1. Treatment Information
Texas Cancer Registry

2. Texas Cancer Registry | Treatment Information
Objectives
By the end of this training, you should be able to discuss:
First course treatment
Coding instructions
Surgery of Primary Site
Regional Lymph Node Surgery
Radiation
Chemotherapy
Hormone Therapy
Immunotherapy
SEER*Rx- Interactive Antineoplastic Drug Database
12/2/2019
Texas Cancer Registry | Treatment Information

3. First Course Treatment
All methods of treatment intended to modify, control, remove or destroy cancer tissue
Before disease progression or recurrence
“Active surveillance” is a form of planned treatment
“Palliative treatment” can be first course IF
Part of original treatment plan AND
Destroys or modifies cancer tissue
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Texas Cancer Registry | Treatment Information

4. First Course Treatment
Includes benign and borderline malignancy of intracranial and CNS tumors
Does not include Hematopoietic & Lymphoid neoplasms
Hematopoietic & Lymphoid Neoplasm Coding Manual
dex.html
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Texas Cancer Registry | Treatment Information

5. First Course Treatment Timing (Hierarchical)
Rule 1. Use documented first course of therapy (treatment plan) Rule 2. First course ends when there is documentation of disease progression, recurrence, or treatment failure Rule 3. If no documentation of treatment plan, or progression, recurrence, or treatment failure, first course treatment ends in one year
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Texas Cancer Registry | Treatment Information

6. First Course Treatment Timing Rule Example
Treatment plan for breast cancer
Surgery
Chemotherapy
Radiation
Surgery and Chemo completed. Bone mets is dx before radiation began but Dr. recommends radiation as planned
What is the First Course Treatment Plan?
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Texas Cancer Registry | Treatment Information

7. First Course Treatment Timing Rule Example
Treatment plan for sarcoma
Neoadjuvant chemotherapy
Surgery
Radiation or chemotherapy
Scan (after neoadjuvant chemo) shows tumor is not regressing
Surgery is cancelled and a different type of chemo is started
What is the First Course Treatment Plan?
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Texas Cancer Registry | Treatment Information

8. First Course Treatment Coding Instructions
Patient initially refused treatment but:
Begins prescribed treatment within a year of diagnosis
No evidence of disease progression
Code all treatment started and administered, whether or not it was completed
Unknown primary site that is later identified
Code all RX fields to 0 or 00 (Not done) when:
Active surveillance is treatment plan
Patient refuses treatment
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Texas Cancer Registry | Treatment Information

9. Coding Instructions for Multiple Primaries
Code the treatment on both abstracts
multiple primaries
the treatment given for one primary also affects/treats the other primary
Code the treatments only for the site affected
treatment affects only one of the primaries
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Texas Cancer Registry | Treatment Information

10. Heme & Lymphoid Neoplasms Treatment
Hematopoietic Neoplasms
Leukemias
Chemotherapy
Bone marrow transplants
Immunotherapy
Hormones
Supportive care, observation, other
Lymphomas
Surgery (extranodal or nodal)
Radiation
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Texas Cancer Registry | Treatment Information

11. Heme & Lymphoid Neoplasms Coding Instructions
One primary
Documented first course of therapy
Ends when treatment completed, no matter how long
Multiple primaries
Treatment for one primary affects the other
Code treatment on both abstracts
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Texas Cancer Registry | Treatment Information

12. Leukemia First Course Treatment
Treatment is divided into three phases:
Induction Phase
Consolidation Phase
Maintenance Phase
Do not code treatment AFTER the patient relapses (is no longer in remission)
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Texas Cancer Registry | Treatment Information

13. Leukemia First Course Treatment
If Partial or complete remission during first course therapy, code all therapy that is
remission-inducing
consolidation
remission-maintaining
If Patient does not have a remission
Code treatment given in an attempt to induce a remission
Do not record treatment administered after a change in treatment plan
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Texas Cancer Registry | Treatment Information

