Tag Archives: cancer registry

8 Ways Your Cancer Registry Can Support Your Cancer Committee

by Linda Corrigan, MHE, RHIT, CTR

Check boxCommission on Cancer (CoC)-accredited facilities must establish a cancer committee and charge it to develop and monitor all cancer program activities and cancer-education initiatives. The CoC Cancer Program Standards require that the cancer committee has multidisciplinary representation that includes physicians, other allied health professionals, and a cancer registrar.

Cancer registrars play a critical role on the cancer committee, since they are the only member who has a complete picture of the facility’s cancer burden in their database. The cancer registrar can serve as the committee’s data expert by analyzing data and bringing those findings to the committee for use in program planning. Here are eight ways in which cancer registrars can support their organization’s  cancer committee in meeting CoC Standards, and more:

  • Standard 1.12 Public Reporting of Outcomes is a commendation standard that lists seven possible other standards that can be included and at least three of these are based on cancer registry data. Accountability and quality measures are regularly reviewed by the cancer committee and your registrar may provide guidance on which measures demonstrate the best outcomes.
  • Standard 2.1 CAP Protocols and Synoptic Reporting. Most cancer registry databases can be set up to track CAP synoptic summary adherence, allowing the cancer registrar to provide an important piece of needed data.
  • Standard 3.3 Survivorship Care Plans. Procedures can be established such that the registrar and nurse navigator work as a team to implement and monitor survivorship care plans (SCPs). In many cases, the registry data can be downloaded directly to create and update the SCP, saving the nurse navigator hours of work and ensuring these plans are up-to-date and patients are kept informed.
  • Standard 4.1 Prevention Programs target risk factors that contribute to a diagnosis of cancer. Effective prevention programs start with data, which can be community-wide data or facility-specific data. Either way, your cancer registrar can assist with data collection and also search the CoC Cancer Forum for examples of best practices for this standard.
  • Standard 4.2 Screening Programs start with data. Your cancer registrar can create graphs to illustrate and explain which sites of cancer present to your facility at an advanced stage at diagnosis. Then the cancer committee can discuss whether there is an evidence-based intervention your facility could implement to diagnose these cancers earlier. Your registrar may also be able to assist with collecting this screening data and the subsequent lower stage at diagnosis.
  • Standard 4.6 Monitoring Compliance with Guidelines. To help meet this requirement, the cancer registrar can look at how many breast cancers are being treated in accordance with the National Comprehensive Cancer Network (NCCN) guidelines and identify the cases not meeting the recommendations.
  • Help with the recruitment of new physicians by providing data on the number of cancer sites diagnosed at the facility. For example, a hospital with a high-volume of lung cancer diagnoses may consider hiring more specialists or establishing a lung cancer institute to meet the community’s needs. Registrars can also evaluate in- and out-migration patterns to help hospital administration understand and address patient-retention patterns. For example, if a patient is diagnosed at the facility, but seeking care and treatment elsewhere, this might be an indication that the facility-of-diagnosis does not have the specialists on staff to address patient care. Registrars can also analyze the time from diagnosis to treatment or from biopsy to final surgery to help the cancer committee spot where improvements can be made. Registrars can also review the distances patients travel for their care, what insurance they carry, and other factors that can be barriers to care.
  • Serve as a resource on CoC standards by reporting on information learned at the National Cancer Registrars Association’s annual conference. The CoC offers a standard Q&A session at this conference, providing an opportunity for cancer registrars to better understand the intent of the standards and clarify any questions. For example, in 2016 Daniel McKellar, MD, FACS, chair of the Commission on Cancer, explained which standards surveyors are reporting as being “noncompliant” and how to make sure your program is compliant on those standards. This was vital information that attending registrars brought back to their cancer committees.

Your cancer registry is a valuable resource for your cancer committees,  housing the data needed to help meet CoC standards and ensure patient-centered care. Key to success, however, is a cancer registrar who knows how to analyze and present the data. Hiring registrars who hold the Certified Tumor Registrar (CTR) credential is a good first step, but providing ongoing training on advancements in cancer treatments and data analysis and informatics is critical.

