Transcript Whats_New_for_Cancer_Registrars_2016x

What’s New in 2016?
For TCR, NPCR, COC
April Fritz, RHIT, CTR
What We’ll Cover
 Newly reportable conditions and tumors
 Continuation of current codes for new terms
 NPCR Requirements
 Data items from COC/FORDS 2016
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Continuing data items
Revised data items
New data items
Other standards setter requirements
Discontinued data items
Newly Reportable Tumors
 8470/2 Non-invasive mucinous cystic neoplasm of the
pancreas with high-grade dysplasia
 Same as mucinous cystadenocarcinoma, non-invasive
 8452/3 Solid pseudopapillary neoplasm of pancreas
 Same as solid pseudopapillary carcinoma (C25._)
 8150/3 Cystic pancreatic endocrine neoplasm (CPEN).
 Unless specified as a neuroendocrine tumor, Grade 1 (8240/3) or
neuroendocrine tumor, Grade 2 (8249/3)
 9080/3 Mature teratoma of testes in adults
 Continues to be non-reportable in prepubescent children
(9080/0). Report only if pubescence is explicitly stated in the
medical record. Do not report if there is no mention of
pubescence in the medical record.
Newly Reportable* Tumors
 8077/2 Laryngeal intraepithelial neoplasia, grade III
(LINIII) (C320-C329)
 8077/2 Squamous intraepithelial neoplasia, grade III
(SINIII) except Cervix and Skin
* Except COC
New Reportable Terms with
Existing Codes 2016
(No changes from 2015)
8163/3
Pancreatobiliary-type carcinoma (C24.1)
Use 8255/3 Adenocarcinoma, pancreatobiliary-type (C24.1)
8213/3
Serrated adenocarcinoma
Use 8213/3*
8265/3
Micropapillary carcinoma, NOS (C18._, C19.9, C20.9)
Use 8507/3*
8552/3
Mixed acinar ductal carcinoma
Use 8523/3
New Reportable CNS Terms
with Existing Codes 2016
(No changes from 2015)
9395/3
Papillary tumor of the pineal region
Use 9361/3*
9425/3
Pilomyxoid astrocytoma
Use 9421/3
9431/1
Angiocentric glioma
Use 9380/1*
9432/1
Pituicytoma
Use 9380/1*
9509/1
Papillary glioneuronal tumor
Use 9505/1 Rosette-forming glioneuronal tumor
NPCR Staging Requirements
Directly coded AJCC
 Clinical and Pathologic T, N, M, Stage Group
 Necessary biomarkers and prognostic factors
Why use AJCC?
 Infrastructure in place to update AJCC regularly
 Physicians readily participate
 Widespread knowledge of system across
individuals and specialties
Adapted from NPCR staging presentation, NCRA 2016
NPCR Staging Requirements
Directly coded Summary Stage
 All registries, all providers
Why use Summary Stage?
 Provides continuity across nation and time
 Easier to learn and collect
 Provides stage information with lowest cost
for training and effort
 Few extra fields needed
 Lymph nodes positive/examined
 Tumor Size Summary
Adapted from NPCR staging presentation, NCRA 2016
NPCR Newly Required
Treatment Fields
 Surg/rad sequence
 Systemic/surg sequence
Continuing Data Items
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Regional Nodes Positive
Regional Nodes Examined
Lymph-vascular Invasion
CS Site-Specific Factors
 Requirements vary by standards setter
 CS Version Input Original
 CS Version Input Current
NPCR Required SSFs
Required for Directly Assigned AJCC TNM Stage
Site (CS Schema)
SSF
Appendix
11
GISTPeritoneum
5, 10
GISTs: Esoph,
Sm Int, Stomach
6
GISTs: Appendix,
Colon, Rectum
11
MycosisFungoides
1
Placenta
1
Prostate
1
Testis
13, 15, 16
Description
Histopathologic Grading
Mitotic Count; Location of Primary Tum
Mitotic Count
Mitotic Count
Peripheral Blood Involvement
Prognostic Scoring Index
PSA Lab Value
Post Orch AFP, hCG, and LDH Range
SSF 25 (Schema Discriminator) required for: BileDuctsDistal,
BileDuctsPerihilar, CysticDuct, EsophagusGEJunction,
LacrimalGland, LacrimalSac, MelanomaCiliaryBody, MelanomaIris,
Nasopharynx, PharyngealTonsil, Stomach
NPCR Required SSFs
Required by NPCR (but not for AJCC Staging)
Site (CS Schema)
Brain, CNS Other,
Intracranial Gland
Breast
SSF Description
1
WHO Grade
1
2
8
9
11
13
14
15
16
ERA
PRA
HER2: IHC value
HER2: IHC Interpretation
HER2: FISH Interpretation
HER2: CISH Interpretation
HER2: Result of other test
HER2: Summary Result testing
Combination of ERA, PRA and HER2
Testing
Revised Data Items
TNM Clin Staged By – to 2 digits
TNM Path Staged By – to 2 digits
 Conversion of previous to
new codes available
Conversion Table 1 to 2 digits
0
00
1
10
2
14
3
15
4
10
5
20
6
30
7
50
8
88
Code 9 converted separately based on T,
N, M, Stage Group values (blank, X, 88)
or directly to 99
TNM Staged By
00
Not staged
10
Physician, NOS, or physician type not
specified in codes 11-15
11
Surgeon
12
Radiation Oncologist
13
Medical Oncologist
14
Pathologist
15
Multiple Physicians; tumor board, etc
20
Cancer registrar
30
Cancer registrar and physician
40