14. Web Plus Data Fields Date of Initial Treatment
YYYYMMDD (complete date)
YYYYMM (year and month)
YYYY (year only)
Blank (not done)
Date of Initial Treatment Flag
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Texas Cancer Registry | Treatment Information

15. Date of Initial Treatment
This date of initial treatment:
Measures delay between diagnosis and onset of treatment
Starting point for survival statistics
Start date for treatment for the tumor
Surgery (primary site, regional lymph node, other site)
Radiation Therapy
Systemic Therapy (chemo, hormone, immune)
Other Therapy
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Texas Cancer Registry | Treatment Information

16. Date of Initial Treatment
Surgery of Primary Site
Scope of Regional Lymph Node Surgery
Surgical Procedure of Other Site
Radiation Therapy
Chemotherapy
Hormone Therapy
Immunotherapy
Hematologic Transplant & Endocrine Procedures
Other Therapy
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Texas Cancer Registry | Treatment Information

17. Date of Initial Treatment
Code date of admission if exact date of first treatment is unknown
Leave blank if:
No treatment is given during the first course
Active surveillance (watchful waiting)
It is unknown whether the patient had treatment
Case is only from autopsy or DCO
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Texas Cancer Registry | Treatment Information

18. Date of Initial Treatment
Code the date of excisional biopsy if initiated as first course of therapy
Code the date of incisional biopsy IF further surgery reveals no residual or only microscopic residual
Date of initial Treatment CoC
Code date for active surveillance/refuses Tx
Date of Initial Treatment SEER
Leave blank for active surveillance/refuses Tx
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Texas Cancer Registry | Treatment Information

19. Date of Initial Treatment Flag
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Texas Cancer Registry | Treatment Information

20. Web Plus Data Fields Regional Lymph Node Surgery
Rx Summary – Scope of Regional Lymph Node Surgery
Regional Lymph Nodes Positive
Regional Lymph Nodes Examined
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Texas Cancer Registry | Treatment Information

21. Scope of Regional Lymph Node Surgery
Removal, biopsy, or aspiration of regional lymph nodes during initial work-up or first course of therapy regardless of whether surgery of primary site is performed
Compare and evaluate the extent of surgical treatment
Can be Date of Initial Treatment
Important to include text to support codes!
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Texas Cancer Registry | Treatment Information

22. Scope of Regional Lymph Node Surgery
Read Operative Report
Regional nodes
Distant nodes are coded in “Surgical Procedure of Other Site”
Data is cumulative
Lymph node aspirations
Do NOT count if aspiration and resection in same field
Record removal of regional nodes for 2 Primaries with common regional Lymph Nodes in both abstracts
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Texas Cancer Registry | Treatment Information

23. Scope of Regional Lymph Node Surgery Codes
Description
Definition
None
No regional lymph node surgery. No lymph nodes found in the pathologic specimen. Diagnosed at autopsy. 1
Biopsy or aspiration of regional lymph nodes, NOS
Biopsy or aspiration of regional lymph node(s) regardless of the extent of involvement. 2
Sentinel lymph node biopsy (only)
Biopsy of the first lymph node or nodes that drain a defined area of tissue within the body. Sentinel node(s) are identified by the injection of a dye or raadio label at the site of the primary tumor. 3
Number of regional lymph nodes removed unknown or not stated; regional lymph nodes removed, NOS
Sampling or dissection of regional lymph node(s) and the number of nodes removed is unknown or not stated. The procedure is not specified as sentinel lymph node biopsy. 4
1-3 regional lymph nodes removed
Sampling or dissection of regional lymph node(s) with fewer than four lymph nodes found in the specimen. The procedure is not specified as sentinel node biopsy. 5
4 or more regional lymph nodes removed
Sampling or dissection of regional lymph nodes with at least four lymph nodes found in the specimen. The procedure is not specified as sentinel node biopsy. 6
Sentinel node biopsy and code 3, 4, or 5 at same time, or timing not stated
Code 2 was performed in a single surgical procedure with code 3, 4, or 5; or code 2 and 3, 4, or 5 were performed, but timing was not stated in patient record. 7
Sentinel node biopsy and code 3, 4, or 5 at different times
Code 2 was followed in a subsequent surgical event by procedures coded as 3, 4, or 5. 9
Unknown or not applicable
It is unknown whether regional lymph node surgery was performed; death certificate-only; for lymphomas with a lymph node primary site; an unknown or ill-defined primary; or for hematopoietic, reticuloendothelial, immunoproliferative, or myeloproliferative disease.
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Texas Cancer Registry | Treatment Information

