Supplementary Methods: Imputation of mortality outside ...
Clinical and Economic Burden of Head and Neck Cancer: a Nationwide Retrospective Cohort Study from France. Schernberg A et al.Supplementary material contents TOC \o "1-3" \h \z \u Supplementary Methods: Imputation of mortality outside hospital PAGEREF _Toc4575984 \h 2Overview PAGEREF _Toc4575985 \h 2Methods PAGEREF _Toc4575986 \h 2Morbidity profile of patients with HNSCC discharged in 2008 PAGEREF _Toc4575987 \h 3Imputation of mortality outside hospital from 2008 to 2013 PAGEREF _Toc4575988 \h 3Cross-validation of mortality rates at 3 years PAGEREF _Toc4575989 \h 3Reference PAGEREF _Toc4575990 \h 3Supplementary Methods Table 1. Morbidity profile of patients discharged with HNSCC in 2008, by vital status (N=40 811) PAGEREF _Toc4575991 \h 5Supplementary Methods Table 2. Risk of in-hospital death in 2008 among patients with HNSCC and known vital status in 2008 (N=35 515) PAGEREF _Toc4575992 \h 8Supplementary Methods Table 3. Vital status of patients discharged with HNSCC, by year PAGEREF _Toc4575993 \h 10Supplementary Methods Table 4. Cross-validation of mortality rates at 3 years for HNSCC between French cancer registries and the study population PAGEREF _Toc4575994 \h 11Supplementary Table 1: Coding dictionary PAGEREF _Toc4575995 \h 13Reference PAGEREF _Toc4575996 \h 14Supplementary Table 2: Imputation of radiation therapy in the private sector PAGEREF _Toc4575997 \h 15Supplementary Methods: Imputation of mortality outside hospitalOverviewHospital admission remains frequent at end-of-life in France, overall and for cancer patients in particular. A majority of deaths occur at hospital, with stable figures over the last three decades. ADDIN EN.CITE <EndNote><Cite><Author>Institut national de la statistique et des études économiques</Author><Year>2014</Year><RecNum>209</RecNum><DisplayText><style face="superscript">1</style></DisplayText><record><rec-number>209</rec-number><foreign-keys><key app="EN" db-id="eppf5rrfqrxtxee99pw5evzpeevvzxaf0f0d">209</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors><authors><author>Institut national de la statistique et des études économiques,</author></authors></contributors><titles><title>Répartition des décès selon le lieu du décès [Distribution of deaths according to location]</title></titles><dates><year>2014</year></dates><publisher>Institut national de la statistique et des études économiques</publisher><urls><related-urls><url> In addition, about two-third patients receive hospital care in the month preceding death.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5QZW5uZWM8L0F1dGhvcj48WWVhcj4yMDEyPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA 2,3 In cancer patients, the role of hospital is even exacerbated at end-of-life: death was recorded at hospital for 73% deceased patients in 1993-2008, without changes over time, ADDIN EN.CITE <EndNote><Cite><Author>Gisquet</Author><Year>2012</Year><RecNum>828</RecNum><DisplayText><style face="superscript">4</style></DisplayText><record><rec-number>828</rec-number><foreign-keys><key app="EN" db-id="eppf5rrfqrxtxee99pw5evzpeevvzxaf0f0d">828</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Gisquet, E.</author><author>Aouba, A</author><author>Aubry, R.</author><author>Jougla, E.</author><author>Rey, G.</author></authors></contributors><titles><title>Où meurt-on en France ? Analyse des certificats de décès (1993-2008) [Where do we die in France? Analysis of death certificates (1993-2008)]. Epidémiologique Hebdomadaire</secondary-title></titles><periodical><full-title>Bulletin Epidémiologique Hebdomadaire</full-title></periodical><pages>547-51</pages><volume>48</volume><dates><year>2012</year><pub-dates><date>Dec. 11, 2012</date></pub-dates></dates><urls></urls></record></Cite></EndNote>4 and above 90% patients received hospital care in the month preceding death in 2009.