Concordance of Lung Cancer, Melanoma, and Renal Cell Cancer Diagnosis Information Recorded in Health Care Databases in England: Analysis of Linkage Between Primary Care, Hospital Care, and Cancer Registry Data

Abstract

Purpose: Real-world evidence (RWE) addresses clinical trial limitations by capturing more representative patient populations and improves evaluation of anticancer treatments, although it becomes available only years after market authorization. As many RWE sources capture only parts of the healthcare continuum, dataset linkage is necessary to enhance data richness. Linkage quality must be assessed to prevent information bias due to incomplete data linkage. Methods: We evaluated diagnosis concordance for lung cancer (LC), melanoma, and renal cell cancer (RCC) in England. Patients were matched based on national health service (NHS) number, sex and date of birth. Eligible patients were drawn from the National Cancer Registry and Analysis Service (NCRAS), and matched with three other datasets: Clinical Research Practice Database Aurum (CPRD Aurum), Hospital Episode Statistics Admitted Patient Care (HES-APC), and systemic anticancer treatment (SACT). Concordance was evaluated for cancer diagnosis and date of diagnosis. Determinants of non-concordance were investigated to assess representativeness. Results: In total, 89 797 patients with LC, melanoma or RCC were identified, and concordance of cancer diagnosis records between NCRAS, CPRD Aurum and HES-APC exceeded 70%. Because patients are only registered in SACT upon receiving systemic anticancer treatment, matched numbers in SACT were significantly lower (3.0%–21.1%), as anticipated, particularly among patients over 80 years of age. However, differences in patient characteristics across datasets were limited. Concordance analyses showed that the majority of cases with LC diagnoses were registered within 3 months of the initial diagnosis within all data sources, whereas melanoma and RCC showed longer delays. Conclusions: Given the high concordance, NCRAS data can be enriched with HES-APC and CPRD Aurum, and further complemented by SACT for systemic therapy. Provided that SACT undergoes further validation, linkage between NCRAS, CPRD Aurum, HES-APC, and SACT may be a promising resource for RWE generation in oncology research.