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219 Background: Although ensuring high-quality care has a central role in Japanese cancer policy, introduction of a system to evaluate quality is still underway. With the goal of establishing a sustainable measurement system, this study assesses adherence to quality indicators (QIs) as an index for evaluating the quality of care for cervical cancer patients in Japan. Methods: Ten measurable QIs were devised by an expert committee using the modified Delphi method. Adherence to each QI was calculated by using hospital cancer registry data of patients diagnosed during 2013 and claims data between October 1, 2012, and December 31, 2014. Using registry-linked claims data across 281 hospitals, we measured 3 QIs on treatment for CIN3, 3 QIs on stage III or IVA, and 1 QI on stage IVB, respectively. We also measured 1 QI on examination of cancer spread and 1 QI on brachytherapy. Results: Data for 11,925 cervical cancer patients were analyzed. Patients’ mean age was 45.4 years (SD: 15.1). Among the QIs, use of platinum-based chemotherapy among stage IVB patients (99.1%), total hysterectomy as the last treatment among intraepithelial adenocarcinoma patients over age 44 years (87.7%), and selection of cisplatin-based regimen for concurrent chemo-radiation therapy (CCRT) (81.2%) to stage III/IVA diseases marked high adherence. In contrast, evaluation with cystoscope or proctoscope among stage IVA patients (32.4%) and use of CCRT as the initial treatment for stage III or IVA patients (49.5%) had relatively low adherence. Conclusions: The observed variation in adherence to QIs could demonstrate the provision of unstandardized care across Japan. Feedback on the results and continued monitoring are necessary to improve the quality of cervical cancer care.

41 Background: Multiple comorbidities and physiologic decline often prevent older patients from receiving the same standard care provided to younger patients. Therefore, providers who mainly treat older patients may become accustomed to not adhering to standards and thus might be less likely to provide standard care to younger patients. In this study, we compared the care provided to younger patients between facilities that care for a large number of elderly patients and those that treat relatively few older patients. Methods: We used a nationwide registry-linked claims database of 297 hospitals. Among the quality indicators (QIs) we formerly developed, we selected 2 and 3 QIs for lung cancer and gastric cancer, respectively, based on the variation in adherence across facilities. Facilities were divided into 2 groups based on the proportion of older patients (≥75) with each cancer type. We then compared the QI adherence in treating patients younger than 60 years old between the groups. The difference in adherence to standards of care (quality scores) between the 2 groups of facilities was assessed by using a logistic regression model adjusting for patient age and sex. Results: We analyzed data for 6,708 patients with lung cancer and 26,470 patients with gastric cancer. Respective quality scores for facilities with more older patients versus facilities with fewer older patients were 63.4% versus 66.1% (p=0.439) for the EGFR mutation test before the first chemotherapy among stage IV lung adenocarcinoma patients; 63.2% versus 52.5% (p=0.238) for concurrent chemoradiotherapy (CCRT) for localized small cell lung carcinoma patients; 51.6% versus 46.9% (p=0.229) for HER2 test before the first chemotherapy among patients with unresectable gastric cancer; 81.8% versus 79.7% (p=0.354) for Helicobacter pylori test on patients with gastric cancer who had ESD/EMR; and 60.9% versus 60.7% (p=0.948) for adjuvant chemotherapy within 6 weeks among pathological stage II/III gastric cancer patients. Conclusions: Caring for a high proportion of older patients is not associated with diminished provision of standard care to younger patients.

e22544Background: Sarcoma clinical guidelines often emphasize the evaluation of patients by an expert multidisciplinary team, and thus in many countries, care is centralized to treatment centers. However, there are no standard guidelines for referrals of sarcoma patients in Japan, and the overall picture of where and by whom they are treated has never been systematically investigated. Methods: We used hospital-based cancer registry and health claims data of sarcoma patients diagnosed in Japan in 2012 and 2013. We analyzed the distribution of patients across hospitals and the extent of centralization of care across treatment modality and cancer topography. Results: We identified 1032 bone and 7257 soft-tissue sarcoma (STS) patients who were newly diagnosed in 2012 and 2013. Bone sarcomas occurred in the limbs in 55% of the patients, with 73% treated by orthopedic surgeons. Care was weakly centralized to 9 high-volume hospitals ( > 10 new cases per year) and 120 hospitals with 1-9 new cases. Care was greatl...

e17656 Background: Care of pediatric cancer patients is only mildly centralized in Japan, and it is not known whether this has led to variations in treatment practices for pediatric solid tumor pat...