Nurse, physician assistant, or other
non-physician medical staff
50
Staging assigned at another facility
60
Staging by Central Registry
88
Case is not eligible for staging
99
Staged but unknown who assigned
stage
Revised Data Items
Sex
3 – Other (intersex, disorders of sexual
development/DSD)
4 – Transsexual, NOS*
5 – Transsexual, Natal Male*
6 – Transsexual, Natal Female*
*changed in 2015
Revised Data Items
 Definitions of many fields (53) modified to
accommodate EHR reporting
 Example: change ‘hospital’ to ‘reporting facility’
New Data Items
 Tumor Size Summary
 Tumor Size Clinical
 Tumor Size Pathologic
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Mets at Dx – Distant Lymph Nodes
Mets at Dx – Other
Mets at Dx – Bone
Mets at Dx – Brain
Mets at Dx – Liver
Mets at Dx – Lung
 Summary Stage 2000
Tumor Size Summary
 Required by COC, NPCR
 FORDS defines as “the most accurate
measurement of a solid primary tumor…”
 Priority
1. Surgical resection specimen if no neoadjuvant
treatment
2. If neoadjuvant treatment then surgery, tumor size
prior to neoadjuvant treatment
3. If no surgical resection, largest measurement
from PE, imaging or other diagnostic procedure
prior to any treatment
4. If 1, 2, and 3 do not apply, largest size from all
information available within 4 months of
diagnosis, with no disease progression
Tumor Size Summary
 No special codes for “less than x cm” etc.
 Specific FORDS instructions for coding less than
x / greater than x
 Examples <2 cm  019; >3 cm  031
Between 2 and 3 cm  025
 Rounding rules, priority of imaging
techniques, and other tumor size guidelines
very similar to CS
Tumor Size Clinical
 Required by SEER
 Tumor size before any treatment
 Priority
1. Largest measurement from PE, imaging or other
diagnostic procedure prior to any form of
treatment
2. Largest size from all information available within
4 months of diagnosis, with no treatment or
disease progression
 Same guidelines for less than x / greater
than x, rounding, priority of imaging, etc., as
Tumor Size Summary
Tumor Size Pathologic
 Required by SEER
 Tumor size from resected specimen
 Priority
1. Largest measurement of invasive portion of
tumor on specimen when surgery is part of first
definitive treatment
a.
b.
c.
d.
CAP protocol
Final diagnosis
Microscopic examination
Gross examination
 Same guidelines for less than x / greater
than x, rounding, priority of imaging, etc., as
Tumor Size Summary
Consider Yourself Fortunate
That you don’t work in a COC-accredited
hospital in a state jointly funded by NPCR and
SEER where SEER continues to require CS
data elements…
You would have to enter
 Tumor Size Summary (for COC and NPCR)
 Tumor Size Clinical (for SEER)
 Tumor Size Pathologic (for SEER)
 Tumor Size in text field (for everyone)
 CS Tumor Size (for SEER)
 Plus everything else…
Mets at Dx – Distant Nodes
 Required by all standards setters
 Similar to Mets at Dx lung/liver/bone/brain
 Codes
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0
1
8
9
None, no distant lymph node metastases
Yes; distant lymph node metastases
Not applicable
Unknown whether distant nodes are involved;
not documented in patient record
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Distant nodes as defined in TNM
May be clinical or pathologic
Code whether or not there was neoadj Tx
Use code 9 when distant nodes not specifically
mentioned as involved
Mets at Dx – Other
 Required by all standards setters
 Similar to Mets at Dx lung/liver/bone/brain
 Codes
 0 None, no other metastases
 1 Yes; distant metastases in known site(s) other
than bone, brain, liver, lung, distant nodes
 2 Generalized metastases such as carcinomatosis
 8 Not applicable
 9 Unknown whether other metastatic site or
generalized metastases; not documented in
patient record
 Guidelines
 Same as for Mets at Dx – Distant Nodes
COC Required SSFs
No changes/additions/deletions from 2015
requirements
One less thing to remember…
No Changes (as of 4/1/2016)
 Multiple Primary and Histology Coding Rules
for solid tumors
 New version likely 2018
 Hematopoietic and Lymphoid Neoplasms
Database
 Stand-alone and web-based versions
 SEER*Rx Drug Database
 Stand-alone and web-based versions
Other New Data Items
(Central Registries)
 Items Populated by Software
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County at Dx Geocode 1990
County at Dx Geocode 2000
County at Dx Geocode 2010
County at Dx Geocode 2020
Rural Urban Continuum 2013
 NPCR Derived Clin Stg Grp
 NPCR Derived Path Stg Grp
 SEER Derived data items (9)
Discontinued* Data Items
 * Still required historically for cases
diagnosed 2004-2015 and in some SEER
areas:
