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ODS > CRM Part 1 > Flashcards

CRM Part 1 Flashcards

1
Q

Central ca regys are the connection between what?

A

Those collecting data on pts and national ca programs

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2
Q

Central regy consolidates reports on same pt and primary cancers for all __, __, and __ items.

A

demographic, dx, and treatment

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3
Q

Consolidation of data occures at the __ and __ level, so that there is only one best record of each possible value

A

individual and record

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4
Q

Consolidation can be used to determine the best possible ___ of cancer within a ____

A

incidence / defined geographic area

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5
Q

Central regy data is aggregated at these levels

A

national and international

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6
Q

Many central regys are located in

A

state health depts

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7
Q

Central regys are governed by (x2)

A

laws of state / standards and requirements of federal funding agencies

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8
Q

All central regys are funded by __, ___ or both

A

CDC’s NPCR / NCI SEER

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9
Q

Staffing for central regy depends on (x3)

A
  1. goals of regy 2. caseload 3. nature of data collection process
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10
Q

What is FTE for essential central regy function

A

12.4

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11
Q

Other professionals employed in central regy (x6)

A

Epidemiologists, statisticians, informaticists, IT and admin support personel and manager or director overseeing BUDGET and PROGRAMATIC PLANNING

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12
Q

Majority of central regy data comes from

A

hospitals

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13
Q

Why is receiving data from different type of reporting sources important

A

fills gaps in patient and tumor record

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14
Q

Central regy - all cases for a diagnosis year must be submitted to the central regy no later than…

A

6 months after dx

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15
Q

RCA is

A

rapdid case ascertainment

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16
Q

Hosital reg maintain data on all patients ___ and report all cases to the central reg after ___, ___, and ___ are completed at the hospital level

A

treated for ca at their facility
casefinding, abstracting, and editing are completed

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17
Q

When hospitals submit their data to the state’s central reg it uses a STANDARDIZED FORMAT. What is the format?

A

NAACCRs data exchange record layout

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18
Q

Name other health-care reporting sources.

Note that they are generally required by STATE STATUTES to report cancer dx and/or tx to their respectiver registries

A

outpt cancer centers
path labs
med onc facilities
surgery centers
imaging and radiology centers

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19
Q

Ca dxs that are often dx outside of hospital setting include (5)

A

prostate
urinary
heme (MDS)
urology
dermatology

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20
Q

Path reports are a critical data source for central regy. What percentage of cases reported to U.S. central regy were dx using path reports

A

94%

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21
Q

Many states have developed ____ which collects claims data from ____ for inpt tx, outpt tx, and pharmacy claims

A

APCD - all payer claims database
health insurance companies

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22
Q

With APCD data can be pulled from claim information through what kind of linkage

A

probablistic

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23
Q

What is the interstate data exchange?

A

Most central reg have data sharing agreements with other states to match data obtained from out-of-state data exchanges with facilities (other ca reg, state depts of health, path labs)

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24
Q

What is signed between different state’s central regys

A

NAACCRs National Interstate Data Exchange Agreement

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25
Q

Who typically does casefinding?

A

Hospital regys, central regys depend on them but the central regy may perform casefinding on NONHOSPITAL facilities

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26
Q

What nonhospital sources do central regys use?

A

path reports from freestanding labs and derm offices
disease indices from outpt centers
disease indices from hospice or nursing homes
death certificate files

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27
Q

Consolidations must occur for data on same pt and tumor. Multiple reports from sources are called

A

source records

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28
Q

What is CCRDB

A

central ca regy database

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29
Q

When consolidating, central regys often use 4 components to ensure data is accurate and each new cancer is counted only once. What are they?

A

data edits
patient record linkage
tumor record linkage
data item consolidation

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30
Q

What happens when central regy source records are subjected to electronic data edits for completeness and and inncuacies or errors are found?

