Access to PET/CT Scans Methodology

• Ontario Health (Cancer Care Ontario), Ontario Cancer Registry
• Discharge Abstract Data (DAD)
• National Ambulatory Care Reporting System (NACRS)
• Registered Person Database (RPDB)
• Activity Level Reporting (ALR)
• Ontario Health Insurance (OHIP) ÷
• Postal Code Conversion File (PCCF)
• PET Access
• PET Registry

1. Diagnosis Cohort:
   
   Inclusion Criteria
   • Use topography code = 'C34' to identify any patient who diagnosed with lung cancer
   • Patient diagnosed with lung cancer between January 01, 2013 and December 31, 2017
   • Use histology codes from Disease Pathway Management (DPM) to differentiate small cell carcinoma cancer, non-small cell lung cancer and unspecified malignant; only non-small cell lung cancer will be included
   • Patient was diagnosed at age 19 or older
   • Postal codes for LHIN of residence in geographical variation analysis are based on postal codes found in RPDB

   
   Exclusion Criteria

   • Patient with missing or invalid health card number
   • Method of confirmation code = 8 (Clinical Diagnosis only) and 9 (Unknown whether or not microscopically confirmed; death certificate only), similar to DPM lung concordance indicator
   • Patient with multiple primaries (regardless of whether the second primary was lung related or another disease site, about 35.2% of lung patients had multiple primaries)
   • Out of Ontario residence
2. Intervention Cohort:
   
   Inclusion Criteria
   • Use Lung Resection procedure codes list that was used for DPM concordance indicator to define lung resection
   • Patient who died after surgery 
   • Patient who received surgery within 3 months prior to the diagnosis and within 6 months after diagnosis
   • If a patient received more than 1 surgery, only the first surgery was included
   • Patient also found in Diagnosis cohort
3. Radiation Treatment Cohort:
   
   Inclusion Criteria
   • Patient received radiation treatment within 3 months after being diagnosed
   • Clinical practice group = LUNG
   • Radical treatment intent only (i.e., adjuvant, curative and neoadjuvant)
   • Active treatment record (i.e., ALR methodology key = 4)
   • Patient also found in Diagnosis cohort
4. Systemic Treatment Cohort:
   
   Inclusion Criteria
   • Patient received systemic treatment within 3 months after being diagnosed
   • Clinical practice group = LUNG if record found in ALR
   • Radical treatment intent only (i.e., adjuvant, curative and neoadjuvant) if record found in ALR
   • Active treatment record (i.e., ALR methodology key = 4)
   • Patient had ICD10 code = Z51.1 if record found in National Ambulatory Care Report System (NACRS)
   • Patient had CCI code = 1.ZZ.35.^^ if record found in Discharge Abstract Database (DAD)
   • Patient also found in Diagnosis cohort

   
   Exclusion Criteria

   • Patient only receiving radical systemic treatment, but no other radical treatment (i.e., no radiation treatment and no surgery) will be excluded

1. Patient diagnosed with non-small cell lung cancer between CY2013 and CY2017 also receiving radical treatment(s)
2. Patient received PET scans that occurred before radical treatments when:
   - within 6 months before surgery
   - within 3 months before radiation treatment or
   - within 3 months before systemic treatment
3. If the patients had more than 1 PET scan, then the PET scan that occurred closest to the date of first treatment will be used for analysis.
4. All PET scans will be considered (the PET scan may have been OHIP encoded as esophageal, SPN etc., but – if it occurred prior to lung treatment it would still have contributed to appropriate staging; there wouldn't be any difference in technique)

Confidence intervals are based on the 95% upper and lower confidence limits for the rates.

1. NOT a Radical Intent if the NACRS record was on or after a palliative intent systemic treatment in ALR
2. Radical Intent otherwise

Assumed patient received 2 PET scans when the PET scan date recorded in PET registry database is different from the service date in OHIP database.