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5QZW5uZWM8L0F1dGhvcj48WWVhcj4yMDEyPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA 6 We used a sequential approach by year of hospital admission to impute mortality outside hospital among all patients with a diagnosis of HNSCC and lost to follow-up in the same year. Expectedly, patients admitted to hospital in 2008 had the lowest level of attrition as they may be followed at hospital over the next five years (2009-2013). Therefore, we characterised the morbidity profile of patients with known vital status in 2008 with use of all hospital records of 2008 and estimated the probability of death in a given year with use of multivariate logistic regression. Then we imputed mortality outside hospital at an optimal cut-off (min (1-specificity)2+(1-sensitivity)2) based on the morbidity profile of patients lost to follow-up at hospital from 2008 to 2013. Finally, because the proportion of patients lost to follow-up at hospital increases exponentially in 2013, we censored all information on vital status at July 1, 2013 in the study population selected in 2010-12, i.e., after the initial treatment period of six months necessary to characterise patients first diagnosed with HNSCC in December 2012.To characterize morbidity profiles, a large amount of information was retrieved from all hospital records in a given year:Demographics: gender, age in January, zip code of residency categorized in French regions.Primary cancer other than HNSCC: lung cancer, oesophageal cancer, and any other primary cancer. ADDIN EN.CITE <EndNote><Cite><Author>Jegu</Author><Year>2014</Year><RecNum>104</RecNum><DisplayText><style face="superscript">7</style></DisplayText><record><rec-number>104</rec-number><foreign-keys><key app="EN" db-id="eppf5rrfqrxtxee99pw5evzpeevvzxaf0f0d">104</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Jegu, J.</author><author>Colonna, M.</author><author>Daubisse-Marliac, L.</author><author>Tretarre, B.</author><author>Ganry, O.</author><author>Guizard, A. V.</author><author>Bara, S.</author><author>Troussard, X.</author><author>Bouvier, V.</author><author>Woronoff, A. S.</author><author>Velten, M.</author></authors></contributors><auth-address>Registre des cancers du Bas-Rhin, Laboratoire d'Epidemiologie et de Sante Publique, EA3430, FMTS, Universite de Strasbourg, 4 rue Kirschleger, Strasbourg, CEDEX 67085, France. jeremie.jegu@unistra.fr.</auth-address><titles><title>The effect of patient characteristics on second primary cancer risk in France</title><secondary-title>BMC Cancer</secondary-title><alt-title>BMC cancer</alt-title></titles><periodical><full-title>BMC Cancer</full-title><abbr-1>BMC cancer</abbr-1></periodical><alt-periodical><full-title>BMC Cancer</full-title><abbr-1>BMC cancer</abbr-1></alt-periodical><pages>94</pages><volume>14</volume><dates><year>2014</year></dates><isbn>1471-2407 (Electronic)
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ADDIN EN.CITE.DATA 8,9 Acceptable causes-of-death and conditions that are intermediate causes of death (e.g., ICD-10 N17 for acute renal failure) were recorded by ICD-10 chapter. In absence of an acceptable cause-of-death, conditions that cannot be considered as the underlying cause-of-death were recorded by ICD-10 chapter (e.g., ICD-10 K02 codes for dental caries). Other prognostic factors. Several factors of ICD-10 chapters XVIII and XXI were recorded: palliative care (ICD-10 Z51.5); chronic dialysis (medical procedures); transplantation status (ICD-10 Z94; T86 and medical procedures); poor general condition (ICD-10 R53.