A

Sent back to reporting facility or corrected and resubmiited for editing by central reg staff

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31
Q

When no errors are found in source records at the central regy, what is the next step?

A

patient record linkage

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32
Q

What is the patient record?

A

the individual person with one or more primary cancers/reportable neoplasms

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33
Q

What data items are included in the patient record?

A

name
dob
SSN
race
etc

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34
Q

Record linkage is performed to determine what?

A

if pt has an existing record in the CCRDB

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35
Q

List the steps in the CCRDB record linkage process (5)

A
  1. souce record is imported
  2. data edits performed to check for errors
  3. if all good PT RECORD LINKAGE performed (exisitng pt vs creating new record for pt)
  4. If pt is already in system TUMOR RECORD LINKAGE performed (pt record updated to add new tumor or patient record updated for original tumor)
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36
Q

What is a perfect match in record linkage?

A

CCRDB algorithms find a match with all key demographics (name, dob, ssn, etc)

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37
Q

What is a probably match in record linkage?

A

CCRDB algorithms find a match in demographics (name, dob, etc) but there is say a 1 digit difference in SSN

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38
Q

What often is the process for probable matches in record linkage?

A

manual review

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39
Q

Each tumor record is counted in what?

A

Incidence data

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40
Q

What are same data items included in a tumor record?

A

primary site
histology
stage
tx
info abt pt at time of dx

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41
Q

What is data item consolidation?

A

Central reg identify difference between info from 2+ sources for the same pt and/or tumor and determine the best data values

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42
Q

If a record is modified during the data item consolidation process, what is the record called?
What happens to the original unmodified source record and what is it called?

A

consolidated record
it is kept unmodified and called the PRISTINE record

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43
Q

If a record is modified during the data item consolidation process, what is the record called?
What happens to the original unmodified source record and what is it called?

A

manual and automated
manual is often for complex, interrelated and compound variables and automated is for simple variables

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44
Q

Why is geocoding helpful?

A

calculating local rates
identifying areas with high or low risk - which can help identify underreporting

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45
Q

Who does geocoding?

A

central reg

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46
Q

Geocoding helps identify and analyze relationships between

A

incidence and cancer risk factors

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47
Q

Follow up os determined by VITAL STATUS, which generally falls into what 2 categories

A

date of last living contact
reports of death

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48
Q

Name some of the linkages that provide date of last living contact

A

DMV
Voter registration
Medicare and Medicare services

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49
Q

Name some of the linkages that provide reports of death

A

National Death Index
Social Securit Death Index

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50
Q

NCI and CDC provide central regs with guidance on requirements for follow up data. NCI funded use ___ methods while CDC requires ___

A

active and passive
passive (through death certificate file from the the state and NCHS National Death Index

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51
Q

Death clearance is the process of matching ____ against _____

A

death in pop
reportable conditions

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52
Q

What are the steps in death clearance?

A

Death clearance match (match is found) and death clearance follow-back (no match found - invesigation must be done to identify missed cases)

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53
Q

During death clearance, if no match can be found and investigation leads to nothing, this is a

A

DCO case - death certificate only

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54
Q

Central reg with a DCO rate (cases identified as DCO) must be below ___ to achieve NAACCR certification

A

5%

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55
Q

What are causes of central reg with high DCO percentages?

A

Incomplete reportable list
1+ newly identified facilities have not begun reporting yet
Known facility failed to report all required cases

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56
Q

Central reg do not have access to this

A

patient medical records

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57
Q

____ and ___ collect data for the entire US

A

CDC and NCI

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58
Q

Standardization of data allow for ___ and ___ across geopolitical boundaries

A

aggregation and comparibility

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59
Q

Standards refer to the __________ and ______ by a SINGLE STANDARD SETTER

A

data collection and

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60
Q

Data standardization refers to these 4 things among multiple standard setters

A

agreement of fields
field lengths
codes
instructions for data collection

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61
Q

Data are _____ that check the content entered in data fields against ____

A

software algorithms / standardized codes

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62
Q

Data edit requirement standard setts are … (4)

