MARCH 2016 Maryland Cancer Registry E-Update W · MARCH 2016 Maryland Cancer Registry E-Update Inside this issue: What’s New 1-2 Quality Control “2016 Changes for Cancer Reg-

A publicaon by Westat under contract with the DHMH Contract #DHMH-OPASS 07-9486

W hat’s New?

MARCH 2016 Maryland Cancer Registry

E-Update

Inside this issue:

What’s New 1-2

Quality Control “2016 Changes for Cancer Reg-istries”

3-8

Lab Only Follow-back 9-10

Announcement (Webinar Schedule)

13

Disease Index 11-12

Death Clearance 12

The beautiful spring came; and when nature resumes her loveliness, the human soul is apt to revive also…. Harriet Ann Jacobs

Important News

• Naonal Cancer Registrars Week is from April 11 – 15, 2016 and the MCR has

received Governor Larry Hogan’s official proclamaon in recognion of this

event. Cancer Registrar’s are an integral part of the prevenon and control of

cancer and their hard work is greatly appreciated.

• The Maryland Cancer Registry website has been updated and has a new web-

site link: hp://phpa.dhmh.maryland.gov/cancer/Pages/mcr_home.aspx.

Please update your browser bookmarks and if needed, clear your website cache.

hp://www.ncra-usa.org/

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Page 2 MARYLAND CANCER REGISTRY E-UPDATE

C ont. What’s New

During our hospital conference call on February 25, 2016, MCR indicated it was changing the reporng requirements to be in

closer alignment to our reporng law by requiring non-analycal cases to be reported. This brought up a tremendous amount of

discussion as well as suggesons. As a result, MCR will be preparing an official announcement leer to go out to you and your

supervisors. MCR is exploring two ways of reporng non-analycal cases through Web Plus direct entry and through non-

NAACCR file upload. By doing a small amount of work on the front end of the registry process, it should help saving me on the

back end of the process by not handling cases twice for disease index, death and lab follow back.

As menoned in our previous E-Update, changes will also include: AJCC “TNM” and summary stage coding to be recorded in the

cancer registry abstract; the change from ICD-9-CM to ICD-10-CM; the conversion of the MCR programs to NAACCR version 16,

and more eligible praconers using cerfied electronic health records (EHR) technology (Meaningful Use).

All of these changes will assist in ensuring the collecon of mely accurate and complete data and will also provide valuable in-

formaon for cancer diagnosis and treatment. We know these changes will bring many inquiries and we want all to be assured,

we will do all we can to be of assistance and listen to any suggesons.

Please send us any ideas you have for arcles; share how you do something more efficiently or effecvely; and share any recog-

nions or special announcements.

Thank you again for all you do.

Problems are not stop signs…they are guidelines

Robert H. Schuller

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Q uality Control, 2016 Changes

Summary for Hospital Cancer Registrars and Reporng Facilies

The Commission on Cancer (CoC), CDC Naonal Program of Cancer Registries (NPCR), and NCI’s SEER would like to collecvely

thank hospital registrars for their perseverance in excellence during this me of annual change. Cancer registraon is an ever

evolving field, and without the connued level of dedicaon demonstrated by hospital registrars across North America these

organizaons would not be able to adapt to change and meet their goals.

Although there are numerous new and revised registry data items for 2016, many of the changes are intended for implemen-

taon at the central registry level (e.g., derivaon of new derived staging data items, geocoded data items), or are informa-

onal in nature (e.g., wording changes to accommodate EHR reporng). The scope of change actually implemented at the

level of the hospital registry is minimal, however, there are a few changes that registrars need to be aware of in order to

smoothly transion to using new and changed data items and updated soware. In parcular, there are new data items being

implemented to accommodate the transion away from Collaborave Stage and it is imperave that hospital registrars be

familiar with the specific reporng requirements of the standard seer(s) to which their data are ulmately reported, as there

are differences in requirements, specifically for staging informaon.

Cases diagnosed on or aer January 1, 2016, must be collected and reported in accordance with the standards and definions

of the Standards Volume II, Version 16.