+0); shock (ICD-10 R57); bedridden (ICD-10 R26..30 or Z74.00); senility (ICD-10 R54).Hospital trajectory in the year: total length of stay in acute inpatient care (in nights); admission in acute day case care (without inpatient care admission); emergency room admission; post-acute care admission; day case care at home; and nursing home admission.In preliminary analyses, we found that patients lost to follow-up in palliative care or chronic dialysis had dramatic immediate mortality risks. Of 30?238 patients recorded in palliative care before October 2013, in-hospital death rate was 90% within 3 months. Of 618 patients on chronic dialysis at last discharge before October 2013, in-hospital death rate was 73%. We assumed that these patients lost to follow-up in palliative care or chronic dialysis before October 2013 all died immediately after hospital discharge.Morbidity profile of patients with HNSCC discharged in 2008Of 40 811 patients discharged with HNSCC in 2008, 8?750 (21.4%) died at hospital in 2008, 26 765 (65.6%) were alive by the end of 2008 (ie, they had hospital records in 2009-2013), and 5 296 (13.0%) were lost to follow-up at hospital in 2008 (Table 1). Patients lost to follow-up in 2008 were rather in better health than patients alive by the end of 2008 and even more so when compared to patients who died in 2008.Imputation of mortality outside hospital from 2008 to 2013Table 2 shows the results of the multivariate logistic regression on the probability of in-hospital death among 35?515 patients with known vital status in 2008. Overall, the concordance reached 88.5% between observed and predicted deaths in 2008. At the optimal cut-off (ie, 20.5% predicted probability of death), sensitivity and specificity were 79.8% and 76.9%, respectively. Mortality outside hospital was imputed at the optimal cut-off based on the morbidity profile of patients lost to follow-up at hospital from 2008 to 2013 (Table 3). Of 5?296 patients lost to follow-up at hospital in 2008, 1?450 (27.4%) deaths were imputed. While the proportion of patients lost to follow-up at hospital increased slightly from 2008 to 2012, it increased exponentially in 2013 and all information on vital status was censored at July 1, 2013. Cross-validation of mortality rates at 3 yearsTable 4 shows the mortality rates at 3 years estimated in the study population (Kaplan-Meier method) and reported in French cancer registries. ADDIN EN.CITE <EndNote><Cite><Author>Cowppli-Bony</Author><Year>2016</Year><RecNum>226</RecNum><DisplayText><style face="superscript">10</style></DisplayText><record><rec-number>226</rec-number><foreign-keys><key app="EN" db-id="eppf5rrfqrxtxee99pw5evzpeevvzxaf0f0d">226</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>Cowppli-Bony, A.</author><author>Uhry, Z.</author><author>Remontet, L.</author><author>Guizard, A.-V.</author><author>Voirin, N.</author><author>Monnereau, A.</author><author>Bouvier, A.-M.</author><author>Colonna, M.</author><author>Bossard, N.</author><author>Woronoff, A. S.</author><author>Grosclaude, P.</author></authors></contributors><titles><title>Survie des personnes atteintes de cancer en France métropolitaine, 1989-2013. ?tude à partir des registres des cancers du réseau Francim. Partie 1 – Tumeurs solides</title></titles><dates><year>2016</year></dates><publisher>Réseau fran?ais des registres des cancers (Francim), service de biostatistique des Hospices civils de Lyon (HCL), Institut de veille sanitaire (InVS), Institut national du cancer (INCa)</publisher><urls></urls></record></Cite></EndNote>10 Overall, mortality rates at 3 years estimated in the study population significantly increased from 43.6% (95% CI, 42.9-44.3) with use of in-hospital death records to 53.1% (95% CI 52.5-53.6) after imputation of mortality outside hospital and censoring at July 1, 2013. After imputation of mortality outside hospital, mortality rates at 3 years were similar between the study population and pooled estimates from French cancer registries, overall and by primary HNSCC site.Reference ADDIN EN.SECTION.REFLIST Reference List1.Institut national de la statistique et des études économiques. Répartition des décès selon le lieu du décès [Distribution of deaths according to location]. 