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CS Tumor Size
CS Extension
CS Tumor Size/Ext Eval
CS Lymph Nodes
CS Lymph Nodes Eval
CS Mets at DX Data Items
CS Mets Eval
CS Version Derived
Derived AJCC-6 Data Items
Derived SS and Flag Data Items
Derived AJCC-7 Data Items
AJCC TNM 8th Edition
 Publication date: October 31, 2016
 Implementation date: January 1, 2017 diagnoses
 Changes expected
 Focus on evidence based medicine
 Based on multiple data sources
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Content harmonization to resolve inconsistencies
 Personalized medicine approach
 Non-anatomic prognostic factors as relevant to site
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Factors required for staging, recommended for collection
AJCC-approved prognostic risk calculation models
Clearer staging rules with easy reference
New chapters and split chapters
More education/training
8th Edition dedicated to cancer registrars
FORDS Ambiguous Terminology
 Clarification issued by NCDB 4-28-2016
 Ambiguous Terminology Lists: References of
Last Resort
…When abstracting, registrars are to use the
“Ambiguous Terms at Diagnosis” list with
respect to case reportability, and the
“Ambiguous Terms Describing Tumor Spread”
list with respect to tumor spread for staging
purposes. However, these lists need to be
used correctly.
FORDS Ambiguous Terminology
 [Abridged] …When the medical record is not
clear is to follow up with the physician.
 If the physician is not available, the medical record,
and any other pertinent reports (e.g., pathology, etc.)
should be read closely for the required information.
 Where wording in the patient record is ambiguous
with respect to reportability or tumor spread and no
further information is available from any resource,
refer to Ambiguous Terminology Lists.
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Do not refer to Ambiguous Terminology Lists when
there is a clear statement of malignancy or tumor
spread (i.e., the registrar can determine malignancy or
tumor spread from the resources available)
FORDS Ambiguous Terminology
 [Abridged]
 The CoC recognizes that not every registrar
has access to the physician who diagnosed
and/or staged the tumor, as a result, the
Ambiguous Terminology lists continue to be
used in CoC-accredited programs and
maintained by CoC as "references of last
resort".
COC Standards
 New Name: Cancer Program Standards:
Ensuring Patient-Centered Care (2016 Edition)
 12 Eligibility Requirements
 34 Standards
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Program management
Clinical services
Continuum of care services
Patient outcomes
Data quality
COC Standards Revisions 2016
 Standard definitions and requirements required
effective 01/01/2016
 First surveys on requirements in 2017
 Eligibility requirements
 Wording changes ER3 to ER12
 Standards requirements changes
 1.7 Monitoring Cancer Conference Activity
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Each calendar year, the cancer conference coordinator monitors
and evaluates the cancer conference activities and reports the
findings to the cancer committee
Source: Brief Summary of 2016 Edition Revisions,
https://www.facs.org/qualityprograms/cancer/coc/standards
COC Standards Revisions 2016
 Standards requirements changes
 1.8 Monitoring of Prevention, Screening, and Outreach
Activities
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Each calendar year, the community outreach coordinator, under
the direction of the cancer committee, monitors the effectiveness
of prevention, screening, and outreach activities. The activities
and monitoring results are documented in an annual community
outreach activity summary that is presented to the cancer
committee at the end of each calendar year.
1.9 Clinical Research Accrual
 As appropriate to the cancer program category, the required
percentages of patients are accrued to cancer-related clinical
research studies each calendar year. The Clinical Research
Coordinator documents and reports clinical research study
enrollment information to the cancer committee annually.
Source: Brief Summary of 2016 Edition Revisions,
https://www.facs.org/qualityprograms/cancer/coc/standards
COC Standards Revisions 2016
 Standards requirements changes
 2.1 College of American Pathologists Protocols and
Synoptic Reporting
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Each calendar year, 95 percent of the eligible cancer pathology
contain all required data elements of the College of American
Pathologists (CAP) protocols and are structured using the
synoptic reporting format as defined by the CAP Cancer
Committee.