Priorize Case Abstracng Registrars should priorize their case abstracng, and ideally, the abstracon of cases diagnosed prior to January 1, 2016

should be completed before converng registry data or the beginning of the use of Standards Volume II-based, Version 16

soware upgrades. Please note that the Maryland Cancer Registry is dependent on the CDC for soware upgrades and the

ancipated release of Version 16 soware is May 2016. Therefore, the MCR should have their systems upgraded by the June

30th quarterly submission deadline.

By Mary Mesnard, BS, RHIA, CTR , Westat, Senior Study Director Tel#: 301-212-3705; Email: [email protected]

2016 Changes for Cancer Registries

mailto:[email protected]

4


Q uality Control cont. New Data Items

New Data Items The following new data items all are being implemented to accommodate transion away from Collaborave Stage: Mets at DX-Bone [1112] Mets at DX-Brain [1113] Mets at DX-Distant LN [1114] Mets at DX-Liver [1115] Mets at DX-Lung [1116] Mets at DX-Other [1117] Tumor Size Summary [756]

CSv2 Data Items that Connue to be Required:

Regional Nodes Posive [820]

Regional Nodes Examined [830]

Lymph-Vascular Invasion [1182]

CS Version Input Original [2935]

CS Version Input Current [2937]

CS Site-Specific Factors 1, 2, 5, 6, 8, 9, 10, 11, 13, 14, 15, 16, 25 [2880, 2890, 2920, 2930, 2862-2865, 2867-2870, 2879]

Other New Data Items

Data Item Name Item # Column Source of Standard

Derived SS2017* 762 894-894 SEER

Directly Assigned SS2017* 764 895-895 SEER

NPCR Derived Clin Stg Grp 3650 896-899 NPCR

NPCR Derived Path Stg Grp 3655 900-903 NPCR

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Q uality Control Cont. Data items

Data Items No Longer Required/Required Historically:

CS Site-Specific Factors 3, 4, 7, 12, 17-24 [2900, 2910, 2861, 2866, 2871-2878]

CS Tumor Size [2800]

CS Extension [2810]

CS Tumor Size/Ext Eval [2820]

CS Lymph Nodes [2830]

CS Mets at DX [2850]

CS Version Derived [2936]

Derived SS2000 [3020]

Derived SS2000-Flag [3050]

CS Lymph Nodes Eval [2840]

CS Mets Eval [2860]

Derived AJCC-7 T [3400]

Derived AJCC-7 T Descript [3402]

Derived AJCC-7 N [3410]

Derived AJCC-7 N Descript [3412]

Derived AJCC-7 M [3420]

Derived AJCC-7 M Descript [3422]

Derived AJCC-7 Stage Grp [3430]

Over-ride CS 1-20 [3750-3769]

Addion of Clinical and Pathologic indicators to AJCC T, N, and M Values

“AJCC ming rules” state that data used for clinical staging includes any informaon obtained about the extent of cancer

before iniaon of definive treatment (surgery, systemic or radiaon therapy, acve surveillance, or palliave care) or

within 4 months aer the date of diagnosis, whichever is shorter, as long as the cancer has not clearly progressed during that

me frame. Data used for pathologic staging includes any informaon obtained about the extent of cancer up through com‐

pleon of definive surgery as part of first course treatment or idenfied within 4 months aer the date of diagnosis, which-

ever is longer, as long as there is no systemic or radiaon therapy iniated or the cancer has not clearly progressed during

that me frame. In specific instances, pathologic findings can be used when assigning clinical stage, and clinical findings can be

used when assigning pathologic stage.

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Q uality Control cont. AJCC, TNM

According to the AJCC manual and trainings, this results in mixing individual clinical T, N, and M components with

individual pathologic T, N, and M components to assign the clinical and/or pathologic stage group. However, can-

cer registry abstracng soware is currently set up to code two separate and mutually exclusive strings of T, N, M,

and stage values; one for clinical, the other for pathologic, with an implied “c” in the clinical TNM string, and an

implied “p” in the pathologic TNM string. Upon abstracon, the registrar has previously had no way of including an

observed clinical finding that meets the pathologic ming rule, or a pathologic finding that meets the clinical me

rule, to assign a group stage.