2014; S, Monnier A, Pontone S, Aubry R. End-of-life medical decisions in France: a death certificate follow-up survey 5 years after the 2005 act of parliament on patients' rights and end of life. BMC palliative care. Dec 3 2012;11:25.3.Observatoire National de la Fin de Vie. Rapport 2012: vivre la fin de vie chez soi. [2012 Report: living end-of-life at home]. . Observatoire National de la Fin de Vie,;2013.4.Gisquet E, Aouba A, Aubry R, Jougla E, Rey G. Où meurt-on en France ? Analyse des certificats de décès (1993-2008) [Where do we die in France? Analysis of death certificates (1993-2008)]. . Bulletin Epidémiologique Hebdomadaire. Dec. 11, 2012 2012;48:547-551.5.Schwarzinger M, Baillot S, Yazdanpanah Y, Rehm J, Mallet V. Contribution of alcohol use disorders on the burden of chronic hepatitis C in France, 2008-2013: A nationwide retrospective cohort study. Journal of hepatology. Sep 2017;67(3):454-461.6.Schildcrout JS, Basford MA, Pulley JM, et al. An analytical approach to characterize morbidity profile dissimilarity between distinct cohorts using electronic medical records. Journal of biomedical informatics. Dec 2010;43(6):914-923.7.Jegu J, Colonna M, Daubisse-Marliac L, et al. The effect of patient characteristics on second primary cancer risk in France. BMC cancer. 2014;14:94.8.Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. Dec 15 2012;380(9859):2095-2128.9.Naghavi M, Makela S, Foreman K, O'Brien J, Pourmalek F, Lozano R. Algorithms for enhancing public health utility of national causes-of-death data. Population health metrics. May 10 2010;8:9.10.Cowppli-Bony A, Uhry Z, Remontet L, et al. Survie des personnes atteintes de cancer en France métropolitaine, 1989-2013. ?tude à partir des registres des cancers du réseau Francim. Partie 1 – Tumeurs solides. Réseau fran?ais des registres des cancers (Francim), service de biostatistique des Hospices civils de Lyon (HCL), Institut de veille sanitaire (InVS), Institut national du cancer (INCa);2016.Supplementary Methods Table 1. Morbidity profile of patients discharged with HNSCC in 2008, by vital status (N=40 811)Morbidity profileIn-hospital death in 2008Alive by the end of 2008Lost to follow-up in 2008P-valueN=8 750N=26 765N=5 296Men7 289 (83.3)21 725 (81.2)4 195 (79.2)<0.0001Age in January 2008, mean (std) years64.3 (11.9)61.4 (11.5)61.5 (12.8)<0.0001French region?Paris area1 337 (15.3)3 885 (14.5)818 (15.5)<0.0001?North-West2 268 (25.9)6 454 (24.1)1 516 (28.6)?North-East2 376 (27.2)7 117 (26.6)1 203 (22.7)?South-West819 (9.4)2 587 (9.7)467 (8.8)?South-East1 893 (21.6)6 555 (24.5)1 247 (23.6)?French West Indies57 (0.7)167 (0.6)57 (0.9)?Other cancer (by ICD-10 chapter)?????Lung cancer (II)1 072 (12.3)1 474 (5.5)207 (3.9)<0.0001Esophageal cancer (II)531 (6.1)809 (3.0)115 (2.2)<0.0001Cancer other than HNSCC lung or esophageal (II)1 688 (19.3)3 875 (14.5)606 (11.4)<0.0001Metastasis (II)3 316 (37.9)2 345 (8.8)518 (9.8)<0.0001Lymph nodes (without metastasis) (II)1 143 (13.1)4 314 (16.1)706 (13.3)<0.0001Other causes-of-death (by ICD-10 chapter)????HIV/AIDS (I)40 (0.5)115 (0.4)12 (0.2)0.078Infectious diseases other than HIV (I)2 506 (28.6)3 167 (11.8)573 (10.8)<0.0001Blood disorders (III)1 964 (22.5)2 725 (10.2)482 (9.1)<0.0001Malnutrition (IV)2 840 (32.5)3 915 (14.6)714 (13.5)<0.0001Endocrine and metabolic disorders (IV)2 291 (26.2)6 073 (22.7)872 (16.5)<0.0001Mental and behavioral disorders (V)2 578 (29.5)8 