24. Scope of Regional Lymph Node Surgery
Code 0
Regional lymph node procedure not performed
Active surveillance
Op report lists a dissection but no nodes found by pathologist
Code 2
SLNBx was performed
Op report describes dye, radio label or combo
Code 3, 4, or 5
Regional lymph nodes removed
3 (Nos), 4(1 to 3), 5(4 or more)
SLNBx was not performed
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Texas Cancer Registry | Treatment Information

25. Scope of Regional Lymph Node Surgery
Code 6
SLNBx and regional lymph node dissection
During the same surgical event or timing unknown
Code 7
Separate events
Code 9
Unknown if performed
Unknown or ill-defined site
Lymphomas with lymph node primary site
Hematopoietic, immunoproliferative, or myeloproliferative
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Texas Cancer Registry | Treatment Information

26. Scope of Regional Lymph Node Surgery Pop Quiz
Transverse colon: Adenocarcinoma with extension into subserosa, 3/10 pericolic lymph nodes are positive.
What is the Regional Lymph Node Surgery Code?
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Texas Cancer Registry | Treatment Information

27. Scope of Regional Lymph Node Surgery Pop Quiz
Patient has a radical neck dissection and the number of lymph nodes removed is not stated. What is the Regional Lymph Node Surgery Code?
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Texas Cancer Registry | Treatment Information

28. Scope of Regional Lymph Node Surgery Pop Quiz
The patient has modified radical mastectomy with sentinel lymph node biopsy and axillary lymph node dissection. The final diagnosis is infiltrating ductal carcinoma with 2/12 axillary lymph nodes positive.
What is the Regional Lymph Node Surgery Code?
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Texas Cancer Registry | Treatment Information

29. Regional Lymph Nodes Positive
Quality measure
Pathology reports
Surgical evaluation and treatment
Examined by Pathologist AND Positive/ “mets”
Regardless of neoadjuvant treatment
AJCC Staging Manual or EOD 2018 to determine regional vs distant LN
Distant lymph nodes positive is coded in M (distant mets) field
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Texas Cancer Registry | Treatment Information

30. Regional Lymph Nodes Positive
In situ cases (code 00 or 98)
Cumulative
Lymph node aspirations
Do NOT count if aspiration and resection in same field
Priority of documentation
Final diagnosis
CAP or synoptic report
Microscopic description
Gross description
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Texas Cancer Registry | Treatment Information

31. Regional Lymph Nodes Positive
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Texas Cancer Registry | Treatment Information

32. Regional Lymph Nodes Examined
Quality measure
Pathology reports
Surgical evaluation and treatment
Removed and Examined by Pathologist
Regardless of neoadjuvant treatment
AJCC Staging Manual or EOD 2018 to determine regional vs distant LN
Distant lymph nodes positive is coded in M (distant mets) field
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Texas Cancer Registry | Treatment Information

33. Regional Lymph Nodes Examined
Code 00
Clinical assessment
No lymph nodes removed or examined
Cumulative
Lymph node aspirations
Do NOT count if aspiration and resection in same field
Priority of documentation
Final diagnosis
CAP or synoptic report
Microscopic description
Gross description
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Texas Cancer Registry | Treatment Information