Contributing blogger ACCC Member Linda Corrigan, MHE, RHIT, CTR, is currently serving as President of the National Cancer Registrars Association.


The Cancer Registry’s Role in Creating Survivorship Care Plans

by Barbara J. Dearmon, BS, CTR

Solutions on corkboard (small)Survivorship Care Plans  are required by facilities accredited by the American College of Surgeons Commission on Cancer (CoC) and the National Accreditation Program for Breast Centers (NAPBC). These plans assist patients in being active participants in their post-treatment plan of care. The Survivorship Care Plan (SCP) helps promote continuity of care, provides a plan for future care, alerts the patient to delayed effects long after treatment has concluded, and provides a source document to share with future providers. Having a SCP helps patients maintain appropriate follow-up, such that late effects can be properly managed and recurrences identified and treated quickly. The SCP also provides the opportunity to address psychosocial and other health issues related to the cancer experience. The CoC’s Survivorship Care Plan requirements are outlined in Standard 3.3; the NAPBC’s requirements are detailed in Standard 2.20.

St. Vincent’s Medical Center Riverside in Jacksonville, Florida, is accredited by both the CoC and NAPBC. To meet these organizations’ SCP standards, St. Vincent established a Survivorship Committee in 2014 to examine the requirements and develop a process for disseminating SCPs and comprehensive treatment summaries to cancer patients who completed cancer treatment at the facility. The process also included a system to monitor and evaluate these efforts annually. The Survivorship Committee was multidisciplinary and included representatives from administration, cancer registry, information services, medical oncology, radiation oncology, surgery, clinical staff (physicians and nursing), and the survivorship nurse navigator.

The Survivorship Committee unanimously agreed that the cancer registry was the most complete data source for creating SCPs and treatment summaries to meet compliance with both standard-setting organizations. The cancer registry currently captures the majority of required data elements that will ultimately be included in these care plans. Some cancer registry software applications have the ability to interface data into a preformatted care plan template or Word document. St. Vincent’s reviewed several resources and decided to use Journey Forward, which interfaced easily with its cancer registry database. Policies and procedures were established to guide the process. Specific policies outlined the roles of the cancer registry staff and the survivorship nurse navigator and detailed the purpose, case eligibility, and dissemination process for the Survivorship Care Plans.

Role of the Cancer Registry:

  • The cancer registry generates a list of eligible cases abstracted using the cancer registry software and exports the data into Journey Forward.
  • The information for the care plans derived from the cancer registry database includes: cancer diagnosis, demographics, first course of treatment, stage of disease, and treating physicians. Treatment information to be captured includes chemotherapy, drugs administered (start and end dates), hormones, immunotherapy, radiation, and surgery.
  • Follow-up information on date-of-last contact is captured on the template. Cases are selected retrospectively, eight months from date-of-first contact at facility.
  • The cancer registry interfaces (exports) registry data into Journey Forward’s breast, colon, and lung templates.
  • For the primary sites that to do not correspond with Journey Forward templates, the cancer registry saves the information in a secured Excel file on a shared drive. The survivorship nurse navigator, with assistance from the cancer registry, manually enters demographics, treatment, stage, physician contact, and prognostic indicators into the Journey Forward’s generic template. The completed templates generated monthly from the registry database are saved in a folder located on the secured shared drive for the survivorship nurse navigator to access.

Role of the Survivorship Nurse Navigator:

  • The survivorship nurse navigator accesses the shared drive and selects the current cases for the month. The survivorship nurse navigation obtains from patient records and/or the physician office the clinical documentation necessary to complete the survivorship care plan and treatment summary.
  • The survivorship nurse navigator reviews information for accuracy and contacts the cancer registry if there are questions related to data interfaced from the registry database.
  • The survivorship nurse navigator works with outside physician offices to obtain necessary information to complete the remaining care plans.
  • The survivorship nurse navigator contacts the patient and offers an appointment to review the SCP in-person.
  • If the patient declines an appointment, a hard copy of the SCP with a cover letter and contact information is mailed to both the patient and the patient’s primary care provider.
  • All correspondence with the patient is documented in Nursenav Oncology, St. Vincent’s nurse navigator software. In addition to generating templates in Journey Forward, clinical staff use Nursenav to chart information and all correspondence with patients.
  • The survivorship nurse navigator maintains an electronic copy of all completed SCPs.