This discrepancy between “soware rules” and “AJCC rules” causes a dilemma for registrars when abstracng data

items in the registry soware while aempng to strictly comply with AJCC rules, resulng in inconsistent coding

pracces and data loss. Consequently, as part of the transion away from Collaborave Stage towards directly-

assigned TNM stage, all of the standard seng organizaons have agreed to address this issue by adding clinical

and pathologic indicators to the AJCC T, N, and M data items [940, 950, 960, 880, 890, and 900]. The indicators will

be incorporated by adding the prefixes of “c” and “p” to exisng valid clinical and pathologic T, N, and M codes

respecvely, modifying a few of the exisng codes for the individual T, N, and M data items, as well as adding and

deleng specific exisng codes newly prefixed with a ‘c’ or ‘p’ (for example, addion of c0, c1, c1A, c1B, c1C, c1D,

and c1E to the list of valid values for pathologic M data item). In addion, in some cases conversion of historical

data will be required.

This will allow for selecon of necessary ‘p’ values within the clinical string and selecon of necessary ‘c’ values

within the pathologic string within NAACCR Version 16-compliant abstracon soware. The benefits of this imple‐

mentaon will reduce coding confusion and increase registrar confidence in coding AJCC stage, decrease data

compromise and loss and increase data integrity, and reduce the me and resources registrars and standard

seers currently spend addressing these issues. AJCC will be providing trainings to reinforce the proper abstracon

of clinical and pathologic T, N, and M data items and assignment of AJCC stage. See FORDS Revised for 2016 for

valid values and instrucons for coding.

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Q uality Control cont. ICD-0 Histologies

ICD-O-3 Histologies New Terms and Codes Not Yet Implemented

The NAACCR Guidelines for ICD-O-3 Update Implementaon (published December 2013) included a table of new ICD-O-3

codes and terms effecve for 2015 however, the use of the new codes was postponed due to issues surrounding the addion

of these codes to the CSv2 soware. For diagnosis year 2016, all standard seers have agreed to postpone implemenng the‐

se codes once again, and to use the alternate codes published in Table 2 of the NAACCR Guidelines for ICD-O-3 Update Imple-

mentaon. It is ancipated that these codes will be implemented in 2017 when the AJCC-TNM 8th Edion goes into effect.

Hospital registrars should ancipate that these codes will be used by their pathologists, but since these terms have not yet

been officially adopted for cancer surveillance in North America, registrars should abstract cases using the acceptable codes

listed to report them to central registries and to the CoC.

The complete document can be found on the NAACCR web site: Guidelines for ICD-O-3 Update Implementaon.

Newly Reportable Condions/Tumors:

In 2014 and 2015, SEER added new reportable histology terms to their Program and Coding Manual. These terms had not

been included in any ICD-O-3 errata and therefore were not addressed throughout the cancer surveillance community. CDC

has reviewed the terms and determined that the following list below are reportable. While there has not been an official erra-

ta to address these histology terms, CDC recommends adding them to ICD-O-3 Manuals and educang reporng sources

about these new updates.

1. Non-invasive mucinous cysc neoplasm of the pancreas with high-grade dysplasia replaces mucinous cystadenocarcino-

ma, non-invasive (8470/2).

2. Solid pseudopapillary neoplasm of pancreas (8452/3) is synonymous with solid pseudopapillary carcinoma (C25._)

3. Based on pathologist consultaon, metastases have been reported in some cysc pancreac endocrine neoplasm (CPEN)

cases. With all other pancreac endocrine tumors now considered malignant, CPEN will also be considered malignant,

unl proven otherwise. Most CPEN cases are non-funconing and are REPORTABLE using histology code 8150/3, unless

the tumor is specified as a neuroendocrine tumor, grade 1 (assign code 8240/3) or neuroendocrine tumor, grade 2

(assign code 8249/3)

