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Exploration of PCORnet Data Resources for Assessing Use of Molecular-Guided Cancer Treatment
Ryan M Carnahan1, Lemuel R Waitman2, Mary E Charlton3
1Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA.
Purpose:
Examine the ability of PCORnet data resources to investigate molecular-guided cancer treatment.
Patients And Methods:
Patients (N = 86,154) had single primary solid tumors (diagnosed 2013-2017) from hospital oncology registries linked to the PCORnet Common Data Model (CDM) at 11 medical institutions. Molecular and anatomic test procedures and oral and infused therapies were identified with Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes, RxNorm Concept Unique Identifier, and National Drug Codes from CDM tables. Chart review (2 institutions, n = 213) for advanced colorectal cancer and Medicare claims linkages (7 institutions, n = 1,731) for breast cancer explored options for increasing electronic data capture.
Results:
Molecular testing prevalence detected via analyte-specific molecular CPT/HCPCS codes was 5.5% (n = 4,784); for the nonspecific anatomic pathology codes, for which only some testing is performed to guide therapy selection, it was an additional 44.8% (n = 38,610). Molecular-guided therapy prevalence was 5% (n = 4,289). Testing and treatment were most common with stage IV disease and varied across cancer types and study institutions (testing, 0%-10.4%; treatment, 0.8%-8.4%). Therapy-concordant test results were found in charts for all 36 treated patients with colorectal cancer at the 2 institutions, 3 (8.3%) of whom received treatment outside the institution. Breast cancer Medicare claims linkage increased rates of identified testing from 62.7%-98.9% and treatment from 3.9%-8.2%.
Conclusion:
Although a minority of patients received molecular-guided therapies, the majority had testing that could guide cancer treatment. Claims data extended electronic data capture for therapies and test orders but often was uninformative for types of test ordered. Test results continue to require text data curation from narrative pathology reports.
Insights
PCORnet data can identify molecular testing in cancer patients, but capturing molecular-guided therapy requires further data integration. Electronic data capture for testing and treatment improved with claims linkage.
Area of Science:
- Oncology
- Biomedical Informatics
- Health Services Research
Background:
- Molecular-guided cancer therapy relies on identifying specific genetic alterations to tailor treatment.
- Real-world data resources are crucial for evaluating the uptake and impact of precision medicine in oncology.
- PCORnet (National Patient-Centered Clinical Research Network) offers a large-scale data infrastructure for clinical research.
Purpose of the Study:
- To assess the capability of PCORnet data resources in identifying patients receiving molecular-guided cancer treatments.
- To determine the prevalence of molecular testing and molecular-guided therapy within a large patient cohort.
- To explore methods for enhancing electronic data capture of molecular testing and treatment information.
Main Methods:
- Utilized PCORnet Common Data Model (CDM) data from 11 medical institutions, linking hospital oncology registries for 86,154 patients with solid tumors (2013-2017).
- Identified molecular and anatomic tests, and therapies using CPT, HCPCS, RxNorm, and NDC codes.
- Conducted chart reviews for advanced colorectal cancer and linked Medicare claims for breast cancer to improve data capture.
Main Results:
- Molecular testing was identified in 5.5% of patients using specific codes, with an additional 44.8% having non-specific anatomic pathology tests.
- Molecular-guided therapy was utilized by 5% of patients, with higher prevalence in stage IV disease and variation across institutions.
- Claims data linkage significantly improved the identification of testing (62.7% to 98.9%) and treatment (3.9% to 8.2%) for breast cancer.
Conclusions:
- While a minority received molecular-guided therapies, most patients had molecular testing that could inform treatment decisions.
- Claims data enhance electronic capture of therapy and test orders but lack detail on test types.
- Accurate capture of molecular test results still necessitates manual curation of narrative pathology reports.
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