ArticleCancer epidemiology2018
Missing data and chance variation in public reporting of cancer stage at diagnosis: Cross-sectional analysis of population-based data in England.
Article in Cancer epidemiology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed.
- Inequalities in cancer diagnostic outcomes for patients with a learning disability: a retrospective cohort study in England.BMJ oncology · 2026Article
- The good, the bad and the ugly: What do we really do when we identify the best and the worst organisations?BMJ quality & safety · 2024Article
- Experiences of pain and pain management in advanced disease and serious illness for people from South Asian communities in Leeds and Bradford: a qualitative interview study.BMC palliative care · 2023Article
- Article
- Obtaining long-term stage-specific relative survival estimates in the presence of incomplete historical stage information.British journal of cancer · 2022Article
- Variations in Demand across England for the Magnetic Resonance-Linac Technology, Simulated Utilising Local-level Demographic and Cancer Data in the Malthus Project.Clinical oncology (Royal College of Radiologists (Great Britain)) · 2021Article
- Efficacy of continuous i.v. infusion of recombinant human vascular endothelial growth inhibitor in combination with chemotherapy in patients with advanced lung cancer.American journal of translational research · 2021Article
- Article
- The influence of patient case mix on public health area statistics for cancer stage at diagnosis: a cross-sectional study.European journal of public health · 2019Article
- Reliability of hospital scores for the Cancer Patient Experience Survey: analysis of publicly reported patient survey data.BMJ open · 2019Article
- The problem with composite indicators.BMJ quality & safety · 2019Article
- An ethnographic study of improving data collection and completeness in large-scale data exercises.Wellcome open research · 2019Article
- Which indicators of early cancer diagnosis from population-based data sources are associated with short-term mortality and survival?Cancer epidemiology · 2018Article
Corrections and comments
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Authors and funding
4 authors.
Funding
Abstract
backgroundThe percentage of cancer patients diagnosed at an early stage is reported publicly for geographically-defined populations corresponding to healthcare commissioning organisations in England, and linked to pay-for-performance targets. Given that stage is incompletely recorded, we investigated the extent to which this indicator reflects underlying organisational differences rather than differences in stage completeness and chance variation.
methodsWe used population-based data on patients diagnosed with one of ten cancer sites in 2013 (bladder, breast, colorectal, endometrial, lung, ovarian, prostate, renal, NHL, and melanoma). We assessed the degree of bias in CCG (Clinical Commissioning Group) indicators introduced by missing-is-late and complete-case specifications compared with an imputed 'gold standard'. We estimated the Spearman-Brown (organisation-level) reliability of the complete-case specification. We assessed probable misclassification rates against current pay-for-performance targets.
resultsUnder the missing-is-late approach, bias in estimated CCG percentage of tumours diagnosed at an early stage ranged from -2 to -30 percentage points, while bias under the complete-case approach ranged from -2 to +7 percentage points. Using an annual reporting period, indicators based on the least biased complete-case approach would have poor reliability, misclassifying 27/209 (13%) CCGs against a pay-for-performance target in current use; only half (53%) of CCGs apparently exceeding the target would be correctly classified in terms of their underlying performance.
conclusionsCurrent public reporting schemes for cancer stage at diagnosis in England should use a complete-case specification (i.e. the number of staged cases forming the denominator) and be based on three-year reporting periods. Early stage indicators for the studied geographies should not be used in pay-for-performance schemes.
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