Abstract
PURPOSE: Cancer stage is a key determinant of outcomes; however, stage is not available in claims-based data sources used for real-world evaluations. We compare multiple methods for classifying lung cancer stage from claims data. METHODS: Our study used the linked SEER-Medicare data. The patient samples included fee-for-service Medicare beneficiaries diagnosed with lung cancer from 2010 to 2011 (development cohort) and 2012 to 2013 (validation cohort) who received chemotherapy. Classification algorithms considered Medicare Part A and B claims for care in the 3 months before and after chemotherapy initiation. We developed a clinical algorithm to predict stage IV (v I to III) cancer on the basis of treatment patterns (surgery, radiotherapy, chemotherapy). We also considered an ensemble of claims-based machine learning algorithms. Classification methods were trained in the development cohort, and performance was measured in both cohorts. The SEER data were the gold standard for cancer stage. RESULTS: Development and validation cohorts included 14,760 and 14,620 patients with lung cancer, respectively. Validation analyses assessed clinical, random forest, and simple logistic regression algorithms. The best performing classifier within the development cohort was the random forests, but this performance was not replicated in validation analysis. Logistic regression had stable performance across cohorts. Compared with the clinical algorithm, the 14-variable logistic regression algorithm demonstrated higher accuracy in both the development (77% v 71%) and validation cohorts (77% v 73%), with improved specificity for stage IV disease. CONCLUSION: Machine learning algorithms have potential to improve lung cancer stage classification but may be prone to overfitting. Use of ensembles, cross-validation, and external validation can aid generalizability. Degradation of accuracy between development and validation cohorts suggests the need for caution in implementing machine learning in research or care delivery.