MCR MINI-UPDATE JUNE 2015
Fellow Registrars,
National Cancer Survivors Day is June 7. We have much to celebrate with more cancer survivors each year. For
more info on the celebration see: http://www.ncsd.org/
DUE DATES
Large hospitals (>500 cases/yr.) are to report Nov. 2014 cases by June 15 and smaller facilities (<300 cases /yr.) report the 4th Quarter of 2014
by July 15.
EDUCATION
NAACCR Webinars – Get 3 CEs By Viewing Recorded Webinars. Request Access Now! Check out our Education and Training page to find out
how you can receive access to the recorded NAACCR Webinars.
June 4, 2015 – Collecting Cancer Data: Pancreas
GoToMeeting - There are only 25 lines available so it will be a first come, first served on the day of the meeting. I recommend if there are several
of you from one facility that want to participate in a meeting that you call in together. For those of you not familiar with GoToMeeting, you can
listen via your computers’ speakers and ask questions via a microphone or the chat within GoToMeeting. If you have to call in, you will be
charged a long distance call.
June 10, 2015 – SEER Summary Stage: Corpus Uteri
To register for any of our educational opportunities, call 1-866-240-8809 or contact Shari Ackerman at ackermans@health.missouri.edu.
CancerCare: Connect Education workshop - These workshops are free – no phone charges apply. You can listen to leading experts in oncology
provide the most up-to-date information on the telephone or via live streaming. Please feel free to forward to your colleagues or anyone
affected by cancer.
These workshops will be taking place from 1:30 p.m. to 2:30 p.m. EST:
June 10, 2015 – Update on the Treatment of Pancreatic Cancer
June 15, 2015 – Treatment Update on Liver Cancer and Managing the Costs of Care
June 17, 2015 – Understanding the Role of Immuno-Oncology in Treating Cancer
June 18, 2015 – New Perspectives in the Treatment of Renal Cell Cancer
June 22, 2015 – Gastric Cancer: Current Perspectives and Treatment Options
June 23, 2015 – Managing the Side Effects of Immuno-Therapy
June 24, 2015 – Advances in the Treatment of Lung Cancer
For more information and to register, visit the CancerCare Website or call 1-800-813-HOPE (4673).
MCR NEWS
Nancy Cole Retirement Party
You should have received a separate invitation email, but here is a reminder to have any written good wishes to us tomorrow so that we can
assemble them for presentation on Thursday 6/4. We’ll try to send some party photos for those who can’t join us. Nancy is doing great and
enjoying retirement so much that it was hard to pin her down for a party date!
Conversion to v15 – Reminder
We anticipate converting our systems and being ready to receive abstracts in v15 in August. We would appreciate all reporting facilities sending
us their new 2014 abstracts completed-to-date v14A by mid-July, and then converting their software to v15 by the end of July. That way newly
completed cases for any year can be sent to us in v15 in August. If you convert to v15 earlier than this, you can hold all v15 cases until we are
ready to accept them. Please upload one transmittal form stating this in the comments section of the form if you have to hold submissions due
to having converted to NAACCR v15. That way I won’t bug you about missed submissions!
I have been in touch with the software vendors about the progress they have made toward incorporating the Missouri v15 specifications that I
sent them in early April. All expect to have Missouri v15 software available to you sometime this month.
MCR Abstract Code Manual
The MCR Abstract Code Manual for 2015 case reporting was published to our website in May. It is a good idea to review it annually. Changes are
noted in blue font for your convenience.
Trenton Trip
Last month, Angela and Brenda traveled to Trenton, MO to educate HIM students and reporters from low volume rural hospitals about the
basics of cancer registry work. They got rave reviews from the organizer, who told us that eyes were opened about the diligence that goes into
compiling cancer statistics.
Notes from NCRA
Angela and Kirsten are just back from the NCRA meeting in San Antonio and have the some initial information to share:
 One of the speakers on the topic of cancer surveillance recommended a lengthy opinion article in The New Yorker, May 11, 2015 titled
“Overkill: An Avalanche of Unnecessary Medical Care is Harming Patients Physically and Financially. What Can We Do About it?” by Dr.
Atul Gawande. http://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande
 At the Education-Training Coordinators (ETC) training session, they recommended that everyone review the first chapter of the AJCC
staging manual again. All general rules are in Chapter One and even experienced CTRs may discover additional nuances.