34. Regional Lymph Nodes Examined
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Texas Cancer Registry | Treatment Information

35. Web Plus Data Fields Surgery
Rx Date – Surgery
Rx Date –Surgery Flag
Rx Date - Most Definitive Surgery
Rx Date- Most Definitive Surgery Flag
Surgical Procedure of Primary Site
Reason for No Surgery of Primary Site
Rx Summary – Surgery Other Regional/Distant
Rx Text Surgery
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Texas Cancer Registry | Treatment Information

36. Texas Cancer Registry | Treatment Information
Rx Date – Surgery
First cancer-directed surgical procedure
Surgical Procedure of Primary Site
Scope of Regional Lymph Node Surgery
Surgical Procedure of Other Site
May or may not be date of most definitive procedure
YYYYMMDD format
If unknown, record the year of diagnosis
Document in text field
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Texas Cancer Registry | Treatment Information

37. Texas Cancer Registry | Treatment Information
Rx Date – Surgery Flag
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Texas Cancer Registry | Treatment Information

38. Date-Most Definitive Surgical Resection of Primary Site
Most extensive resection of the primary site during the first course of treatment
Measures lag time between diagnosis and the most definitive surgery of the primary site
May or may not be the date of initial surgery
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Texas Cancer Registry | Treatment Information

39. Date-Most Definitive Surgical Resection of Primary Site
1/2/2018-patient undergoes an excisional biopsy for right breast cancer (code 22)
1/25/2018-patient undergoes a right modified radical mastectomy (code 51)
What is the Date of Initial Treatment?
What is the Date of First Surgical Procedure?
What is the Date of Most Definitive Surgery?
What is the Surgery code?
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Texas Cancer Registry | Treatment Information

40. Rx Date – Most Definitive Surgery Flag
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Texas Cancer Registry | Treatment Information

41. Surgical Procedure of Primary Site
Received as first course of treatment at any facility
Most invasive, extensive or definitive surgery
Code excisional (even if documented incisional)
Margins free
Gross disease removed/only microscopic residual disease
Do NOT code if macroscopic residual disease is present
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Texas Cancer Registry | Treatment Information

42. Surgical Procedure of Primary Site
Code total removal of primary site
Previous procedure resected a portion of site
Cancer direct or non-cancer directed surgery
Current surgery removes the rest of the organ
Extra-lymphatic lymphoma
Use site-specific surgery code
Not lymph node scheme
Code 00
No surgery performed
Active surveillance/watchful waiting
Dx at autopsy
Excludes cases that qualify as Code 98
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Texas Cancer Registry | Treatment Information

43. Surgical Procedure of Primary Site
Code 98
C420, C421, C423 C424
Cervical Lymph Nodes and Unknown Primary
Plasma Cell Myeloma
Plasma Cell Disorders
HemeRetic
Ill-defined/ unknown primary site
Site-specific surgery codes
Appendix B of the STORE manual
Appendix C of the SEER manual
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Texas Cancer Registry | Treatment Information

44. Surgical Procedure of Primary Site Codes
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Texas Cancer Registry | Treatment Information

45. Surgical Procedure of Primary Site
Surgery Code for Prostate
Surgery Code for Bladder
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Texas Cancer Registry | Treatment Information

46. Surgical Procedure of Primary Site Pop Quiz
1/2/2018 Patient undergoes a incisional bx of the right breast
1/12/2018 Patient undergoes simple mastectomy (removal of breast tissue w/out the nipple and areolar complex or overlaying skin)
1/25/2018 Patient undergoes excision of axillary lymph nodes
Note: Surgical Procedure of Primary Site is defined as the most extensive procedure performed as First Course of Treatment?
What is the Surgical Procedure of the Primary Site?
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Texas Cancer Registry | Treatment Information

47. Reason for No Surgery of Primary Site
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Texas Cancer Registry | Treatment Information

