Health Records (EHRs) can be used to study this rare disease, but validated algorithms to identify PDAC in the United States EHRs do not currently exist.

Aims

To develop and validate an algorithm using Veterans Health Administration (VHA) EHR data for the identification of patients with PDAC.

Methods

We developed two algorithms to identify patients with PDAC in the VHA from 2002 to 2023. The algorithms required diagnosis of exocrine pancreatic cancer in either ≥ 1 or ≥ 2 of the following domains: (i) the VA national cancer registry, (ii) an inpatient encounter, or (iii) an outpatient encounter in an oncology setting. Among individuals identified with ≥ 1 of the above criteria, a random sample of 100 were reviewed by three gastroenterologists to adjudicate PDAC status. We also adjudicated fifty patients not qualifying for either algorithm. These patients died as inpatients and had alkaline phosphatase values within the interquartile range of patients who met ≥ 2 of the above criteria for PDAC. These expert adjudications allowed us to calculate the positive and negative predictive value of the algorithms.

Results

Of 10.8 million individuals, 25,533 met ≥ 1 criteria (PPV 83.0%, kappa statistic 0.93) and 13,693 individuals met ≥ 2 criteria (PPV 95.2%, kappa statistic 1.00). The NPV for PDAC was 100%.

Conclusions

An algorithm incorporating readily available EHR data elements to identify patients with PDAC achieved excellent PPV and NPV. This algorithm is likely to enable future epidemiologic studies of PDAC.

Graphic Abstract

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Abbreviations

PDAC:

Pancreatic ductal adenocarcinoma

EHR:

Electronic health record

SEER:

Surveillance, epidemiology, and end results

VHA:

Veterans health administration

VACCR:

Veterans affairs central cancer registry

ICD:

International classification of disease

REDCap:

Research electronic data capture

IPMN:

Intraductal papillary mucinous neoplasm

UHDDS:

Uniform hospital discharge dataset

References

  1. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin 2022;72:7–33.

    Article  PubMed  Google Scholar 

  2. Paparrizos J, White RW, Horvitz E. Screening for pancreatic adenocarcinoma using signals from web search logs: feasibility study and results. J Oncol Pract 2016;12:737–744.

    Article  PubMed  Google Scholar 

  3. Evans J, Chapple A, Salisbury H, Corrie P, Ziebland S. “It can’t be very important because it comes and goes”–patients’ accounts of intermittent symptoms preceding a pancreatic cancer diagnosis: a qualitative study. BMJ Open 2014;4:e004215.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Pannala R, Basu A, Petersen GM, Chari ST. New-onset diabetes: a potential clue to the early diagnosis of pancreatic cancer. Lancet Oncol 2009;10:88–95.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Pannala R, Leibson CL, Rabe KG et al. Temporal association of changes in fasting blood glucose and body mass index with diagnosis of pancreatic cancer. Am J Gastroenterol 2009;104:2318–2325.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Sharma A, Kandlakunta H, Nagpal SJS et al. Model to determine risk of pancreatic cancer in patients with new-onset diabetes. Gastroenterology 2018;155:e733.

    Article  Google Scholar 

  7. Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory care quality improvement project (ACQUIP). Alcohol use disorders identification test. Arch Intern Med 1998;158:1789–1795.

    Article  CAS  PubMed  Google Scholar 

  8. Department of Veterans Affairs Managerial Cost Accounting Office. Program documents: stop codes (2023).

  9. Patridge EF, Bardyn TP. Research electronic data capture (REDCap). J Med Libr Assoc 2018;106:142–144.

    Article  PubMed Central  Google Scholar 

  10. Haeberle L, Esposito I. Pathology of pancreatic cancer. Transl Gastroenterol Hepatol 2019;4:50.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Zullig LL, Jackson GL, Dorn RA et al. Cancer incidence among patients of the U.S. Veterans Affairs Health Care System. Mil Med 2012;177:693–701.

    Article  PubMed  Google Scholar 

  12. Park LS, Tate JP, Rodriguez-Barradas MC, Rimland D, Goetz MB, Gibert C, Brown ST et al. Cancer incidence in HIV-infected versus uninfected veterans: comparison of cancer registry and ICD-9 code diagnoses. J AIDS Clin Res 2014;5:1000318.