 The ETC training also emphasized that we are all in this process of change together. The hardest part for everyone may be the use of the
X and blanks in TNM staging. It was recommended that everyone view the presentation from AJCC on this topic. AJCC Presentations and
curriculum (especially the module II webinar recording): https://cancerstaging.org/CSE/Registrar/Pages/default.aspx See also the
CAnswer Forum>ACJJ TNM Staging>AJCC Curriculum for Registrars> Module II Q&A
 Training on staging is also available from the NCRA website: http://www.cancerregistryeducation.org/tnm-ss-transition
Thanks and Congratulations from the Director
NPCR
Standards
Grouping
Missouri
National Data Quality
Standard
Diagnosis
Year
2012
Percent
Completeness
Adjusted for
Duplicates
99.84
95.00
Percent
Unresolved
Death
Duplicate Rates
Certificate
(per 1,000)
Only
Percent Missing or Unknown
Core Data Elements
Age
Sex
Race
County
Percent
Passing
Core Edits
0.41
2.04
0.00
0.00
0.36
0.01
100.00
≤1.00
≤3.00
≤2.00
≤3.00
≤3.00
≤2.00
99.00
As those of you who have been around for a while know, MCR-ARC annually reports Missouri cancer incidence data to CDC’s National Program
of Cancer Registries (NPCR). Following each data submission, we receive a Data Evaluation Report detailing the completeness, accuracy and
timeliness of our data submission. Thanks to great registrars statewide and a top notch MCR QA staff, our data quality evaluation continues to
be superb. Once again, we have met the National Data Quality Standard for 21-month data (2012 data submitted to CDC in November 2014). An
explanation of the measures is provided at the end of this article.
Twelve-month data for 2013 cases were submitted in January 2015. We had hoped to meet the 12-month Advanced National Data Quality
Standard. While we met all other criteria, it was disappointing that our completeness fell just short of the standard. This was due to several
facilities being way behind in their reporting or unable to submit due to the need for software patches. Completeness may also have been
influenced by shifts in population and mortality from year to year, which can affect the calculation.
Percent Missing or Unknown
NPCR
Standards
Grouping
Missouri
Advanced National Data
Quality Standard
Diagnosis
Year*
2013
Percent Completeness
Adjusted for Duplicates
88.06
90.00
Core Data Elements
Unresolved
Duplicate
Rates (per
1,000)
Age
Sex
Race
0.00
0.00
0.00
0.27
0.00
100.00
≤2.00
≤3.00
≤3.00
≤5.00
≤3.00
97.00
County
Percent
Passing
Core Edits
In November, we will again submit 2013 cases. The criteria for 21-month cases will be run again and used to identify data for inclusion in the
United States Cancer Statistics report (http://apps.nccd.cdc.gov/uscs/) published jointly with the National Cancer Institute's Surveillance
Epidemiology and End Results (SEER) Program and in collaboration with NAACCR. Standard-setters (e.g., CDC, NCI, NAACCR) recognize that it
takes much longer than 12 months before a registry’s incidence data are complete (i.e., all the information on a cancer patient has been
reported to and processed by the central cancer registry). With your help, we fully expect that our completeness will again exceed the standard
(≥95%) and that we’ll be celebrating NAACCR Gold Certification once again!
Data quality criteria for all cancer sites combined:
Percent Completeness Adjusted for Duplicates: The percentage of observed to expected, unduplicated cases where the expected cases are
estimated by using methods developed by the North American Association of Central Cancer Registries (NAACCR) http://www.naaccr.org/
Unresolved Duplicate Rate: Because some cancer patients receive diagnostic or treatment services at more than one reporting facility, cancer
registries perform a procedure to identify and resolve duplicate case reporting to ensure that each cancer case is counted only once. Prior to the
submission of data to NPCR-CSS, each registry performs a protocol developed by NAACCR for assessing duplicate cases.
Percent Death Certificate Only: Percent of cases for which the only information came from a death certificate.
Percent Missing Critical Data Elements (Age, Sex, Race and County): The proportion of cases missing information deemed critical for the
reporting of population-based cancer incidence data.
Percent Passing Edits: Edits test the validity and logic of data components. Edits are applied to single field variables, inter-field variables and to
multiple records (each record denotes a case of cancer in a patient) in those instances when a patient has multiple cancer diagnoses. Interrecord (IR) edits are run on the entire data submission from the reference year through the most current 22-month data. There are two types of
edits: core edits that are applied to variables deemed necessary for reporting incidence data; and advanced edits that are applied to variables
used for advanced surveillance activities such as survival analyses.
STANDARD SETTER NEWS
Typo in FORDS 2015 re: Skin margins for code 45-47
*No change was intended from FORDS 2013*
Q to CAForum: Please clarify the revision in FORDS 2015 regarding Melanoma Surgery codes 45-47- "If the excision does not have clinically
negative margins during surgery greater than 1cm, use the appropriate code, 20-36"
A: This was a typo. It should state "If the excision does not have microscopically negative margins during surgery greater than 1cm, use the
appropriate code, 20-36"
In addition, there is a further typo on page 435:
“Skin
01/01/2015
Modified explanation about margins (codes 45-47): If the excision does not have microscopically clinically negative margins during surgery
greater than 1 cm, use the appropriate code, 20-–36.”