A

SEER - primary site, morphology, grade
COC - TNM
NAACCR - SSDI
CDC uses edits sponsored by SEER, CoC and NPCR

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63
Q

Who developed 1st coding guidelines

A

CoC - ACoS & NCI in 1950s, followed by SEER in 1971

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64
Q

Central reg in US confomr to what standards

A

NAACCR standards from the Standards for Ca Reg Volume II

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65
Q

CoC accredited facilities conform to what standards

A

STORE

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66
Q

What is the data exchange standard and who developed it

What language is now used

A

NAACCR
assists with electronic transfer of data bt hospital and central reg

XML

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67
Q

Nonhospital source examples

Their data standards are build on formats developed by who?

A

path lab and physician offices

HL7 - Health Level 7 (develops standards for exchange of electronic health info)

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68
Q

Path labs standards are from who/what

A

NAACCR - Standards for Ca Regs Volume V

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69
Q

Data linkage is a task of which? hospital or central regy? and what is it?

A

central
linking to ensure no cases has been missed

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70
Q

Data edits are checks for ____

A

data accuracy

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71
Q

Who develops edits

A

standard setters from codes and coding instructions

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72
Q

Who makes inter-record edits available?
What are they?

A

NCI SEER and CDC
Compares data recorded across records for pts with than one more for consistency in like data tiems and sequencing of tumor events

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73
Q

Who distributes edits? (x3)

A

SEER*Edits (from NCI SEER)
NAACCR Edits Metafile
CDCs GenEDITSPlus

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74
Q

Different bt sing-field edit and inter-record edit

A

single field - ITEM - checks one field at a time
inter-record - MULTI-RECORD - compares data on more than 1 record (finds errors common to all records)

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75
Q

When does NAACCR provide a new version of the Edits Metafile

A

when new data dictionary is released

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76
Q

In addition to the standard metafile, NAACCR and CDC publish what annually?

A

call for data metafile

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77
Q

What program provides standardized process for creating and distributing an edit metafile as well as standard edits

A

EditWriter

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78
Q

What are the 7 components of NAACR Metafile and briefly describe

A

Agencies - standard setters who sponsor edits
Edits - individual data checks
Edit Sets - groups of edits applie to 1+ records in a processing run
Fields - data elements to be edited in the metafile
Layouts - grouping and organization of FIELDS from NAACCR data dictionary into a file format
Messages - Error messages explaining the edits
Tables - facilitates lookups and bulding list choices for multiple values

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79
Q

Sometimes cases are edited in batch mode prior to submission and a list of errors will generate with frequency counts (ie ERROR REPORT), what are these used for

A

QUALITY-CONTROL
can identify areas of coding confusion for 1 or multiple abstractors and indicate areas for education

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80
Q

Edits can be overriden. Name 2 scenarios when this would apply

A
  1. CTR reviews data and finds it be correct after all
  2. Apparent problems in edit logic (confirmed with the software vendor and/or reported to NAACR)
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81
Q

The library of resources for abstracting are the same for what?

A

writing and resolving edits

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82
Q

Data quality activities: visual editing - briefly describe

What are the risks?

A

comparing text documentation with abstract coded items to detect errors not found in computer edits

bc it depends on humans (experienced CTRs) it is subjective and not all editors with identify same errors

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83
Q

Data quality activities: recoding audits - what is it?

A

verified coding guidelines are correctly applied by registrar

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84
Q

What kind of charts is good for recoding audit? why?

A

pareto

ranks areas that need attention to decreasing order of occurence

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85
Q

Data quality activities: re-abstracting study - why? (x5)

A

assess quality of collected data
est. rates of agreement bt registry data and info in source documents
identifies probls with interpretation and coding of specific data
develop standard guidelines and rules for abstracting ambiguous scenarios

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86
Q

Data quality activities: re-abstracting study - what is it?