485 (31.7)1 326 (25.0)<0.0001Diseases of the nervous system (VI)968 (11.1)1 589 (5.9)298 (5.6)<0.0001Diseases of the circulatory system (IX)2 525 (28.9)6 183 (23.1)912 (17.2)<0.0001Diseases of the respiratory system (X)2 086 (23.8)6 084 (22.7)936 (17.7)<0.0001Diseases of the liver (XI)634 (7.3)1 257 (4.7)184 (3.5)<0.0001Other diseases of the digestive system (XI)1 978 (22.6)5 316 (19.9)744 (14.1)<0.0001Diseases of the skin and subcutaneous tissue (XII)551 (6.3)703 (2.6)125 (2.4)<0.0001Diseases of the musculoskeletal system and connective tissue (XIII)333 (3.8)887 (3.3)111 (2.1)<0.0001Diseases of the urinary system (XIV)473 (5.4)1 026 (3.8)129 (2.4)<0.0001Gynecological diseases (XIV)6 (0.1)52 (0.2)10 (0.2)<0.05External causes of mortality (XX)912 (10.4)1 963 (7.3)286 (5.4)<0.0001Intermediate causes-of-death (by ICD-10 chapter)????Infectious diseases other than HIV (I)607 (6.9)484 (1.8)91 (1.7)<0.0001Endocrine and metabolic disorders (IV)841 (9.6)813 (3.0)159 (3.0)<0.0001Diseases of the circulatory system (IX)555 (6.3)662 (2.5)92 (1.7)<0.0001Diseases of the respiratory system (X)1 556 (17.8)1 140 (4.3)230 (4.3)<0.0001Diseases of the liver (XI)183 (2.1)129 (0.5)19 (0.4)<0.0001Diseases of the urinary system (XIV)804 (9.2)973 (3.6)165 (3.1)<0.0001Other prognostic factors (ICD-10 chapters XVIII and XXI)?????Transplantation status31 (0.4)140 (0.5)11 (0.2)<0.01?Poor health condition2 568 (29.4)1 818 (6.8)428 (8.1)<0.0001Shock2 022 (23.1)1 215 (4.5)208 (3.9)<0.0001Bedridden515 (5.9)133 (0.5)52 (1.0)<0.0001?Senility48 (0.6)36 (0.1)7 (0.1)<0.0001Hospital trajectory (admission)????Inpatient care8 423 (96.3)23 694 (88.5)4 356 (82.3)<0.0001Day case admission without inpatient care3 443 (39.4)13 013 (48.6)1 991 (37.6)<0.0001Emergency room3 765 (43.0)5 027 (18.8)869 (16.4)<0.0001Post-acute care2 033 (23.2)3 845 (14.4)553 (10.4)<0.0001Day case care at home974 (11.1)784 (2.8)74 (1.4)<0.0001Nursing home302 (3.5)361 (1.4)181 (3.4)<0.0001Supplementary Methods Table 2. Risk of in-hospital death in 2008 among patients with HNSCC and known vital status in 2008 (N=35 515)Morbidity profile?Adjusted odds-ratio(95% CI)P-valueMen1.15 (1.06-1.25)<0.001Age1.25 (1.13-1.38)<0.0001Age21.00 (0.99-1.00)<0.0001Age31.00 (1.00-1.00)<0.0001French region (reference: Paris area)North-West1.28 (1.16-1.42)<0.0001North-East1.12 (1.02-1.24)South-West1.18 (1.04-1.33)South-East1.11 (1.00-1.22)French West Indies1,43 (1,01-2,03)Other cancer (by ICD-10 chapter)???Lung cancer (II)1.22 (1.10-1.36)<0.001Esophageal cancer (II)1.42 (1.24-1.64)<0.0001Cancer other than HNSCC, lung or esophageal (II)0.93 (0.86-1.01)0.073Metastasis (II)5.37 (4.98-5.79)<0.0001Lymph nodes (without metastasis) (II)1.32 (1.21-1.43)<0.0001Other causes-of-death (by ICD-10 chapter)??HIV/AIDS (I)1.03 (0.65-1.63)0.9Infectious diseases other than HIV (I)1.46 (1.35-1.58)<0.0001Blood disorders (III)1.31 (1.20-1.42)<0.0001Malnutrition (IV)1.55 (1.44-1.66)<0.0001Endocrine and metabolic disorders (IV)0.76 (0.71-0.82)<0.0001Mental and behavioral disorders (V)0.72 (0.67-0.78)<0.0001Diseases of the nervous system (VI)1.18 (1.06-1.32)<0.01Diseases of the circulatory system (IX)0.90 (0.84-0.97)<0.01Diseases of the respiratory system (X)0.97 (0.90-1.05)0.48Diseases of the liver (XI)1.64 (1.44-1.85)<0.0001Other diseases of the digestive system (XI)0.72 (0.67-0.78)<0.0001Diseases of the skin and subcutaneous tissue (XII)1.42 (1.23-1.65)<0.0001Diseases of the musculoskeletal system and connective tissue (XIII)0.69 (0.58-0.81)<0.0001Diseases of the urinary system (XIV)0.62 (0.54-0.72)<0.0001Gynecological diseases (XIV)0.30 (0.11-0.81)<0.05External causes of mortality (XX)0.77 (0.69-0.86)<0.0001Intermediate causes-of-death (by ICD-10 chapter)??Infectious diseases other than HIV (I)1.93 (1.65-2.25)<0.0001Endocrine and metabolic