The Bottom Line - Cancer Registry Education5/20/2014 2 Collaborative Stage Innovative idea CS...

5/20/2014

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Transition to the Direct Collection of AJCC Stage

Christie Eheman, PhD, MSHP

Chief, Cancer Surveillance Branch

Division of Cancer Prevention and Control

Home of the National Program of Cancer Registries

National Center for Chronic Disease Prevention and Health Promotion


The Bottom Line

The Commission on Cancer (COC), American Joint Committee on Cancer (AJCC); the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI) will transition to the direct coding of AJCC staging for cancers diagnosed in 2016.

Biomarkers and Prognostic factors will still be collected.

NCRA and NAACCR were both part of CS Governance Committee and are part of transition planning.

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Collaborative Stage

Innovative idea

CS Version 1 worked well after initial adjustment

Many people committed time and energy to CSV1 and CSV2 and we acknowledge their efforts

Why the transition?

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Collaborative Stage Version 2 (CSV2)

Very complex To collect

To create

To manage

Over $2M in resources in 2009 alone

Questions about accuracy (due to complexity)

Significant burden on central registries to collect and consolidate and to convert databases with new versions

Burden on hospital registries

Multiple efforts to simplify CS have failed

Technically: CS is not sustainable

The computer systems and algorithms have become so complex that only a few individuals understand the mapping system and how changes cascade through the system Relatively small changes were very challenging

Simplification was daunting

Resources and decision making structure not sufficient to revamp system

The future of the system was impossible to guarantee

The intellectual investment and knowledge is limited to a small number of individuals

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Fiscally: CS is not sustainable

The current system is expensive

U.S. Agency budgets have been reduced and will likely be reduced again in future.

In 2011, AJCC estimated $1,269,000 needed for CSV3 and a estimated $850,000 deficit in available funds

Transition

With overwhelming evidence that CS cannot be sustained, Agencies and Organizations must manage resources to best meet the future needs of registries and clinical medicine and ensure the collection of stage.

We cannot wait for CS to collapse or fail

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AJCC Staging

AJCC, TNM staging is used by clinicians We will be speaking the same language

Clinical and pathological staging provide specific information in treatment pathway Assessing quality of care

Knowledge is wide-spread across individuals and specialties

[email protected]

For more information please contact Centers for Disease Control and Prevention

1600 Clifton Road NE, Atlanta, GA 30333

Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348

E-mail: [email protected] Web: http://www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.


mailto:[email protected]

5/20/2014

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Carol L. Kosary, DMgt

Program Manager, SEER

Surveillance Research Program

Division of Cancer Control and Population Science

TNM Transition Activities, Timeline, and Requirements for the Collection of Cancer Stage

within the Surveillance Epidemiology and End Results

Program

Surveillance, Epidemiology, and End Results Program

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- Established in 1973 as a result of the National Cancer Act of 1971

- Currently covers 28% of the US population

- Aligned with the research oriented mission of the National Cancer Institute

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SEER TNM Transition Activities – Overall

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Along with our other partners the NCI is a participant in the Cancer Registry Steering Committee’s TNM Transition Workgroup

NCI also participates in the NAACCR Change Control Board, which I currently chair, as well as other involved NAACCR committees and work groups

NCI is working with the CoC on the latest version of FORDS

NCI coordinates with CDC through regular teleconferences

SEER TNM Transition Activities – Internal NCI

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Short assessment of the availability of clinical and pathological TNM within SEER (completed and presented at NCRA meeting in Los Vegas)

Evaluation of frequency of pTNM in surgical pathology reports Study using SEER’s ePath reporting network

Comparison of cases restaged with AJCC TNM Similar to a SEER reliability study, will be open to all,

early July, CEUs will be available

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Evaluation of prognostic SSFs and potential new biomarkers Ongoing to determine what to continue to collect and

what procedures are needed to determine decisions on new items

TNM Informatics Determine and meet IT needs going forward

Proposed collapse of current schemas

Focus groups to determine registrar needs


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Summary Stage 2016 Version of SEER Summary Stage using the

components of TNM

Analysis of NCDB data Coordinated with CoC and ACS

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SEER TNM Transition Activities Timeline and Requirements

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SEER will require CS for cases diagnosed in 2014 and 2014 and will implement TNM with cases diagnosed as of 1/1/2016; this will include at the very least: Directly assigned clinical and pathological T, N, and

M (either physician or CTR assigned)

Stage Group as derived from TNM (not directly entered)

Expanded dates already collected by CoC

Tumor size, number of lymph nodes examined and positive


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SEER will require CS for cases diagnosed in 2014 and 2014 and will implement TNM with cases diagnosed as of 1/1/2016; this will include at the very least: Those prognostic factors and biomarkers determined

to be relevant to the support of NCI’s mission will initially consist of current prognostic factors (SSFs) SEER

currently requires

Evaluation of these items as well as new items will be ongoing

Other items not commonly associated with CS that SEER already collects such as surgery/radiation sequence, etc.