A

qualified staff member abstracts the sample case again from medical records
that is compared to the OG
discrepancies bt can be identified as MINOR or MAJOR

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87
Q

Data quality activities: text documentation - it is a vital aspect of what? and it must do what?

A

data COMPLETENESS

must tell story in language that supports coding

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88
Q

Data quality activities: why is text the most important tool for central reg?

A

it is used for reconsiling conflicting codes from different sources during the CONSOLIDATION process

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89
Q

Data quality activities: Unknown values and ill-defined codes pose problems to data analysis. why?

what does a high rate of unknown codes indicate?
what does low rates of unknown codes indicate?

A

it can skew data in a way thay may for example rep. more of a given pop

sources of information are being overlooked
registrar may be making unsupported assumptions about data
(rate of uknowns should be somewhat stable)

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90
Q

What data field has the greatest number of missing/unknown values?

A

grade

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91
Q

Reports ensuring timeliness:

comparitive coding can monitor what?
how is it measured?

A

consistency

reliability studies

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92
Q

What is a lag time report?

A

report that tracks cases by date of dx against
date of received in central reg

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93
Q

How often are timeliness standards monitored for being met? and how?

A

monthly
by timeliness reports

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94
Q

Reports ensuring timeliness:

what does a reliability study test?
what does it help with?

A

registry rules and measures whether rules provide consistent and reliable guidance so coding the same case by diff. registars is consistent

study helps find areas where coding rule documentation is unclear

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95
Q

Completeness:

casefinding audits ensure _____ and guards against ____

A

case incidence completeness

duplication of cases

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96
Q

comleteness rate (%) = 100 - [(missed cases/total # identified) *100]

A

casefinding audit

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97
Q

missed rate = (# missed total/#identified) *100

A

casefinding audit

98
Q

Completeness:

historical data review = what?

A

comparing # of cases expected based on previous years or on standard incidence rates and those observed

99
Q

why would a historical data review be done?

A

cheap

can indicate changes in case completeness over time

100
Q

if central reg accepts all submitted records and does not check for quality of data this could result in what?

A

greater case completeness but poorer quality

101
Q

no matter what kind of case rejection criteria a central reg uses, this should be in place to ensure resubmission of those cases to the registry

A

follow-up

102
Q

what activities do central reg use to ensure ACCURATE and COMPLETE data

A

audit on casefinding, consolidation, reabstraction, recoding
de-duplication
manual record consolidation
process monitoring

103
Q

this certification provides objective measure of DATA QUALITY, COMPLETENESS AND TIMELINESS when looking at other registries

A

NAACCR certification

104
Q

Four audit types that central reg perform on facilities

A

casefinding audit
consolidation audit
re-abstracting audit
recording audit

105
Q

reliability studies are conducted from central reg on facilities to assess

A

reproducibility (cancer registrars) and validity (source documents)

106
Q

what is the initial type of audit that a central reg will perform if they suspect underreporting?

A

casefinding

107
Q

when central reg performs audits, what do they do with this information

A

they inform the hosp reg for correction and education opportunity

108
Q

what kind of cases do central reg often choose for audits (x2)

A

sources of high quantity (top primary site for ex)
sources with high risk of missed cases (new practices reporting or bone marrow transplant from hospital for ex)

109
Q

what is purpose of de-duplication

A

evaluates number of duplicate record in the CENTRAL regy database that have not been identified or corrected using matching, linkages or other protocols

110
Q

de-duplication is the process of ____ ____ in the CENTRAL reg database that are recorded as __________

A

identifying individuals
recorded as two or more people or same person having mutiple primaries when they have a single

111
Q

how are duplicate identified on matchin

A

name, DOB and SSN then reviewing the other variables

112
Q

how are duplicate records tracked

A

Identificatioin of Duplicates Form

113
Q

what is the most common activity of the central reg in regard to QUALITY CONTROL of the RECORD CONSOLIDATION PROCESS

A

running of data quality and inter-record edits after consolidation is complete

114
Q

QI goes beyond data ____ and looks at what?