289 Background: Treatment wait times for cancer patients is among the key performance indicators of cancer policy in Japan, but has never been measured across a large number of patients. We aimed to measure treatment wait times for cancer patients across a large number of hospitals in Japan using health claims data. Methods: We developed a database of claims data (Jan 2011 - Dec 2012) linked to 2011 hospital-based cancer registry data of breast, cervical, colorectal, liver, lung, prostate and stomach cancer patients from 126 designated cancer hospitals in Japan. Treatment wait time was defined as the number of days between the date of diagnosis (the date on which a pathological test or imaging exam that contributed the most to the diagnosis was performed) and initiation of treatment. Dates of diagnostic tests, therapeutic procedures, and chemotherapy (chemo) administration were obtained from health claims data. We calculated wait times by cancer type, treatment, and stage, and investigated if these factors were significantly associated with wait times even after adjusting for age using multiple linear regression. Results: Among 44,102 cancer patients who received cancer treatment, the median wait time was 31 days (IQR=18-50) for all patients, and 32, 42, 31, 22, 22, 55 and 31 days for breast, cervical, colon, liver, lung, prostate and stomach cancer patients, respectively. Wait times were longer for surgery (36 days) compared to radiation (22 days) and chemo (21 days), and shorter for later stage patients: 48, 36, 35, 23, and 14 days for stages 0, I, II, III, and IV, respectively. Cancer type, treatment type, and stages were all independently and significantly associated with treatment wait times even after adjusting for age (p

264 Background: Health insurance claims data have been used extensively as a less labor-intensive method of collecting data than medical record reviews, which are the preferred source of data collection in most medical studies. Although recent reports have raised questions about its validity of use in measuring care quality, validity of using claims data may differ by health systems and should therefore be assessed by country. We aimed to test the validity of using claims data in Japan by comparing quality performance scores obtained from claims data to those derived from medical record reviews. Methods: We reviewed medical records from Apr 2013 to Apr 2014 of gastric and colorectal cancer patients who were diagnosed in 2011 from 4 cancer care hospitals in Okinawa. We calculated the proportion of patients who received adjuvant chemotherapy for gastric and colorectal cancer using claims data, and compared the results with those obtained from medical record reviews. Chart reviews were performed by certified tumor registrars. We used kappa coefficients to measure the level of agreement between claims data and medical record reviews. Results: Analysis using claims data resulted in 14 Stage II and III gastric cancer patients who had undergone surgery, with 50% receiving adjuvant chemotherapy; whereas medical record reviews resulted in 19 patients, 94.7% of whom either received or had a clinically valid rationale for not undergoing adjuvant therapy. For colorectal patients, claims data resulted in 48.5% of 68 surgical stage III colorectal patients receiving adjuvant therapy, compared to 74.4% of 78 patients using medical record reviews who either received adjuvant therapy or had a valid reason for not undergoing therapy. Agreement between claims data and chart reviews was low (kappa=0.14) for gastric cancer, but fair (kappa =0.37) for colorectal cancer. Conclusions: Our analysis showed that use of claims data may greatly underestimate quality performance measures if they are not compensated by medical record reviews. Claims data alone cannot capture a large proportion of patients who either choose not to, or has a clinically valid reason for not undergoing standard care.

287 Background: To ensure equitable access to high-quality cancer care, efforts to routinely measure key performance indicators of cancer policy began in Japan in 2014. Although assessing the quality of cancer care is a vital component of this initiative, a system for evaluating process of care across a large number of hospitals has not yet been established. We aimed to establish this system by creating a database of health claims data linked to hospital-based cancer registry (HBCR) and measuring quality indicators (QIs) for cancer care. Methods: We created a database of 28 months (Sept10-Dec12) of health claims data linked to HBCR for 100,825 breast, prostate, colorectal, stomach, lung, liver, and cervical cancer patients who were newly diagnosed in 2011 from 178 designated cancer care hospitals in Japan. Among 206 QIs that were previously developed by a panel of experts, we measured 13 that were measureable from claims data: 1) seven QIs on adherence to guidelines on adjuvant therapy, 2) four QIs on lab tests, procedures, and medication, and 3) two QIs on supportive care. Results: QIs investigating adherence to clinical guidelines on adjuvant therapy tended to be lower compared to QIs for supportive care. For example, 48.0% [46.4, 49.6] of stage III colorectal cancer patients (n=3,638) received adjuvant chemotherapy (5FU+LV, UFT+LV, Cape, FOLFOX, or CapeOX) within 8 postoperative weeks, whereas 68.1% [67.2, 69.0] of patients (n=10,104) received three-drug combination (5HT3-r antagonist, dexamethasone, and aprepitant) before receiving highly emetogenic chemotherapy. QIs on appropriate testing and procedures were higher overall, such that 83.3% [82.6, 84.0] of invasive breast cancer patients (n=12,447) received HER2 testing. In all QIs, there was large variability in performance across hospitals. Feedback was given to hospitals through interactive webpages. Conclusions: This is the first attempt at measuring the quality of cancer care across such a large number of hospitals in Japan. Our research showed that in all QIs, there was ample room for improvement. Continuous monitoring, improving feedback methods, expansion of QIs, and application of electronic health records, will be our next challenge as we move forward in this initiative.