Cancer stage documentation and accuracy: Single-center retrospective study on oropharyngeal cancers

The objectives were to (1) conduct an electronic health records (EHRs) review of oropharyngeal cancer patients, (2) determine EHR stage documentation rates, and (3) compare staging accuracy within EHRs and by Cancer Center Coders.

Retrospective analysis of oropharyngeal cancer patients seen between January 1, 2010, and August 1, 2020, at a tertiary care center. Two experts reviewed EHRs to determine tumour (T), nodal (N), metastatic (M) and overall cancer stages. EHR staging documentation was abstracted and accuracy was reported in comparison to expert staging. Cancer Center Coders independently captured cancer staging, and accuracy was reported in comparison to expert staging.

803 patients were included. EHR stage documentation rates were 80 %, 78 %, 16 %, and 16 % for T, N, M, and overall stage, respectively. Average annual concordance (SD) between expert review and Cancer Center Coders were 65.6 %(5.0), 67.0 %(5.4), 90.7 %(4.9), 65.8 %(11.9) for T, N, M and overall stage, respectively. Concordance (SD) between expert review and EHR stage were 65.6%(8.6), 58.5 %(7.8), 9.3 %(3.8) and 13.6 %(7.5) for T, N, M and overall stage, respectively. In a sub-cohort of patients with only chart-documented staging, concordance (SD) rates were 80.9 %(5.4), 74.1 %(5.6), 58.0 %(16.3) and 78.2 %(15.0) for T, N, M and overall cancer stages.

EHR stage documentation rates were good for T and N stages, however poor for M and overall cancer stages. Staging accuracy was moderate-to-good when comparing staging from expert reviews to staging by Cancer Center Coders and clinicians. Quality improvement interventions may improve accuracy and frequency of HNC staging, thus improving patient outcomes.