48. Surgical Procedure of Other Site
Other regional sites
Distant sites
Distant lymph nodes
Documents extent of surgical treatment
Evaluates extent of metastatic disease
Codes are hierarchical (highest number code)
Do not code tissue/organs removed incidentally and not involved
Codes 1-5 have priority over codes 0 and 9
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Texas Cancer Registry | Treatment Information

49. Surgical Procedure of Other Site Codes
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Texas Cancer Registry | Treatment Information

50. Web Plus Data Fields Radiation Treatment
Date Radiation Started
Rx Date Radiation Flag
Radiation Treatment Modality Phase I
Rx Text Radiation
Rx Summary – Surgery/Radiation Sequence
Reason For No Radiation
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Texas Cancer Registry | Treatment Information

51. Date Radiation Started
Date Radiation therapy began at ANY facility as the first course of treatment
YYYMMDD format
If date unknown, record the year of diagnosis
Document in the text field date is unknown
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Texas Cancer Registry | Treatment Information

52. Texas Cancer Registry | Treatment Information
Rx Date Radiation Flag
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Texas Cancer Registry | Treatment Information

53. Radiation Treatment Modality Phase I
TCR only collects Phase I (initial plan)
Initial phase of radiation delivered during first phase of first course of treatment
Found in radiation oncologist summary
CTR Guide to Coding Radiation Therapy Treatment in the STORE
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Texas Cancer Registry | Treatment Information

54. Radiation Treatment Modality Phase I
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Texas Cancer Registry | Treatment Information

55. Rx Summary Surgery/Radiation Sequence
Code
Label
No radiation therapy and/or surgical procedures 2
Radiation therapy before surgery 3
Radiation therapy after surgery 4
Radiation therapy both before and after surgery 5
Intraoperative radiation therapy 6
Intraoperative radiation therapy with other therapy administered before or after surgery 7
Surgery both before and after radiation 9
Sequence unknown, but both surgery and radiation were given
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Texas Cancer Registry | Treatment Information

56. Reason for No Radiation
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Texas Cancer Registry | Treatment Information

57. Web Plus Data Fields Chemotherapy
Date Chemotherapy Started
Rx Date Chemotherapy Flag
Rx Summary – Chemotherapy
Rx Text Chemotherapy
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Texas Cancer Registry | Treatment Information

58. Date Chemotherapy Started
Date Chemotherapy began at ANY facility as the first course of treatment
YYYMMDD format
If date unknown, record the year of diagnosis
Document in the text field date is unknown
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Texas Cancer Registry | Treatment Information

59. Rx Date - Chemotherapy Flag
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Texas Cancer Registry | Treatment Information

60. Texas Cancer Registry | Treatment Information
Chemotherapy
Chemotherapy uses chemical substances (drugs) to kill cancer cell and prevent them from reproducing.
Chemotherapeutic agents are divided into five groups:
Alkylating agents
Antimetabolites
Natural Products
Targeted therapy
Miscellaneous
Chemotherapy start date is coded and flagged similar to radiation.
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Texas Cancer Registry | Treatment Information

61. Rx Summary - Chemotherapy
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Texas Cancer Registry | Treatment Information

62. Web Plus Data Fields Hormone Therapy
Date Hormone Therapy Started
Rx Date – Hormone Flag
Rx Summary – Hormone Therapy
Rx Text Hormone
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Texas Cancer Registry | Treatment Information

63. Date Hormone Therapy Started
Date Hormone Therapy began at ANY facility as the first course of treatment
YYYMMDD format
If date unknown, record the year of diagnosis
Document in the text field date is unknown
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Texas Cancer Registry | Treatment Information

64. Texas Cancer Registry | Treatment Information
Rx Date – Hormone Flag
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Texas Cancer Registry | Treatment Information

65. Texas Cancer Registry | Treatment Information
Rx Summary - Hormone
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Texas Cancer Registry | Treatment Information