A

ACCURACY
systems and processes that affect accuracy of data and performance indicators

115
Q

QA measures ____ while QI examines ____

A

QA measures accuracy
QI examines the causes behind inaccuracies and changes that can be made to reduce errors

116
Q

Process improvement is also called

A

performance improvement

117
Q

QI Methodologies:

PDSA/PDCA - Plan, Do, Study/Check, Act is often used for testing effectiveness of change/intervention for

A

small or limited scale items

118
Q

PDSA is usually depicted as a cycle, why?

A

intended to be repeatedly checked small incremental changes

119
Q

Which QI methodology is best applied to rapid-cycle processes

A

PDSA/PDCA

120
Q

Outline PDSA steps

A

P - Plan by defining problem and desired outcome
D - Implement the change or intervention
S - Analyze data collected and compare to before intervention
A - Use the results for S step to plan the NEXT step

121
Q

QI Methodologies:

DMAIC means

A

Define
Measure
Analyze
Improve
Control

122
Q

This QI methology is a six sigma method

A

DMAIC

123
Q

DMAIC is typically used for …

A

larger scale projkect where careful planning is needed

124
Q

This QI methology relies heavily on data to get to the root of the problem

A

DMAIC

125
Q

What does LEAN offer by reducing waste

A

efficiency

126
Q

What are the two types of tools for QI

A

Idea driven and data driven

127
Q

What are the 7 tools of QI

A

Cause and effect diagram
Check sheet
Flowchart
Histogram
Pareto chart
Run chart
Scatter plot

128
Q

Cause and effect diagram is good for what/not the best for what

A

identifiying all possible causes
the primary cause

129
Q

Check sheets are used to document ____ over time

A

OCCURENCES

130
Q

What are check sheets useful

A

finding trends and patterns over time

131
Q

Flowcharts is a diagram of _____ and used to identify _____ ______

A

multistep process
redundencies and delays

132
Q

This QI tool looks start and end points and steps and decisions between the two

A

flowchart

133
Q

This QI tool is represents FREQUENCY of events over DISCRETE categories

A

histogram

134
Q

Parteo charts different from histogram in what 2 ways

A

bars of pareto go from largest to smallest
a line shows cumulative % of total represented area on the pareto

135
Q

This QI tool identifies primary causes of a problem to priortize improvement interventions

A

pareto chart

136
Q

This QI tool is a line graph of data over time and used to identify what?

A

run chart
variations in a process or measure

137
Q

extreme variation in a run chart could indicate

A

need for improvement

138
Q

This QI tool shows the relationship between two CONTINUOUS variables

A

scatter plot

139
Q

where should the CQI process be housed

A

cancer reg’s policy and procedure manua

140
Q

Process monitoring requires what to determine the NATURAL VARIABLILITY of measures whether the move way out of range

A

statistical evaluation

141
Q

Common MANAGEMENT REPORTs for a cent reg include (x5)

A

data submissions
timeliness interval bt date of dx and submission
# and type of errors
% unknowna and unspecific values
completeness

142
Q

Why are productivity standards important in regard to QI?

A

helps meet state and national deadlines

143
Q

___ and ___ are used to determine staffing and productivity levels

A

workflow and workload

144
Q

This is an ordered list of all steps needed to complete a task (mapping of workflow)

A

step assessment

145
Q

step assessment vs workflow chart

A

step = simple linear process
workflow chart = complex processes

146
Q

once a step assessment or workflow chart is complete this can be performed to measure time requird for each step

A

time and motion study

147
Q

Casefinding at the facility level is the process of identifying cases that need to be reported to …
and for CoC facilities reported to…

A

central cancer registry
NCDB

148
Q

Where does one get information on the casefinding process?