4. Laryngeal intraepithelial neoplasia, grade III (LINIII) (8077/2), C320-C329)

5. Squamous intraepithelial neoplasia, grade III (SINIII) (8077/2), except Cervix and Skin

8


Q uality Control Cont. Reportable conditions/tumor

6. Mature teratoma of the testes in adults is malignant and REPORTABLE as 9080/3, but connues to be non-reportable in pre-

pubescent children (9080/0). The following provides addional guidance:

- Adult is defined as post puberty

- Pubescence can take place over a number of years

- Do not rely solely on age to indicate pre or post puberty status. Review all informaon (physical history, etc.) for documenta-

on of pubertal status. When tescular teratomas occur in adult males, pubescent status is likely to be stated in the medical

record because it is an important factor of the diagnosis.

- Do not report if unknown whether paent is pre or post pubescence. When tescular teratoma occurs in a male and there is no

menon of pubescence, it is likely that the paent is a child, or pre-pubescent, and the tumor is benign.

Lab Only Follow-back 2016 will soon be underway. The MCR is mandated to collect informaon on inial diagnosis, inial

treatment, the extent of disease, and paent demographic informaon on all malignant tumors diagnosed or treated in the

state of Maryland. Laboratory reports cannot always provide all demographic and clinical informaon that we are required to

collect. Therefore, we review laboratory reports sent to the MCR to idenfy physicians who ordered the lab test on non-

hospitalized paents and request further informaon. To this end, the MCR followed back melanomas, prostate, and uro‐

logic cases to physicians offices that were reported to the registry by independent or hospital-affiliated laboratories but lack-

ing a report from a physician office.

Please review the follow FAQs below regarding Lab Only Follow-back cases:

Lab Only Follow-back

By Wilhelmina Ross, PA, MPH, CTR Maryland Cancer Registry Tel#(301) 212-2184; Email: [email protected]


9


Maryland Department of Health and Mental Hygiene

Center for Cancer Prevention and Control Maryland Cancer Registry

Frequently Asked Questions – “Lab Only” Follow Back

May 2016 Below are a list of frequently asked quesons regarding “lab only” follow back reporng of cancer cases to the Maryland Cancer Registry (MCR). “Lab only” tumors are those reported to the MCR only by a laboratory and not by any other hospital, radiaon facility, or physician.

1. Queson: If a pathology laboratory reports a newly diagnosed reportable tumor to the MCR, is it necessary for the physician to report the same case to the MCR?

Answer: Maryland law states that “…each physician who has care of or has diagnosed cancer or a central nervous sys-tem tumor for a nonhospitalized paent not otherwise reported shall…submit a cancer report to the Secretary” hp://phpa.dhmh.maryland.gov/cancer/Documents/1-Health_General_18-203-18-204.pdf

Furthermore, Maryland law states that a cancer report consists of demographic informaon, inial histology, inial treatment, and the extent of disease (by the end of the first hospitalizaon). Because a laboratory report only provides MCR with a histology, primary site, and very limited demographics, MCR sll needs race, county of residence, disease stage, and treatment informaon on the cases. To obtain this addional informaon, MCR sends leers to physicians who ordered the lab test on non-hospitalized paents with cancer reported by a lab. The physician receiving the leers may either 1) reply to the MCR’s request for informaon on cases where the MCR only has informaon from a lab, or 2) choose to become a reporter to the MCR and report these cases directly.

2. Queson: Do physician offices get reimbursed for the me it takes to report these cases? Answer: No. The MCR does not pay any reporng facility to submit cases.

3. Queson: What are the HIPAA guidelines that cover reporng paent informaon to the MCR and where can this informaon be located? MCR is a public health authority, as defined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Federal regulaons [see 45 C.F.R. §164.512(a), (b), and (d) and §160.203(c)] authorize disclosure without pa‐ent consent in a number of circumstances.

Q uality Control, Lab Only Follow-back

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Page 10 MARYLAND CANCER REGISTRY

Disclosure is permied to a public health authority authorized by law to access informaon to prevent/control disease, injury, disability, e.g., disease reporng, vital stascs reporng, public health surveillance, public health invesgaons, public health intervenons and partner noficaon.