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SEER will require CS for cases diagnosed in 2014 and 2014 and will implement TNM with cases diagnosed as of 1/1/2016; this will include at the very least: (Probably) a version of SEER Summary Stage

algorithmically derived from TNM Trying to avoid having to have CTRs responsible for both the

direct assignment of TNM and Summary Stage

Other data items deemed relevant (decisions must be made by late Summer 2014)

SEER TNM Transition Activities Further Questions

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[email protected]

mailto:[email protected]:[email protected]:[email protected]

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Collection of Cancer Stage within the National Program of Cancer Registries

Christie Eheman, PhD, MSHP

Chief, Cancer Surveillance Branch




NPCR *

NPCR/SEER

HAWAII

PUERTO RICO ALASKA

*National Program of Cancer Registries (CDC)

National Program of Cancer Registries

American Samoa; Commonwealth of the

Northern Mariana Islands; Federated

States of Micronesia; Guam; Republic of

Marshall Islands; Republic of Palau

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NPCR changes in data collection phased in 2014 - 2016

Provides time for:

Additional training

Testing procedures for reporting

Software development and refinement

Establishing procedures at central registry

NPCR Requirements

Directly assigned/coded AJCC Clinical and pathological (c,p)

TNM

Stage Group

• Derived from TNM; or directly entered as found in physician notes, etc.

With necessary biomarkers and prognostic factors

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AJCC staging

Clinical and Pathological Stage provide two different aspects of patient staging

• Clinical – drives initial treatment

• Pathological – more precise prognosis estimates; defines subsequent therapy

Can be staged by physician or registrar

NPCR Requirements

Directly assigned AJCC plus:

Surg/rad sequence

Systemic/surg sequence

• Provide vital data on the use of neoadjuvant therapy

• Critical to interpreting clinical and pathological stage and how to use them

NPCR Requirements

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Auxiliary data:

Tumor size

Number of lymph nodes examined

Number of lymph nodes positive

NPCR Requirements

NPCR Requirements

Directly Coded Summary Stage Will be required for all registries all providers

Provides continuity across Nation and across time

Easier to learn and collect than AJCC TNM

Many small or remote providers do not have CTRS!

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Timeline for Transition 2014

Directly Assigned TNM (clinical and pathological) - as available from all facilities Staging by registrar or physician – consistent with CoC

CS version 2.05 will be released and in use

2014 2015 2013 2016


Directly Assigned TNM (clinical and pathological)

Required from CoC hospitals

As available from non-CoC facilities and small providers

Directly Assigned Summary Stage – required from all facilities

2014 2015 2013 2016

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Directly Assigned TNM (clinical and pathological) - required Including relevant biomarkers and prognostic factors

Directly Assigned Summary Stage – required from ALL providers

CS no longer accepted by NPCR

2014 2015 2013 2016

PROGRESS AND COLLABORATIONS

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Cancer Registry Steering Committee Stage Transition Workgroup

Includes all partners

Truly collaborative – each organization can plan to collect what they need while working together on transition plan

Regular calls

Identifying any changes needed in variables or new variables

Exchanging information on activities

Update/communication being prepared to share with all of registry community

CDC Collaborations

CDC is working with COC and AJCC on transition

CDC and NCI are coordinating with each other

CDC will work with NCRA, NAACCR, and other partners on planning, training, and implementation

The resources CDC has been devoting to CS can shift to:

Development of training materials and tools for collection of directly coded TNM and Summary Stage plus necessary Biomarkers/Prognostic Factors

Delivery of training

Software changes

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CDC Collaborations

CDC-NPCR revised the cooperative agreement with AJCC from support of CS stage to transition activities for AJCC stage

The expanded cooperative agreement with AJCC includes the following:

• Production of effective training materials

• Mechanisms to disseminate training (classroom, on-line, webcasts, etc.)

• Establishment and maintenance of a mechanism to respond to staging questions

CDC-NPCR Internal Transition Workgroup

The major focus of this CDC workgroup is to implement a smooth, timely staging transition for NPCR

Ensure communication with NPCR registries

Collaborate with partner organizations in the cancer surveillance community and provide NPCR specifics to registries and partners

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CDC-NPCR Internal Transition Workgroup

Education will begin Saturday during the NCRA special track for NPCR registries’ Education and Training Coordinators

All materials will be available on the NCRA web-site

IT Needs

CDC staff will be working with grantees and partners to identify the IT needs and timeline for the transition

This will include a vendor communication plan to assure that the broader IT needs are met

One more time - Overview

2014 diagnoses 2015 diagnoses 2016 diagnoses

Directly assigned c,pTNM required as available

Directly assigned c,pTNM required from COC , as available from other facilities

Directly assigned c,pTNM required

Directly assigned Summary Stage required

Directly assigned Summary Stage required

CS used for staging CS used for staging

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[email protected]

For more information please contact Centers for Disease Control and Prevention

1600 Clifton Road NE, Atlanta, GA 30333

Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348

E-mail: [email protected] Web: http://www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.



mailto:[email protected]

5.1-Transition to Directly Coded Stage5.2-Transition to Directly Coded Stage5.3-transition to Directly Coded Stage

The Bottom Line - Cancer Registry Education5/20/2014 2 Collaborative Stage Innovative idea CS...

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