A

policy and procedure manual of the dept

149
Q

When is an accession # assigned

A

when picked up from casefinding, moved from suspense to the registry to begin abstracting

150
Q

What is difference between analytic cases and nonanalytic (class of case)?

A

analytic required by CoC to be abstracted
non-analytic may be abstracted to meet CENTRAL regy requirements OR REPORTABLE BY AGREEMENT requests

151
Q

What are the 3 main, primary casefinding sources?
Which is #1?

A

path reports - #1
med/rad oncology logs - treatment summaries
HIM disease indices

152
Q

What could be included in a path reports? (4)

A

surgical specimens
cytology
bone marrow biopsies
autopsy reports

153
Q

Most hospital registries abstract cases within how many months of what?

A

6 months
date of first contact

154
Q

What doise the ICD-O behavior code have to be to be reportable?

A

/2 /3 behavior

155
Q

What is the most important use of the disease index

A

identify cases not found through other means

156
Q

What are the 4 factors for determining if a case is eligible for inclusions (pulled from suspense file to abstract)

A

dx
primary site
reference date
reason for visit

157
Q

What is the reference date?

A

effective date which cancer registration began for the facility
it is always january 1st for month and day
anything after reference date must be reported

158
Q

What is the case completeness goal for central registries?

A

95%

159
Q

Explain death clearance and when this occurse for whom

A

central regy at end of year
compares/links to their database those who died that year compared to those alive cancer pts in registry
info comes from mortality files from state dept of vital statistics

160
Q

What is an abstract?

A

Info on pt from dx to death

161
Q

What is the abstracting time frame?

A

pt initial contact with institution with a reportable dx to completion of abstract
based on date of 1st contact, not dx

162
Q

What is concurrent abstracting?

A

abstracting as information becomes available

163
Q

Who owns the RCRS - Rapid Cancer Reporting System?
what did it replace?

A

COC
Rapid Quality Reporting System

164
Q

Write the accession # for bx positive pt in January 2020 and was the 3rd case of the year

A

20200003

165
Q

What is the year in the accession #

A

year which pt was seen in the reporting facility

166
Q

When thinking of the accession #, if they come back years later for a new primary, what is done?

A

the same accession number is used for all additional primaries

167
Q

What is the sequence #?

A

identifies seperate primaries for each pt

168
Q

What happens to an accession # of pt where the found out it was actually not reportable?

A

delete it

169
Q

other than who it is reportable to, what dose class of case tell you?

A

identifies the interaction pf has with YOUR REPORTING facility

170
Q

1st course of tx is

A

tx given or PLANNED at time of intitial dx

171
Q

What is case administration

A

overide flags and identifies coding system used to abstract the case, version of coding manual used, reporting institution and CTR who coded

172
Q

Who provides and is the only one to receive text accompanying an abstract

A

central registry

173
Q

Cancer incidence definition

A

Number of new cancer cases occurring in a defined population in a defined period of time

174
Q

Incidence vs. prevalence

A

Incidence tells us how many new cases of cancer are being diagnosed.
Prevalence tells us how many people in total have cancer at a certain time.
Imagine a bucket filling with water:

Incidence measures how fast water is pouring into the bucket.
Prevalence measures how much water is already in the bucket at any given moment.

175
Q

What are the purposes of staging? (3)

A
  1. assess extent of cancer to effectively treat
  2. prognosis
  3. comparing institution data with national data
176
Q

Who owns Summary Stage?

A

NCI SEER

177
Q

What should registrar do if staging doesn’t match that of the managing physician?

A

consult with doctor to see if additional documentation exists

178
Q

What must doctor state to denote LNs are affected…
This applies to all cancers except what?

A

“involved” - not enlargement
lymphomas

179
Q

Endoscopic is what?