It should state: "If the excision does not have microscopically negative margins during surgery greater than 1cm, use the appropriate code, 2036"
AJCC
The free AJCC Curriculum for Registrars Module III Intermediate is available on the AJCC website. Register for the June 23 live webinar, take the
pre-test and review the provided materials in advance of the webinar. In this module they will present nuances and exceptions for complex
cases. CEUs can be earned.
https://cancerstaging.org/CSE/Registrar/Pages/AJCC-Curriculum.aspx
REGISTRY TO RESEARCH
The Global Burden of Cancer 2013 (global registry data/IARC)
http://oncology.jamanetwork.com/article.aspx?articleid=2294966
The incidence of melanoma, a deadly form of skin cancer, has increased by more than 250% among children, adolescents and young adults since
1973
http://www.sciencedaily.com/releases/2015/05/150528163042.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+
sciencedaily%2Ftop_news%2Ftop_health+%28ScienceDaily%3A+Top+Health+News%29
Effect of age on the efficacy of adjuvant chemotherapy for resected non-small cell lung cancer (VA Central Registry)
http://onlinelibrary.wiley.com/doi/10.1002/cncr.29360/full
In a Group of Over 200 Men Age 70+, Prostate Cancer Was Not Innocuous (Stratton VA Medical Center Tumor Registry)
http://www.practiceupdate.com/c/25303/2/0/?elsca1=emc_enews_dailydigest&elsca2=email&elsca3=practiceupdate_onc&elsca4=oncology&elsca5=newsletter&rid=NTU2MjE4MTE1NjYS1&lid=10332481
US Breast Cancer Cases Expected to Rise as Much as 50% by 2030 (SEER data)
http://www.practiceupdate.com/c/24148/32/1/?elsca1=emc_conf_AACR2015Post1&elsca2=email&elsca3=practiceupdate_onc&elsca4=201543_AACR2015Post-1&elsca5=conference&rid=NTU2MjE4MTE1NjYS1&lid=10332481
Trends in Relative Survival for Ovarian Cancer From 1975 to 2011 (SEER data)
http://journals.lww.com/greenjournal/Citation/2015/06000/Trends_in_Relative_Survival_for_Ovarian_Cancer.13.aspx
Racial differences in male breast cancer outcomes (NCDB data)
http://www.medicalnewstoday.com/releases/293444.php?tw
Population-based analysis of salvage radical prostatectomy with examination of factors associated with adverse perioperative outcomes (NCDB
data)
http://www.sciencedirect.com/science/article/pii/S1078143915000502
RESOURCES
Effect of Oophorectomy on Survival after Breast Cancer in BRCA1 and BRCA2 Mutation Carriers
http://oncology.jamanetwork.com/article.aspx?articleid=2276101
The Majority of People with BRCA Mutations Undergo Preventive Surgery, yet a Minority Undergo Preventive Screening
http://www.practiceupdate.com/c/24245/32/1/?elsca1=emc_conf_ONS2015Post1&elsca2=email&elsca3=practiceupdate_onc&elsca4=201541_ONS2015Post-1&elsca5=conference&rid=NTU2MjE4MTE1NjYS1&lid=10332481
Is androgen receptor targeting an emerging treatment strategy for triple negative breast cancer?
http://www.cancertreatmentreviews.com/article/S0305-7372%2815%2900078-X/abstract
Dartmouth team devises use of food dye, near infrared light to aid in breast resection
http://www.medicalnewstoday.com/releases/293842.php?tw
ASA: Tumors glow green in new ‘optical biopsy’ technique
http://t.co/Nhzle3qjT8
Cancer cells 'disguise themselves as immune cells' to spread via lymphatic system, study finds
http://www.medicalnewstoday.com/articles/293745.php
Study discovers how pancreatic cancer spreads to the liver
http://www.medicalnewstoday.com/releases/294187.php?tw
Stage I and II Low-to-Intermediate-Risk Thyroid Cancer Can Be Treated Without Radioactive Iodine Using Postoperative Non-suppressed
Thyroglobulin
http://www.practiceupdate.com/c/25193/32/1/?elsca1=emc_conf_AACE2015During1&elsca2=email&elsca3=practiceupdate_onc&elsca4=201545_AACE2015During1&elsca5=conference&rid=NTU2MjE4MTE1NjYS1&lid=10332481
MRI: prostate cancer screening for the future?
http://medicalxpress.com/news/2015-05-mriprostate-cancer-screening-future.html
State-Specific Prevalence of Current Cigarette Smoking and Smokeless Tobacco Use among Adults Aged ≥18 Years — United States, 2011–2013
(BRFSS data from CDC)
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6419a6.htm?s_cid=mm6419a6_w
Nancy H. Rold, CTR
Operations Manager
Missouri Cancer Registry and Research Center