The Survivorship Care Plan process at St. Vincent’s is evaluated and monitored on a regular basis by the survivorship nurse navigator and the facility’s Cancer Committee. Tracking to ensure compliance with the process is presented to the Cancer Committee and the breast program leadership annually at a minimum.

Implementation of a Survivorship Care Plans benefits patients, who will be better informed about the treatment they’ve received and the resources available to ensure continuity of care. There are a variety of ways for a facility to develop Survivorship Care Plans and to ensure these plans are disseminated and the needed follow-up conducted. At St. Vincent’s, the multidisciplinary team that formed its Survivorship Committee, believed the cancer registry and the survivorship nurse navigator played critical roles. As facilities develop their process for implementing SCP plans, they too may want to consider the role of the cancer registry. Resources to help a facility get started include the American Cancer Society; American Society of Clinical Oncology; Institute of Medicine; Journey Forward; LIVESTRONG; and the National Cancer Institute.

Guest blogger Barbara J. Dearmon, BS, CTR, is manager, Oncology Support Services, at ACCC Cancer Program Member St. Vincent’s Medical Center, Jacksonville, Florida.

Cancer Registars: Is Concurrent Abstracting that Scary?

by Holly J. Kulhawick, CTR

ThinkstockPhotos-180686516Concurrent abstracting is the process of completing the cancer registry abstract in stages after each treatment occurs, rather than all at one time, four to six months after diagnosis. Some registries have always abstracted concurrently, but others are finding—or at least feeling as if—they are being forced into concurrent abstracting by the new Commission on Cancer (CoC) requirement to submit to the Rapid Quality Reporting System (RQRS). RQRS is a reporting and quality improvement tool that provides real-time clinical assessment of hospital-level adherence to quality of cancer care measures. On January 1, 2017, participation in RQRS will become mandatory for all CoC-accredited cancer programs.

Facing Down the Fear

Recent discussions on the National Cancer Registrars Association’s Facebook page indicate a high level of anxiety among those converting to concurrent abstracting. As with all fears, this one is best dealt with by facing it down and examining it under a bright light. Is concurrent abstracting really that difficult? No. Does it take more time? Sometimes. Cancer programs implementing concurrent abstracting for RQRS, can use resources on the RQRS website to help with updates and data quality assurance. CoC-accredited facilities can log on to CoC DataLinks to access their RQRS data. The password-protected site provides monthly alerts on the patients submitted to RQRS as well as updates on the treatment administered, offered, or recommended.

As CTRs embark on concurrent abstracting, they need to release the mantra that it has no advantages. Instead, recognize that this is the best way to provide quality, up-to-date cancer data, and accept the challenge. A major concern when converting to concurrent abstracting is who completes the updates. Certified Tumor Registrars (CTRs) are fiercely territorial regarding their work. This is not a helpful position to take when conducting concurrent abstracting. It is important to allow different members of the team to take turns updating the cases. In doing so, registrars may find that two sets of eyes are better than one at spotting errors or capturing all the nuances of a case. This can also prove to be an advantage in improving data quality and fostering teamwork.

Another concern is the need to return repeatedly to cases to provide treatment updates. To many CTRs, this seems like a doubling of the work. It does increase the time in certain abstracts, but the improvement in quality can be an offsetting factor. Think about it. How many times is an abstract seen only once? Not many, since in many large cancer registries the tasks are assigned to different staff members. One person may load the case and another may add surgeries and biopsies. Some registries use an automated system to load radiation or chemotherapy data with a staff person conducting follow-up months later. This same type of work plan can be used for concurrent abstracting. Allowing several staff to construct and review the abstract can also assist with quality assurance (QA). If only one person is assigned to conduct QA, they may be less attentive. If they know others will be reviewing the abstract, they may be more conscientious.