A

inserted into internal passages or hollow organs and viscera

180
Q

What are prognostic factors
Give examples of prognostics factors

A

tumor markers

diseases like HPV or Crohn’s
lab tests like CEA, CA19-9, CgA, LDH, Ki 67
genetic factors like HER2, KRAS, 18q loss (LOH)

181
Q

What does ER PR tell you

A

estimate potential response to endocrine (hormone) therapy
they are both steroid hormone receptors
determinates in prognosis
denotes whether cancer is growin in presence of either or both naturally occuring hormones

182
Q

CEA tumor marker is associated with what cancers (4)

A

colon, lung, breast, pancreas

183
Q

CA125 tumor marker is associated with what cancer

A

ovarian

184
Q

AFP tumor marker is associated with what cancers (2)

A

seminoma testicular cancer and some ovarian

185
Q

hCG hormone tumor marker is associated with what cancers (4)

A

germ cell tumors, breast, choriosarcoma, testicle

186
Q

Who developed the SOR (synoptic operative report)

A

Cancer Surgery Standards Program of ACoS

187
Q

Bypass surgeries create a passage around a tumor often for palliation. What does the ending prefix?

A

-otomy
gastrotomy, cystotomy, laparotomy, thoracotomy

188
Q

Difference between incision bx and excisional

A

incisional removes portion of tissue
excisional attempts to remove tumor

189
Q

___ takes prescedence over preliminary reports and frozen sections

A

final diagnosis

190
Q

___ takes prescedence over gross descriptions when determining involvement

A

microscopic

191
Q

another name fo rmultifocal tumors

A

multicentric

192
Q

thoracentesis vs paracentesis

A

thora = thoracic = lung / para is puncture in abdominal cavity to remove fluid

193
Q

Summary stage is most often used by _____ as it rarely changes of time / has longtitudinal stability

A

population based regys

194
Q

What is difference between stage group and prognostic stage group

A

Stage group = TNM, Prognostic stage group includes biomarkers, anatomy and other prognostic factors

195
Q

Extent of disease is this, not this and is used by who

A

coding system, not staging system
central registries and it uses algorithms to determine stage based on codes

196
Q

Ann Arbor system is for what and what did it become

A

staging Lymphomas
Ann Arbor > Lugano classification

197
Q

What is grade
What are the traditional categories before they varied by site

A

measure of aggressiveness of tumor & is prognostic factor
well diff, mod diff, poor diff, undiff/anaplastic

198
Q

Who developed grade coding tables and SSDIs

A

NAACCR

199
Q

What did SSDI used to be called and when were they established

A

2004, SSF site specific factors

200
Q

What are the 3 major forms of curative treatment?

A

surgery, radiation, systemic

201
Q

What 3 categories of systemic tx

A

chemo, hormone, immuno

202
Q

What is it called when you give multiple tx types at once

A

multimodality

203
Q

Who creates the standard tx guidelines

A

NCCN Natl Comprehensive Cancer Network

204
Q

Explain NOTES surgery

A

natural orifice transluminal endoscopic surgery
minimally invasive, through natural orifice using endoscopy

205
Q

Radiofrequency abalation (RFA) uses what

A

heat energy (heated with radiofrequency waves

206
Q

name a form of laser therapy

A

photodynamic therapy - photosenstitizing agent is injected, absorbed by cancer cells, 2 days late light ablates

207
Q

what is another name for endocrine surgery

A

surgical ablative therapy

208
Q

IMRT is a specialized form of what

A

3d conformal therapy

209
Q

stereotactic xrt is used for
name a type

A

brain lesions
gamma knife

210
Q

name the common type of partial breast intraCAVITARY radiation

A

mammosite

211
Q

most commonly used isotope for brach

A

I-131 - for thyroid

212
Q

What is isotope Phosphorus 32 (32P) given for (3)

A

polycythemia vera, malignant ascites, malignant pleural effusion

213
Q

Strontium 89 (89SR) isotope is deritive of calcium and collects in osteoblastic lesions. what is most used for?

