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Treatment Information

Treatment Information. Texas Cancer Registry. 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

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Treatment Information

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  1. Treatment Information Texas Cancer Registry

  2. 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 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 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 • http://seer.cancer.gov/tools/heme/index.html Texas Cancer Registry | Treatment Information

  5. First Course TreatmentTiming (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 Texas Cancer Registry | Treatment Information

  6. First Course TreatmentTiming 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? Texas Cancer Registry | Treatment Information

  7. First Course TreatmentTiming 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? Texas Cancer Registry | Treatment Information

  8. First Course TreatmentCoding 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 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 • multiple primaries • treatment affects only one of the primaries Texas Cancer Registry | Treatment Information

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

  11. Heme & Lymphoid NeoplasmsCoding 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 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) Texas Cancer Registry | Treatment Information

  13. LeukemiaFirst 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 Texas Cancer Registry | Treatment Information

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

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

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

  23. 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 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 • SLNBx and regional lymph node dissection • Separate events • Code 9 • Unknown if performed • Unknown or ill-defined site • Lymphomas with lymph node primary site • Hematopoietic, immunoproliferative, or myeloproliferative 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? 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? 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? 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 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 Texas Cancer Registry | Treatment Information

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

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

  35. Web Plus Data FieldsSurgery • 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 Texas Cancer Registry | Treatment Information

  36. 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 Texas Cancer Registry | Treatment Information

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

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

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

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

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

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

  50. Web Plus Data FieldsRadiation 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 Texas Cancer Registry | Treatment Information

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