 2.2 Oncology Nursing Care
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Oncology nursing care is provided by nurses with specialized
knowledge and skills. Nursing competency is evaluated each
calendar year. Results are reported to the cancer committee and
documented in the cancer committee minutes.
 2.3 Genetic Counseling and Risk Assessment
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Cancer risk assessment, genetic counseling, and genetic testing
services are provided to patients either on-site or by referral to a
qualified genetics professional.
Source: Brief Summary of 2016 Edition Revisions,
https://www.facs.org/qualityprograms/cancer/coc/standards
COC Standards Revisions 2016
 Standards requirements changes
 4.1 Cancer Prevention Programs
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Each calendar year, the cancer committee organizes and offers
at least one cancer prevention program designed to reduce the
incidence of a specific cancer type and targeted to meet the
prevention needs of the community. Each prevention program is
consistent with evidence-based national guidelines for cancer
prevention
 4.2 Cancer Screening Programs
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Each calendar year, the cancer committee organizes and offers
at least one cancer screening program that is designed to
decrease the number of patients with late-stage disease and is
targeted to meet the screening needs of the community. Each
screening program is consistent with evidence-based national
guidelines and interventions and must have a formal process
developed to follow up on all positive findings
Source: Brief Summary of 2016 Edition Revisions,
https://www.facs.org/qualityprograms/cancer/coc/standards
CP3R
 Cancer Program Practice Profile Reports
 19 Quality measures covering 8 primary
cancers
 3 types of measures
 Accountability
 Quality improvement
 Surveillance
 More measures for 2016
 Melanoma
 Bladder
 Pediatric cancers
2016 CP3R New Quality Measures
 Melanoma
 M10AxLN – At least 10 regional lymph nodes are
removed and examined in Axillary lymph node
dissection
 M05IgLN – At least 5 regional lymph nodes are
removed and examined in Inguinal lymph node
dissection
 MCLND – Completion Lymph Node Dissection use
after positive Sentinel Lymph Nodes biopsy
 Bladder:
 BL2RLN – At least 2 lymph nodes are removed in
patients under 80 undergoing partial or radical
cystectomy
RQRS
 Rapid Quality Reporting System
 2016 Updates
 New measure added: Radiation therapy is
recommended or administered following any
mastectomy within 1 year (365 days) of diagnosis of
breast cancer for women with greater than or equal to
4 positive regional lymph nodes (MASTRT).
 Manual case exclusions will now be allowed in RQRS.
Measure exclusions will be added to the RQRS case
list and updated nightly.
 The abbreviation of the RQRS "BCS" measure
'Radiation therapy is administered within 1 year (365
days) of diagnosis for women under age 70 receiving
breast conserving surgery for breast cancer' has
been updated to "BCSRT" to be more consistent with
CP3R.
RQRS
 Rapid Quality Reporting System Purpose
 Allows expedited data entry of a critical subset of
items specifically relevant to anticipated standard of
care treatments
 Enables accredited cancer programs to report data
on patients concurrently.
 Shows cancer programs up‐to‐date concordance
rates relative to the state, other similar programs, and
all CoC accredited programs across the country.
 Provides the hospitals timely notification of treatment
expectations.
Source: RQRS User Guide 04/2016
RQRS
 Rapid Quality Reporting System Benefits
 Improve patient care with access to real clinical time
performance rates.
 Evaluate historical performance to compare with current
practice.
 Use the information in RQRS to develop real clinical time
interventions to enhance the quality of care in your cancer
program.
 Monitor and prevent patients from experiencing a delay in
treatment or catch patients who are at risk of “slipping through
the cracks.”
 Compare performance rates in your cancer program with other
participating cancer programs.
 Encourage timely and accurate collection of adjuvant treatment
information.
 Negotiate favorable reimbursement rates with payors through
demonstrating current practices.
Source: RQRS User Guide 04/2016
RQRS
 REQUIRED participation starting 2017
 Potential Changes In Registry Operations
 Concurrent abstraction may take time to master.
 RQRS cases are followed from diagnosis through the
end of treatment, which can be as much as one year
after diagnosis.
 Registrars may need to follow up with treating
physicians regularly to determine the treatment status
of RQRS cases with alerts.
 RQRS case alerts may be reviewed in cancer
conferences or at cancer committee meetings.
Source: RQRS User Guide 04/2016
Future COC Initiatives
 Integrate NAPBC (breast center accreditation)
with COC
 Launch of NAPRC (rectal cancer accreditation)
 Phase II Oncology Medical Home Accreditation
Program
Housekeeping Details
 Finish 2015 cases before you start 2016
diagnoses
 Use consistent rules for entire diagnosis year
 New data fields, new c/p indicators,
discontinued data items effective for
01/01/2016 diagnoses and forward
 Follow your standards setter(s) instructions
Any Questions?