Data Clinicians Want and Need

Physicians have long complained about the latency of cancer registry data. Concurrent abstracting and RQRS help to address their concerns. Cancer registrars must respond. The cancer registry data does take too long to collect and to be put to use. Today, everyone wants instant results and oncology is no different. Any patient’s case can spiral out of control over a matter of days. Clinicians want to be able to monitor and respond as close to real time as possible. If it takes cancer registrars four to six months to even start a case, they are not providing clinicians with the data that they want and need—data that helps ensure high-quality cancer treatment and care.

Programmatic Benefits

The cancer registry department also benefits from concurrent abstracting. In addition to physicians valuing real-time data, your facility’s Finance and Administrative departments will too. They can analyze the data to help improve operations and services. As a result, these departments see the cancer registry fulfilling a vital need for the organization. This can often lead to more timely responses to requests for budget items, IT support, and additional staff. The cancer registry database can also be used to prepare tumor conference presentation forms. In many facilities, the completion of these forms is very involved, requiring registry staff to create the equivalent of an abbreviated abstract. This is a drain on staff time, since most tumor conferences occur monthly. With concurrent abstracting, the timely data can be merged to populate the forms, reducing the time to just minutes per form. Clinical staff appreciate the results and the doctors no longer need to haul office medical records to tumor conferences.

A near-to-real-time cancer registry database can also help in preparing Survivorship Care Plans (CoC Standard 3.3). To assist with these plans, cancer registry departments may want to consider educating nurse navigators on the database and providing them access so that they can update chemotherapy and/or offsite treatments. Sharing the database will not only help with these important plans, but will also foster a sense that the registry belongs to the team, not just CTRs.

Moving to concurrent abstracting may seem daunting—and, yes, even scary—but it’s an important step that can support and advance the work of the entire cancer care team.

Guest blogger Holly J. Kulhawick, CTR, is Supervisor, Cancer Registry, at ACCC Cancer Program Member Renown Health in Reno, Nevada.

Three Ways to Support Your Cancer Registrars

By Linda Corrigan, MHE, RHIT, CTR

Check boxCommission on Cancer (CoC) Cancer Program Standards 2016 are designed to ensure a comprehensive approach to the care and treatment of patients. Cancer programs seeking CoC accreditation must demonstrate that they’ve met or exceeded these standards—many of which require data tracking. Your cancer registrar can assist your clinicians in designing the best “tracking tool” for your program. For many programs, the best tool will be your cancer registry software. Cancer registrars well-versed in high quality data collection are key to the success of a cancer program. In turn, there are three critical ways your program can support its cancer registrars:

  • Make sure your cancer registrars are up-to-date by supporting training and continuing education opportunities. Change is a constant in the world of oncology. Treatments are advancing, CoC standards are added and/or revised, and state cancer registry data-collection guidelines are updated annually. A prime example of this constant change is the American Joint Committee on Cancer’s (AJCC) soon-to-be-released Cancer Staging Manual. The new 8th edition, scheduled for publication in October 2016, will revise how cancer is staged.
  • Encourage your cancer registrars to get involved in state and national organizations and provide funds for them to attend meetings and conferences. The key to helping your cancer registrar stay current is networking and continuing education. Some registrars have as many as three separate organizations and/or federal agencies that “set” the standards for exactly how and what data are collected from a facility’s cancer program. Cancer registrars who attend national conferences and state meetings or who are encouraged to volunteer for national and state-level organizations develop a network of colleagues from across the country that can be tapped as a resource when your program has questions.
  • Staff your cancer registry appropriately. The best way to support and retain your cancer registrar and to ensure high-quality data collection is to make sure you have the staffing bandwidth for the number of cancer cases your facility manages each year. Review NCRA’s Workload and Staffing Study: Guidelines for Hospital Cancer Registry Programs to help assess your staffing needs.

