Presentation on theme: "What the Heck is a Cancer Registrar"— Presentation transcript:
1What the Heck is a Cancer Registrar Has anyone ever asked you what you do.And, when you reply, they either nod their head or ask what the heck is thatThat is not an unusual response when I tell someone that I’m a cancer registrarWhat the Heck is a Cancer RegistrarBerna Glassman, CTRWY Cancer Surveillance Program
2IntroductionConcept of describing disease by stage or extent introduced in 1929 by League of Nations’ World Health OrganizationFirst primary site so described was the cervixStaging=shorthand method for grouping cases into broad categories based on disease extentPrimary tumor site, tumor size, number of tumors, depth of tumor invasion, involvement of lymph nodes and/or spread to distant sites (distant metastases)Indicates type of treatments to use & prognosisThe concept of describing disease is close to 100 yrs old; thus, not a new concept.What have been become increasingly sophisticated are by many by which we are able to describe extent of disease-electron microsocpy, imaging technology, laparoscopic surgery
3What Is Cancer Registry? Systematic collection about occurrence of cancerType of cancerExtent of disease at time of diagnosisTreatmentsOutcomes of treatmentQuality of Medical careWhere do we begin?CasefindingCoding into into specialized databaseUltimate GoalPrevent and control of Cancer!!!Systematic is a KEY word----there are rules by which we collect data and, in turn, enter it into a specialized cancer database. Uniformity in coding is very important allowing for data analysis locally, nationally and internationally.WCSP motto: inspect, monitor, prevent
4How It All WorksFrom bottom to top, the hospitals, clinics, laboratories, stand alone treatment facilities are required by law to submit cases of any patient diagnosed and/or treated for cancer at their facilities. These cases are sent to the Central Cancer Registry for processing, especially quality assurance. After editing and processing these cases, the state registry submits their data to 2 national organizations. Often this data is further analyzed and used for international studies.
5Now, What the Heck is a Cancer Registrar? Medical Healthcare ProfessionalMedical CoderCancer-Registry Software ExpertPublic Relations PersonEducatorDetectiveSTUDENT!
6Why Would Anyone Want to be a Cancer Registrar? Right Livelihood- support yourself without harming othersChallengingWorthwhileMAKING A POSITIVE DIFFERENCE!My answer to this question is WHY NOT?It’s something I cannot explain, other than I knew this is MY job!
7Sample Case Scenario The Story Michael Mouse, aka Mickey--76-yr old married, white male, retired actor, lives in Jackson, WY. Presented to St. John’s Hospital w/ chief complaint of frequent & urgent urination (3-4x/night). Mickey’s PSA was elevated at 22.5 (normal range 0-4). Mickey’s H&P were basically unremarkable. He is in excellent health for a gentleman of his age. A prostate nodule was detected on digital rectal exam (DRE). Mickey agreed to needle biopsies of his prostate. Needle bxs indicated that both prostatic lobes were involved with invasive adenocarcinoma. Treatment options were discussed. Mickey agreed to hormone therapy followed by radical prostatectomy. The prostate gland was removed. The 6 lymph nodes dissected were negative, as were the surrounding tissues & surgical margins. Via CT scans, a metastatic work up was performed to determine the extent of his disease. All scans were negative. Mickey’s disease was confined to his prostate gland with no evidence of disease spread.It is easiest to abstract a case when medical records are organized in chronological order—in doing so, a story is told of the patient’s history, cancer diagnosis, treatment and outcome
8Summary of the Story Staging Treatment Outcome T2-tumor involvement - both prostate lobesN0-lymph node involvement - noneM0-Metastases to bones and/or distant organs – noneT2 N0 M0- tumor involvement in both lobes; ln neg; no evid metsStage 2, Local DiseaseTreatmentHormone Treatment followed byRadical Retropubic Prostatectomy w/6 lymph nodes sampledOutcomePatient is AliveCancer Status is No Evidence of Disease (NED)Good Prognosis!Cancer abstracting is a way of pulling out the necessary information needed to tell a patient’s cancer “experience” in a combination of codes w/narrative support. This is the summary of pages and pages of medical records.
9The Cancer Abstract – Part 1 Patient Information (Demographics)MOUSE, MICHAEL WALTER aka MOUSE MICKEY CTR #:Hos #1 ST. JOHN'S HOSPITAL Hosp. #Admit: 01/10/ CC:1 DX / RXChart: Acc Yr:2005 Payer:60 (Medicare/Medicade) Abs:BLGReporting Source: 1 HOSPITAL-IN Follow-up Hospital: 1SSN: Sex : 1 MALE Date of Birth: 04/15/1928ADDR AT DX: 444 FRIENDSHIP BLVD JACKSON WY 83331FU ADDRESS: PO BOX JACKSON WY 83331Marital St:2 MARRIED Place of Birth: 097(Calif) Age at Dx: 76 yrsRace: 010 WHITE; non Hispanic County: 039 TETONOccupation: ACTORIndustry: WALT DISNEY ENTERPRISESI’ve divided the cancer abstract into 4 parts:The first one being patient information, demographics
10The Cancer Abstract – Part 2 Disease Specific InformationDate of Dx: 01/01/2005 Histology(2): ADENOCARCINOMAGRADE: II MOD DIFF. Hist-3: ADENOCARCINOMASite: C619 PROSTATE Stage: Stg-2000:Paired Organ:0 NOT PAIRED ORGAN Diag. Conf.: 1 HISTOLOGYTumor Size: 999 mm. Positive Nodes: Nodes Examined: 08Clinical: TNM: AJCC Stage: Staged by: NOT STAGEDPathological: TNM: AJCC Stage: Staged by: NOT STAGEDSites of Distant Metastasis: 0 NONE NONE NONEDisease Specific Information – date of diagnosis, primary site of cancer, morphology= histology, behavior code (\0 \2 \3), grade (how different are cancer cells form the normal cells---greater the difference then higher the grade), confirmation of diagnosis
11The Cancer Abstract – Part 3 Best Treatments Code DateDIAG/STG /00/0000SURG /10/2005RAD /00/0000CHEM /00/0000HORM /15/2005BRM /00/0000OTHER /00/0000Surgical Approach: 8 (retropubic)1st course: Scope LN Surg 0 Surg Other Site 0 Reg’l LN Examined 06Subseq Reconstruct Del: 0Treatment summary – types of treatment, day administered
12The Cancer Abstract – Part 4 Follow Up InformationPhysicians21436 ROLAND FLECK24481 LISA J FINKELSTEIN28231 ST. JOHN’S HOSPITALSurvival Time: 1 Yr. 9 Mon.Date Last Seen: 10/27/2006Vital Status:1 (alive)Cancer Status: 1 (no evidence of disease)Follow up-Central Registry sends a letter to patient’s follow up physician requesting date patient last seen, cancer status. Patients are followed on a yearly basis. The Central Registry has no direct patient contact.
13Acknowledgments THANK YOU! Cancer Registry Management Principles & Practices Hutchison, Roffers, Fritz (editors)National Cancer Registrars Association (NCRA); Alexandria, VirginiaDiagnosis & Treatment Workgroup –WY Comprehensive Cancer Control CoalitionHIM & Cancer Registry Professionals Everywhere –THANK YOU!And now,It’s Time to Go!Thank youI will be my new position as a hospital Exempla/St. Joseph’s Hospital in Denver on November 13Special thanks to Dr. Barnes for making me feel welcome in the WCCCC. She is a wonderful advocate for the Cancer Registrar