Bias Introduced by Relying on Incomplete Electronic Pathology Reporting for Rapid Case Ascertainment in Patient...

Relying on electronic pathology (ePath) reporting to state cancer registries for rapid ascertainment of cases for patient contact research studies may introduce bias if the patient populations differ for reporting facilities with vs without ePath. We examined changes between 2014-2019 in the percent of cases reported to the New York State Cancer Registry by ePath within 3 months of diagnosis and characteristics of the most recent cases by ePath status. Our goal was to assess the potential bias introduced by relying on incomplete ePath reporting for patient recruitment.

We restricted our analysis to first malignant cancers diagnosed in New York State residents aged 18 years and older. We examined patient characteristics and used χ2 tests to examine differences in the distribution of each characteristic by ePath status for diagnosis years 2017-2019, and used multivariable-adjusted logistic regression to calculate odds ratios and 95% CIs for the association between each patient characteristic and ePath status for all 2017-2019 cancers combined and common cancer sites. All analyses were conducted using SAS 9.4.

The percent of cases reported by ePath increased over time from 15.7% in 2014 to 44.8% in 2019. Among 264,607 cancers diagnosed in 2017-2019 and reported through July 2021, there were statistically significant differences in all variables examined by ePath status (all P ‹ .0001). For all cancers combined, cases reported by ePath were more likely to be younger, female, non-Hispanic White, married, live outside of New York City/ Long Island, still be alive, and have received treatment. We observed statistically significant odds ratios for the associations between all variables examined and ePath status for all cancers combined, but the strength and statistical significance of the associations varied by cancer site.

Our results indicate that relying on incomplete ePath reporting for rapid case ascertainment will introduce selection bias in the study sample for patient contact studies. This bias should decrease as additional facilities acquire ePath reporting capability.