The Maryland Cancer Registry is a public health authority, cancer reporng and surveillance is required by state law, and the MCR is not performing such funcon on behalf of the covered enty, it is not necessary to complete a business asso‐ciate’s agreement before providing the MCR, or enes officially acng on the MCR’s behalf, with the requested person‐ally idenfiable informaon. The requested informaon is needed to conduct public health surveillance and will be re-disclosed only upon approval by the Maryland Department of Health and Mental Hygiene’s Instuonal Review Board. For a copy of the HIPPA guidelines go to:

hp://phpa.dhmh.maryland.gov/cancer/Documents/HIPAA_Informaon.pdf

4. Queson: Where is the law stang that physicians have to report? For a copy of the law and regulaons go to:

hp://phpa.dhmh.maryland.gov/cancer/SitePages/mcr_regs.aspx

5. Queson: I have never received these forms before. Why am I receiving them now? The MCR began conducng follow back on “laboratory only” cases (that is, tumors only reported by laboratories) in 2009. If you have not received follow back request forms recently, all of your paents must have been reported to the MCR by a facility other than the laboratory.

6. Queson: I did not treat this paent and/or I have no informaon, what do I do? Fill out any informaon you do have. If you know who treated the paent for cancer, please write that informaon on the form and return it via fax to the MCR at 240-314-2377. If you have no informaon at all, please also note that on the form and fax it back to the MCR.

7. Queson: How can I make sure I do not receive these forms? To make sure you do not receive these forms, you can take an acve part in the reporng of cancer by becoming a re‐porter. By becoming an acve reporter, you will let us know when you have diagnosed or treated a cancer paent. Con‐tact the MCR technical help line Westat: 1-888-662-0016 or 301-315-5990 to become a reporter or for more infor-maon.

Q uality Control Cont. Lab Only Follow-back

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Disease Index MCR requested submissions of annual disease indices for the data year 2014 from reporng hospitals and radiaon oncology

facilies in December 2015. The disease indices will be used to improve the completeness of its database and to streamline the

death clearance follow-back process. MCR now requests your reconciliaon for all cases followed back to your facility to beer

understand why they did not match with cases from the MCR database so please reference the guidelines as you construct your

reconciliaon replies. Reporters are generally given 30 days of the dated leer to submit their reconciliaon replies. If you have

any quesons or concerns about your disease index or reconciliaon, please contact Wilhelmina Ross at

[email protected]. We look forward to receiving your reconciliaon file submissions!

Disease Index Reconciliaon Guidelines For cases appearing on the follow back spreadsheet lisng, please formulate your responses according to the guidelines below

and include enough informaon for MCR QADM staff to determine reportability. Please note that Class of Case 30, 31, 34, 35,

36, 37 and 38 are reportable to the MCR for all Maryland residents and should be abstracted and submied via Web Plus.

• For all cases indicate Class of Case and any other details that will be helpful in case resoluon.

• For cases that are Class of Case 32 or 33, please indicate, if available, a date of diagnosis (exact or esmated) and a

place of diagnosis.

• Submit a full abstract for cases that should have been reported to MCR.

• If there was no malignancy found, indicate ‘no malignancy’, i.e., situaons where ICD-9-CM diagnosis codes appear

but no malignancy was found during the workup.

• If a paent is an internaonal resident at the me of diagnosis, indicate “internaonal resident” as your reply. These

cases are not reportable.

• Class of case 40, 41, 42, 43 are not required for reporng.

• Please do not use the words ‘non-analyc’ or ‘analyc’ as these terms are Commission on Cancer terms and concepts

that are not part of Maryland State reporng regulaons. A reconciliaon reply of ‘non-analyc’ will not be accepted

for case resoluon.

• Use of the words ‘reportable’ and ‘non-reportable’ are permied but will need more explanaon, (i.e., Non-

reportable, Class of Case 40 or Reportable, Class of Case 10).

• For a case appearing on the Disease Index non-match list that were reported previously by your facility, indicate pre-

viously reported’, the accession number, and the date of submission.

• Provide further explanaon for all Class of Case 99. A reconciliaon reply of “Class of Case 99” or “Unknown” will not

be accepted for case resoluon.