disorders (IV)0.72 (0.63-0.83)<0.0001Diseases of the circulatory system (IX)1.55 (1.34-1.80)<0.0001Diseases of the respiratory system (X)2.83 (2.56-3.14)<0.0001Diseases of the liver (XI)2.57 (1.95-3.40)<0.0001Diseases of the urinary system (XIV)1.19 (1.05-1.35)<0.01Other prognostic factors (ICD-10 chapters XVIII and XXI)???Transplantation status0.76 (0.47-1.24)0.27?Poor health condition3.20 (2.95-3.46)<0.0001Shock3.96 (3.57-4.40)<0.0001Bedridden4.77 (3.82-5.97)<0.0001?Senility1.87 (1.14-3.08)<0.05Hospital trajectory (admission)??Inpatient care1.39 (1.22-1.59)<0.0001Day case admission without inpatient care0.54 (0.51-0.58)<0.0001Emergency room2.15 (2.01-2.29)<0.0001Post-acute care1.11 (1.03-1.20)<0.05Daycare at home3.06 (2.71-3.45)<0.0001Nursing home1.42 (1.17-1.72)<0.001Supplementary Methods Table 3. Vital status of patients discharged with HNSCC, by yearYearTotal patients dischargedin the yearNew patientsin the yearIn-hospital death in the yearAlive at the end of the yearPatients lost to follow-up in the yearIncrease in total deathsafter imputationTotalImputation of death statusImputation of alive status200840 81140 811 (100)8 750 (21.4)26 765 (65.6)5 296 (13.0)1 450 (27.4)3 846 (72.6)1.17200947 00826 232 (55.8)9 693 (20.6)30 747 (65.4)6 568 (14.0)1 692 (25.8)4 876 (74.2)1.17201050 22423 158 (46.1)10 142 (20.2)32 345 (64.4)7 737 (15.4)1 793 (23.2)5 944 (76.8)1.18201152 96421 647 (40.9)10 372 (19.5)21 195 (60.8)10 397 (19.6)2 146 (20.6)8 251 (79.4)1.21201255 07420 505 (37.2)10 396 (18.8)28 521 (51.8)16 157 (29.3)2 922 (18.1)13 235 (81.1)1.28201356 93819 598 (34.4)10 383 (18.2)404 (0.7)46 151 (81.1)10 732 (23.3)35 419 (76.7)2.03Supplementary Methods Table 4. Cross-validation of mortality rates at 3 years for HNSCC between French cancer registries and the study populationPrimary head and neck cancer siteStudy population?FRANCIM 2005-2010N(%)In-hospital death and follow-up to last discharge in 2010-2013?Overall death and complete follow-up to 07/01/2013?N(%)SurvivalNasal cavity/paranasal sinuses (C30.0;C31)2 8545.4%46.1 (42.5-49.6)56.4 (53.8-58.8)6514.1%53 (49-57)Nasopharynx (C11)1 7813.3%52.9 (48.5-57.1)57.7 (54.9-60.5)2831.8%61 (56-67)Lip (C00)2 1574.1%67.8 (63.0-72.2)73.1 (70.4-75.6)4122.6%80 (76-84)Tongue (C01-C02)7 82614.7%40.4 (38.6-42.3)50.8 (49.4 (52.2)2 37615.0%48 (46-50)Oral cavity (C03-C06)8 21515.4%43.8 (41.9-45.6)53.5 (52.1-54.9)2 84718.0%53 (51-54)Oropharynx (C09-C10)10 42419.6%40.2 (38.5-41.9)50.5 (49.3-51.8)3 11719.7%48 (46-50)Hypopharynx (C12-C13)6 57912.4%32.6 (30.7-34.5)40.9 (39.4-42.5)2 39215.1%36 (34-38)Ill-defined head and neck (C14)1 3602.6%30.9 (27.1-34.8)36.4 (33.2-40.0)4432.8%--Head and neck (C01-C06; C09-C14)41 19677.4%42.7 (41.9-43.4)?52.0 (51.4-52.5)?11 45872.3%46 (45-47)Larynx (C32)12 06222.6%52.2 (50.6-53.8)59.7 (58.6-60.8)3 31620.9%62 (60-64)All head and neck53 258100%43.6 (42.9-44.3)?53.1 (52.5-53.6)?15 837100%-- FRANCIM : French cancer registriesSupplementary Table 1: Coding dictionaryVariablesInternational Classification of Diseases and Related Health Problems, 10th Revision, French version (ICD-10-FR)RefHNSCC characteristics at initial treatment (6 months after first diagnosis of HNSCC)Primary HNSCC site (primary discharge diagnosis)? ADDIN EN.CITE <EndNote><Cite><Author>Amin</Author><Year>2017</Year><RecNum>476</RecNum><DisplayText><style face="superscript">1</style></DisplayText><record><rec-number>476</rec-number><foreign-keys><key app="EN" db-id="eppf5rrfqrxtxee99pw5evzpeevvzxaf0f0d">476</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Amin, M.B.,</author><author>Edge, S., </author><author>Greene, F.,</author><author>Byrd, D.R.,</author><author>Brookland, R.K.,</author><author>Washington, M.K.,</author><author>Gershenwald, J.E.,</author><author>Compton, C.C.,</author><author>Hess, K.R.,</author><author>Sullivan, D.C.,</author><author>Jessup, J.M.,</author><author>Brierley, J.D.,</author><author>Gaspar, L.E.,</author><author>Schilsky, R.L.,</author><author>Balch, C.M.,</author><author>Winchester, D.P.,</author><author>Asare, E.A.,</author><author>Madera, M.,</author><author>Gress, D.M.,</author><author>Meyer, L.R.