66. Web Plus Data Fields Immunotherapy Codes
Date Immunotherapy Started
Rx Date – Immunotherapy Flag
Rx Summary – Immunotherapy
Rx Text Immunotherapy
Rx Summary – Transplant/Endocrine Procedures
Rx Summary Systemic/Surgery Sequence
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Texas Cancer Registry | Treatment Information

67. Date Immunotherapy Started
Date Immunotherapy began at ANY facility as the first course of treatment
YYYMMDD format
If date unknown, record the year of diagnosis
Document in the text field date is unknown
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Texas Cancer Registry | Treatment Information

68. Rx Date – Immunotherapy Flag
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Texas Cancer Registry | Treatment Information

69. Rx Summary - Immunotherapy
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Texas Cancer Registry | Treatment Information

70. SEER*Rx - Interactive Antineoplastic Drugs Database
One-step look for oncology drugs
Latest revisions (automatic updates)
Cancer dx 1/ and later
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Texas Cancer Registry | Treatment Information

71. SEER*Rx - Interactive Antineoplastic Drugs Database
12/2/2019
Texas Cancer Registry | Treatment Information

72. Transplant and Endocrine Codes
Bone marrow transplants
Allogeneic-donor
Autologous-patient
Syngeneic-identical twin
Stem cell harvests
Endocrine surgery/radiation
Combination transplant and endocrine therapy
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Texas Cancer Registry | Treatment Information

73. Transplant and Endocrine Codes
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Texas Cancer Registry | Treatment Information

74. Rx Summary Systemic/Surgery Sequence
Code
Label
No systemic therapy and/or surgical procedures; Unknown if surgery and/or systemic therapy given 2
Systemic therapy before surgery 3
Systemic therapy after surgery 4
Systemic therapy both before and after surgery 5
Intraoperative systemic therapy 6
Intraoperative systemic therapy with other therapy administered before or after surgery 7
Surgery both before and after systemic therapy 9
Sequence unknown, but both surgery and systemic therapy were given
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Texas Cancer Registry | Treatment Information

75. Web Plus Data Fields Other Treatment
Date Other Treatment Started
Rx Date Other Flag
Rx Summary – Other Treatment
Tx Text – Other Treatment
Rx Summary – Treatment Status
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Texas Cancer Registry | Treatment Information

76. Date Other Treatment Started
Date Other Treatment began at ANY facility as the first course of treatment
YYYMMDD format
If date unknown, record the year of diagnosis
Document in the text field date is unknown
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Texas Cancer Registry | Treatment Information

77. Hematopoietic Diseases “Other Treatment”
Phlebotomy
Polycythemia vera (9950/3) ONLY
Blood-thinners/anti-clotting agents
Essential thrombocythemia (9962/3) ONLY
Donor Leukocyte Infusions
Abstract as immunotherapy
Do not collect
Blood transfusions (whole blood, platelets, etc)
Aspirin therapy
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Texas Cancer Registry | Treatment Information

78. Rx Date – Other Treatment Flag
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Texas Cancer Registry | Treatment Information

79. Texas Cancer Registry | Treatment Information
Other Treatment
Patients might receive other treatment that modifies or controls cancer cells that isn’t surgery, radiation or systemic therapy.
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Texas Cancer Registry | Treatment Information

80. Rx Summary – Treatment Status
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Texas Cancer Registry | Treatment Information

81. Texas Cancer Registry | Treatment Information
Summary
First course treatment
Coding instructions
Surgery of Primary Site
Regional Lymph Node Surgery
Radiation
Chemotherapy
Hormone Therapy
Immunotherapy
SEER*Rx- Interactive Antineoplastic Drug Database
SEER*Educate educate.fredhutch.org
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Texas Cancer Registry | Treatment Information

82. Texas Cancer Registry | Treatment Information
Thank you
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Texas Cancer Registry | Treatment Information