Q uality Control, Disease Index

mailto:[email protected].

12


It is imperave that all potenally missed cases diagnosed in 2014 be abstracted and submied to MCR no later than June 30,

2016. The quality and quanty of Maryland data rests with you, our facility reporters. Our goal is to work with you to ensure

that all reportable cases for year 2014, outpaent and inpaent, are reported according to the law and consequently, to naon-

al organizaons that cerfy the Maryland Cancer Registry.

Death Clearance

Death Clearance 2016 will soon begin. You may receive death follow back forms. Please complete these forms and return them

to the MCR within 30 days of the dated leer. This will ensure that the MCR has me to process the informaon received and

update the database in a mely manner. Remember that we will follow back to the place recorded on the death cerficate or to

facilies and physicians that we believe may be able to complete the death follow back forms.

When compleng your forms, please remember that the MCR is looking for some key pieces of informaon: the type of cancer,

whether the cancer diagnosis was confirmed by a medical praconer (includes Physician, Physician Assistant, Nurse Pracon-

er, or any documentaon in medical record informaon of the paent having cancer), the date of diagnosis, and the State

where the person lived at the me of diagnosis. In addion, the MCR would like to collect any available informaon on the first

course of treatment.

Some guidelines on compleng the forms:

- The person was not at your facility or there is no record of the person

◊ Please indicate, “Paent was not at this facility” and return the form. If your facility has mulple sites, please check the

other sites before nong that the person was not at your facility. If the person was at the alternate site, please note the

alternate site and the address before returning the form. We will follow up with the other site.

- Date of diagnosis

◊ Please esmate the date of diagnosis if you do not know the exact date. In parcular, the MCR needs the exact or es‐

mated year of diagnosis. The instrucons enclosed with the forms explain how to esmate the date of diagnosis.

- Confirmaon of cancer diagnosis

◊ Consider the case confirmed if any recognized medical praconer (including physicians and midlevel praconers) docu‐

mented in the medical records that the paent was diagnosed or has a history of cancer.

- State of residence at the me of diagnosis

◊ Please do not esmate the state of residence at diagnosis. If the residence at diagnosis is unknown, please fill in the state

abbreviaon or write “residence unknown.”

Please note that the MCR QADM staff will try to clear death clearance cases to any case matching to disease index by use of your disease index reconciliation reply if available and if the reply contains the needed information.

Q uality Control, Death Clearance

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A nnouncement

Helpful Resources

Maryland Cancer Registry –HOME http://phpa.dhmh.maryland.gov/cancer/Pages/mcr_home.aspx

Point of Contact:

Kimberly Stern, MHA, CTR Program Manager Maryland Cancer Registry 201 W. Preston St. Rm 400 Baltimore, MD 21201 Email: Kimberly.Stern @maryland.gov Phone: (410) 767-5521 Fax: (410) 333-5218 Tumor Registrars Association of Maryland www.tramd.org

Follow on Facebook:

NAACCR

CDC

NCRA

National Cancer Institute

National Cancer Institute, Shady Grove Campus

National Cancer Institute – News and Public Affairs

On Twitter:

@CDC Cancer

@NCRAnews

@NAACCR

@theNCI

@NCIBulletin

Send us your Feedback:

[email protected] or [email protected]

Maryland Cancer Registry. 1500 Research Blvd., Rockville, MD 20850. Tel# 301-315-4292

2016 NAACCR WEBINAR SCHEDULE

4/7/16 – Room 200 Collecting Cancer Data: Ovary

5/5/16 – Room 200 Collecting Cancer Data: Kidney

6/2/16 – Room 200 Collecting Cancer Data: Prostate

7/7/16 – Room 200 Patient Outcomes

8/4/16 – Room 200 Collecting Cancer Data: Bladder

9/1/16 – Room 200 Coding Pitfalls

Note: All webinars are held at: 201 W. Preston Street, Balmore, MD 21201 Interested in aending? Contact Carolyn Davis at Carolyn.davis@maryland. gov

www.tramd.org