The National Cancer Registrars Association (NCRA) and the Association of Community Cancer Centers (ACCC) are two national associations that can help cancer programs support their cancer registrars. NCRA’s Annual Educational Conference provides a thorough and cost-effective way for cancer registrars to stay informed and to network. Attendees learn about updates to treatments and staging, CoC standards, clinical trials, and national trends. The 2017 conference, scheduled for April 5-8, in Washington, D.C., will focus on the AJCC’s 8th edition of the Cancer Staging Manual. Look for conference updates on the NCRA website here.  NCRA’s Center for Cancer Registry Education is a learning management system designed to provide easy access to high-quality educational programming. The website offers a variety of online products to help registrars tailor training and manage the continuing education credits needed to maintain their Certified Tumor Registrar (CTR) credential.

ACCC is also a great resource for cancer registrars. ACCCExchange, the association’s online member discussion forum, connects registrars with peer-to-peer solutions, strategies, and resources for how to best meet CoC standards. ACCC’s journal Oncology Issues provides in-depth articles on programmatic innovations implemented by ACCC member programs, coding updates, and advocacy issues—and can be a valuable resource for registrars to better understand advancements in cancer treatment and care. Coming in October, the ACCC 33rd National Oncology Conference in St. Louis will focus on practical “how to’s” for cancer programs and practices, with peer-to-peer learning on process improvement strategies, putting data to work to improve care, and more. Learn more here.

Contributing blogger ACCC member Linda Corrigan, MHE, RHIT, CTR, is president, National Cancer Registrars Association.

Tap Into the Expertise of Your Cancer Registrar

By Linda Corrigan, MHE, RHIT, CTR

ThinkstockPhotos-507273299Hospitals understand their cancer registry data are sent to state and federal agencies to document incidence rates and to identify cancer clusters. But many may not be realizing the full potential of their cancer registry database, a goldmine full of information that can help your facility. Hospital-specific data provide a wealth of information that can assist with financial and strategic planning, assessing timeliness of treatment, understanding survival rates, conducting community needs assessments, and implementing targeted marketing initiatives.

As the custodians of your data, cancer registrars know it better than anyone and can see trends as they happen. Make sure to include your cancer registrar in meetings and ask for updates. Tap into your cancer registrar’s expertise and put your data to work. Your cancer registrar can:

  • Help your program justify additional staff. For example, by monitoring case volume by site, year, and insurance coverage, your cancer registrar can supply data to make the case for adding physicians to your cancer program.
  • Run reports to identify patterns (or specifics) about who is seen in your cancer program by identifying referring physicians or hospitals. These data can help track trends in patient retention as well as outmigration.
  • Assist with quality improvement/process improvement initiatives. For instance, time to treatment is a frequent target for cancer program improvement efforts. Your cancer registrar can do a deep data dive into your patient population and uncover the exact profile of those patients experiencing the greatest delays.
  • Collect specific data to generate custom reports through user-defined fields in the database. What data do you want to collect? Many registrars have already started reviewing patients seen in the beginning of 2016, so now is the time to talk with your cancer registrar about any additional data you may need for future reports.
  • Compare your data (demographics and disease-site specific data) to that housed in several other national databases.
  • Support your Cancer Committee with data that identifies your patient population and specific health disparities in your service area as the triennial Community Needs Assessment is being completed.

These are just some of the many ways the expertise of your cancer registrar can support your cancer program. An upcoming ACCCBuzz blog post will explore the evolving role of cancer registrars and how your oncology program can support registrars as an integral member of the cancer care team.

ACCC Member Linda Corrigan, MHE, RHIT, CTR, is currently serving as President of the National Cancer Registrars Association.  Learn about the NCRA Annual Education Conference, April 5-7, 2017, here.  Explore NCRA’s Center for Cancer Registry Education here.  The January/February 2016 Oncology Issues features, “Unlock the Potential of the Cancer Registrar,” an article co-authored by Ms. Corrigan that describes how cancer registrars can support lung screening programs within community cancer centers.