    PubMed  PubMed Central  Google Scholar 

  13. Garvin LA, Pugatch M, Gurewich D, Pendergast JN, Miller CJ. Interorganizational care coordination of rural veterans by Veterans affairs and community care programs: a systematic review. Med Care 2021;59:S259–S269.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Creighton N, Walton R, Roder D, Aranda S, Currow D. Validation of administrative hospital data for identifying incident pancreatic and periampullary cancer cases: a population-based study using linked cancer registry and administrative hospital data in New South Wales, Australia. BMJ Open 2016;6:e011161.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Wu JW, Azoulay L, Huang A et al. Identification of incident pancreatic cancer in Ontario administrative health data: a validation study. Pharmacoepidemiol Drug Saf 2020;29(Suppl 1):78–85.

    Article  PubMed  Google Scholar 

  16. Wagner T, Llachance M, Gonsoulin M. A brief history of procedure codes in VHA: inpatient ICD procedure codes and outpatient CPT codes. Hines: Information Resource Center; 2017.

    Google Scholar 

  17. Porta M, Costafreda S, Malats N et al. Validity of the hospital discharge diagnosis in epidemiologic studies of biliopancreatic pathology. PANKRAS II study group. Eur J Epidemiol 2000;16:533–541.

    Article  CAS  PubMed  Google Scholar 

  18. Hwang YJ, Park SM, Ahn S, Lee JC, Park YS, Kim N. Accuracy of an administrative database for pancreatic cancer by international classification of disease 10(th) codes: a retrospective large-cohort study. World J Gastroenterol 2019;25:5619–5629.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Zullig LL, Sims KJ, McNeil R et al. Cancer incidence among patients of the U.S. Veterans affairs health care system: 2010 update. Mil Med 2017;182:e1883–e1891.

    Article  PubMed  Google Scholar 

  20. SEER Cancer Statistics Review 1975–2010: National Cancer Institute

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Funding

This research was supposed by a VHA CS&RD CDA-2 IK2BX005891-01 and by an NIH T32 training grant T32DK007356.

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Authors and Affiliations

  1. Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, 06520, USA

    Catherine Mezzacappa, Navid Rahimi Larki & Louise Wang

  2. VA Connecticut Healthcare System, West Haven, CT, USA

    Melissa Skanderson, Cynthia Brandt, Ronald G. Hauser, Amy Justice & Louise Wang

  3. Department of Epidemiology and Population Health, Stanford School of Medicine, Stanford, CA, USA

    Lesley S. Park

  4. Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA

    Cynthia Brandt

  5. Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA

    Ronald G. Hauser

  6. Section of General Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA

    Amy Justice

  7. School of Public Health, Yale University, New Haven, CT, USA

    Amy Justice

  8. Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Yu-Xiao Yang & Louise Wang

  9. Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA

    Yu-Xiao Yang

Authors
  1. Catherine Mezzacappa
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  2. Navid Rahimi Larki
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  3. Melissa Skanderson
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  4. Lesley S. Park
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  5. Cynthia Brandt
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  6. Ronald G. Hauser
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  7. Amy Justice
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  8. Yu-Xiao Yang
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  9. Louise Wang
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Contributions

CM: data collection, writing—original draft, writing—review & editing. NRL: data curation, formal analysis, and visualization. MS: methodology. LP: methodology and supervision. CB: conceptualization, methodology, writing—review & editing, and supervision. RGH: methodology and data curation. AJ: conceptualization, methodology, writing—review & editing, and supervision. YXY: conceptualization, methodology, data curation, writing—review & editing, and supervision. LW: conceptualization, methodology, data collection, data curation, writing—review & editing, supervision, and project administration.

Corresponding author

Correspondence to Louise Wang.

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The authors have no conflict of interest to disclose.

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Mezzacappa, C., Larki, N.R., Skanderson, M. et al. Development and Validation of Case-Finding Algorithms to Identify Pancreatic Cancer in the Veterans Health Administration. Dig Dis Sci 69, 1507–1513 (2024). https://doi.org/10.1007/s10620-024-08324-w

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  • DOI: https://doi.org/10.1007/s10620-024-08324-w

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