</author></authors></contributors><titles><title>AJCC Cancer Staging Manual, 8th ed</title></titles><dates><year>2017</year></dates><pub-location>New-York</pub-location><publisher>Springer-Verlag</publisher><urls></urls></record></Cite></EndNote>1?Malignant neoplasm of nasopharynx C11.0-C11.9?Malignant neoplasm of nasal cavity or paranasal sinusesC30.0; C31.0-C31.9?Malignant neoplasm of lipC00.0-C00.9?Malignant neoplasm of oral cavity (excluding base of tongue, soft palate, and uvula)C02.0-C04.9; C05.2; C05.8; C05.9; C06.0-C06.9?Malignant neoplasm of oropharynx (including base of tongue, soft palate, and uvula)C01; C05.0; C05.1; C09.0-C10.9; C14.2?Malignant neoplasm of hypopharynx (including epilarynx)C12-C13.9; C32.1?Malignant neoplasm of larynx (excluding epilarynx)C32.0; C32.2; C32.3; C32.8; C32.9?Malignant neoplasm of ill-defined site in HNSCCC14.0; C14.8?HNSCC stage? ADDIN EN.CITE <EndNote><Cite><Author>Amin</Author><Year>2017</Year><RecNum>476</RecNum><DisplayText><style face="superscript">1</style></DisplayText><record><rec-number>476</rec-number><foreign-keys><key app="EN" db-id="eppf5rrfqrxtxee99pw5evzpeevvzxaf0f0d">476</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Amin, M.B.,</author><author>Edge, S., </author><author>Greene, F.,</author><author>Byrd, D.R.,</author><author>Brookland, R.K.,</author><author>Washington, M.K.,</author><author>Gershenwald, J.E.,</author><author>Compton, C.C.,</author><author>Hess, K.R.,</author><author>Sullivan, D.C.,</author><author>Jessup, J.M.,</author><author>Brierley, J.D.,</author><author>Gaspar, L.E.,</author><author>Schilsky, R.L.,</author><author>Balch, C.M.,</author><author>Winchester, D.P.,</author><author>Asare, E.A.,</author><author>Madera, M.,</author><author>Gress, D.M.,</author><author>Meyer, L.R.</author></authors></contributors><titles><title>AJCC Cancer Staging Manual, 8th ed</title></titles><dates><year>2017</year></dates><pub-location>New-York</pub-location><publisher>Springer-Verlag</publisher><urls></urls></record></Cite></EndNote>1?Metastatic stage (any record of distant metastasis)C78.0-C79.9?Locally advanced stage???Any ICD-10 record indicating locoregional extension C00.8; C02.8; C04.8; C05.8; C06.8; C08.8; C09.8; C10.8; C11.8; C13.8; C14.0; C14.8; C77?Any treatment record eliminating an early stagechemotherapy (Z51.1)surgery (HNSCC surgical procedures) and radiotherapy (Z51.0)tracheostomy at index HNSCC diagnosis (Z93.0, Z43.0, J95.0)palliative care (Z51.5)PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HcmVnb2lyZTwvQXV0aG9yPjxZZWFyPjIwMTA8L1llYXI+
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ADDIN EN.CITE.DATA 6-9?Human Immunodeficiency Virus (HIV) infection was added to Acquired Immune Deficiency Syndrome (AIDS)Z21; B20-B24?Reference ADDIN EN.SECTION.REFLIST 1.Amin MB, Edge S, Greene F, et al. AJCC Cancer Staging Manual, 8th ed. New-York: Springer-Verlag; 2017.2.Gregoire V, Lefebvre JL, Licitra L, Felip E, Group E-E-EGW. Squamous cell carcinoma of the head and neck: EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of oncology : official journal of the European Society for Medical Oncology / ESMO. May 2010;21 Suppl 5:v184-186.3.Institut National du Cancer (INCa). Algorithme de sélection des hospitalisations liées à la prise en charge du cancer dans les bases nationales d'activité hospitalière de court séjour ? algorithme cancer ? [Algorithm to select cancer-related hospitalizations in the French National Hospital Discharge (PMSI) database]. Boulogne-Billancourt: INCa;2013.4.Working Group R. International rules for multiple primary cancers (ICD-0 third edition). European journal of cancer prevention : the official journal of the European Cancer Prevention Organisation. Aug 2005;14(4):307-308.5.Jegu J, Colonna M, Daubisse-Marliac L, et al. The effect of patient characteristics on second primary cancer risk in France. BMC cancer. 