Data Sources

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Canadian Cancer Registry
The Canadian Cancer Registry (CCR) contains information about all cancers diagnosed in Canada. This database is compiled from provincial and territorial cancer registries and covers all Canadian residents, living or deceased, diagnosed with cancer since 1992, including new primary (incident) cancers among patients previously diagnosed with cancer. For each calendar year, the CCR reports confirmed information about each new tumour, including tumour type, date of diagnosis, and demographic data about the patient.¹⁹

For record linkage, the 2008 CCR data file, representing all tumours diagnosed between 1992 and 2008 (2.5 million tumours), was used. Given differences in the data linkage approach across provinces, specific data processing and exclusions were applied for Ontario and Manitoba versus Nova Scotia and Prince Edward Island. For Ontario and Manitoba, the full 2008 CCR was linked to both the Manitoba Health Services Insurance Plan (MHSIP) and the Ontario Registered Persons Database (RPDB). For Nova Scotia and Prince Edward Island, 4.3% and 2.9% of records had a missing or invalid HIN and were excluded from the direct linkage.²⁰ For validation and analysis, the static CCR tabulation master file (TMF), vintage September 19, 2012, was used to select breast, colorectal and prostate tumours diagnosed between 2005 and 2008 in Ontario, Manitoba, Nova Scotia and Prince Edward Island. Final tumour cohorts used to report linkage rates and treatment events are reported in Table 1.

Discharge Abstract Database (DAD)
The Discharge Abstract Database (DAD) contains demographic, administrative and clinical data for acute care, some psychiatric, chronic rehabilitation and day surgery hospital discharges. These are reported annually by all jurisdictions, excluding Quebec, to the Canadian Institute for Health Information (CIHI) on a fiscal year basis (April 1 to March 31).²¹ The DAD contains approximately 3.2 million discharges per year.

For record linkage, the national DAD records for fiscal 2004/2005 through 2010/2011 were used to link to the Manitoba and Ontario tumour records using registry-obtained HINs. For Nova Scotia and Prince Edward Island, national DAD records from fiscal 1994/1995 to 2011/2012 were used to link to CCR (1992-to-2008) records with valid HINs. Further information on this record linkage is available elsewhere.²⁰

National Ambulatory Care Reporting System
The National Ambulatory Care Reporting System (NACRS) contains data regarding visits to health care facilities for ambulatory care, including community-based services. At each visit, patient demographics, clinical information (diagnoses, surgical interventions), and administrative, financial and service-specific data are recorded. NACRS data are reported to CIHI on a fiscal year basis (April 1 to March 31).²²

The NACRS captures day surgery procedures, emergency department visits, diagnostic imaging, and ambulatory clinic visits (for example, oncology care). The NACRS data are reported most comprehensively by Ontario, and less comprehensively for Manitoba, Prince Edward Island and Nova Scotia.^{23,24,25,26,27} The NACRS data from fiscal 2004/2005 through 2010/2011 for Ontario were eligible for record linkage to the CCR. For validation and analysis, approximately 27 million NACRS records from Ontario for fiscal years 2004/2005 to 2010/2011, excluding emergency room visits, were used.

Provincial health insurance registries
Provincial health insurance registries for Ontario and Manitoba were used as bridge files to link the cancer and hospital data. The Manitoba Health Services Insurance Plan (MHSIP) and the Ontario Registered Persons Database (RPDB) contain records for all individuals registered to receive health services in Manitoba and Ontario, respectively. Each registrant is assigned a unique Health Insurance Number (HIN).

For record linkage, annual MHSIP for 1992 through 2009 and RPDB files for 1991 through 2011 were provided to Statistics Canada. Before linkage to the CCR, the MHSIP and RPDB were pre-processed, including identification of individuals with multiple HINs (Manitoba = 0.2% or 3,588; Ontario = 1% or 165,123). In total, 1,684,056 MHSIP and 16,580,805 RPDB registrants were eligible for linkage to the CCR. Details about pre-processing of the registry files are available elsewhere.²⁸