2014;14:94.6.Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of chronic diseases. 1987;40(5):373-383.7.Quan H, Sundararajan V, Halfon P, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Medical care. Nov 2005;43(11):1130-1139.8.Quan H, Li B, Couris CM, et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. American journal of epidemiology. Mar 15 2011;173(6):676-682.9.Bannay A, Chaignot C, Blotiere PO, et al. The Best Use of the Charlson Comorbidity Index With Electronic Health Care Database to Predict Mortality. Medical care. Feb 2016;54(2):188-194.Supplementary Table 2: Imputation of radiation therapy in the private sectorInitial HNSCC location and stage at initial careAll incident patientsRadiation therapyObserved in public sectorOverall after imputation in private sectorAll HNSCC53,257 (100)18,583 (34.9)30,832 (57.9)?Early stage (I/II)15,749 (29.6)1,724 (11.0)6,292 (40.0)Locally advanced stage (III/IVb)32,723 (61.4)15,252 (46.6)22,933 (70.1)Distant metastasis (IVc)4,785 (9.0)1,607 (33.6)Nasal cavity/paranasal sinuses (C30.0;C31)2,854 (5.4)1,042 (36.5)1,523 (53.4)?Early stage (I/II)1,266 (44.4)146 (11.5)462 (36.5)Locally advanced stage (III/IVb)1,303 (45.7)769 (59.0)934 (71.7)Distant metastasis (IVc)285 (10.0)127 (44.6)Nasopharynx (C11)1,781 (3.3)725 (40.7)1,215 (68.2)?Early stage (I/II)389 (21.8)45 (11.6)389 (100)Locally advanced stage (III/IVb)1,187 (66.7)609 (51.3)1,187 (100)Distant metastasis (IVc)205 (11.5)71 (34.6)Lip (C00)2,157 (4.0)211 (9.8)343 (15.9)?Early stage (I/II)1,857 (86.1)115 (6.2)238 (12.8)Locally advanced stage (III/IVb)257 (11.9)86 (33.5)95 (37.0)Distant metastasis (IVc)43 (2.0)10 (23.3)Tongue (C01-C02)7,826 (14.7)2,743 (35.1)4,328 (55.3)?Early stage (I/II)2,305 (29.4)146 (6.3)844 (36.6)Locally advanced stage (III/IVb)4,891 (62.5)2,378 (48.6)3,265 (66.8)Distant metastasis (IVc)6,30 (8.1)219 (34.8)Oral cavity (C03-C06)8,215 (15.4)2,826 (34.4)4,222 (51.4)?Early stage (I/II)2,709 (33.0)263 (9.7)263 (9.7)Locally advanced stage (III/IVb)4,839 (58.9)2,324 (48.0)3,003 (62.1)Distant metastasis (IVc)667 (8.1)239 (35.8)Oropharynx (C09-C10)1,0424 (19.6)4,481 (43.0)6,979 (67.0)?Early stage (I/II)1,681 (16.1)283 (16.8)1,099 (65.4)Locally advanced stage (III/IVb)7,721 (74.1)3,861 (50.0)5,543 (71.8)Distant metastasis (IVc)1,022 (9.8)337 (33.0)Hypopharynx (C12-C13)6,579 (12.4)2,806 (42.7)4,383 (66.6)?Early stage (I/II)802 (12.2)172 (21.5)643 (80.2)Locally advanced stage (III/IVb)4,906 (74.6)2,335 (47.6)3,441 (70.1)Distant metastasis (IVc)871 (13.2)299 (34.3)Ill-defined HNSCC (C14)1,360 (2.6)355 (26.1)544 (40.0)?Locally advanced stage (III/IVb)1,170 (86.0)302 (25.8)491 (42.0)Distant metastasis (IVc)190 (14.0)53 (27.9)Larynx (C32)1,2061 (22.6)3,394 (28.1)6,074 (50.4)?Early stage (I/II)4,740 (39.3)554 (11.7)2,354 (49.7)Locally advanced stage (III/IVb)6,449 (53.5)2,588 (40.1)4,974 (77.1)Distant metastasis (IVc)872 (7.2)252 (28.9)Legend: Initial HNSCC site was defined from the primary discharge diagnosis recorded at first HNSCC surgery or panendoscopy (81%), and otherwise the first primary (10%) or secondary (9%) discharge diagnosis. Of 53,257 patients, 2 patients at early stage had a single hospital stay with a billing error and were excluded from the main analysis. ADDIN EN.SECTION.REFLIST ADDIN EN.REFLIST ................
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