A

bone mets

214
Q

INTRA chemo methods: loosely outline them
intravenous administration ***
intraperiotoneal
intra-arterial
intraventricular
intrathecal
intramuscular

A

intravenous administration *** most common - uses pump and chronic venous access
intraperiotoneal - b/t muscles and organs in abdomen
intra-arterial - aka chemoembolization - Gelfoam w/ chemo inserted into atery
intraventricular - circumvents blood brain barrier (into CNS) - given by lumbar puncture
intrathecal - circumvents blood brain barrier (into CNS) - given by lumbar puncture
intramuscular - into the muscle, such as Xeloda and Temodar or topical for Mycosis fung.

215
Q

3 BM transplant types

A

allogenic - donor cells from another person (matched relative)
syngeneic - type of allogenic, cells from identical twin
autologous - from own bone marrow

216
Q

Name 2 other systemic therapies that are coded as chemo

A

Imatinib aka Gleevec - targeted therapy for CML and GIST
Bortezomib aka Velcade - apoptosis inducing drug (not chemo)

217
Q

Endocrine therapy ANTIs - name a few
antiestrogen (3)
antiandrogen (4)
anticorticoids

A

antiestrogen - tamoxifan, arimidex & Aromotase Inhibitors like AG - breast and prostate
antiandrogen - Casodex, Flutamide, Lupron, Zoladex - prostate
anticorticoids - prednisone, Decadron - heme cases

218
Q

Thyroid tx Levothyroxine (Synthroid) and liothyronine (Cytomel) should be coded as what

A

hormonal tx when give after total thyroidectomy for papillary carcinoma

219
Q

Megestrol (Megace) is traditional used for ___ but also used for ___

A

breast hormonal agent, but also for appetite stimulant for all cancers

220
Q

Other names for immunotherapy

A

biological therapy or BRMs - biological response modifiers

221
Q

What does immunotherapy do

A

uses bodys immune system to fight cancer

222
Q

Name some BRMs/immunotherapies and what they treat

A

Rituxan - NHL
Herceptin - HER2+ breast cancer

223
Q

“mab” ending drugs are what?
what should they be coded to?

A

-monoclonal antibodies
-coded to immunotherapy

224
Q

Types of IMMUNOTHERAPIES
1. interferons (IFNS)
2. interleukins (ILs)
3. colony stimulating factors (CSFs)
4. tumor necrosis factor (not widely used) - X
5. cancer vaccines

A

1) IFN alpha leukemias, melanoma, AIDS related KS, kidney cancer
2) ILs - metastic kidney and metastatic melanoma
3) CSFs aka GROWTH FACTORS, encourages BM stem cells ex. erythropoietin
5) Gardasil

225
Q

Alternative therapies that are unproved should be coded as

A

unproven treatment

226
Q

What must be done with studies before they report cancer registry data to RESEARCHERS

A

IRB approval

227
Q

Name a few areas in which cancer registries overlap with clinical research departments

A

DATA DRIVEN
-data is used to form research projects
-QA studies
-QI implementation
-User defined fields
-AJCC stage
-Tumor markers
-Demographics

228
Q

What does the IRB do

A

group who reviews and monitors research involving HUMAN subjects

229
Q

Who protects the rights and welfare of human research subjects

A

IRB

230
Q

IRB reviews can be any of these 3 things depending on the level of risk to the patient

A

expedited, exempt, require full board review

231
Q

Who is a PI

A

Principal Investigator with IRB
They are in charge of a clinical investigation
Carries out the clinical trial protocol, analyzes the data and reports
**almost always a doctor

232
Q

Who carries out the IRB research protocols

A

research staff / team

233
Q

Research can be either interventional or non-interventiional. what is the difference

A

non-interventional means that pt does not receive a therapeutic intervention

234
Q

The ACoS Cancer Research Program (CRP) conducts SPECIAL STUDIES through CoC accredited programs. What do these studies do

A

evaluate patient care
set benchmarks
provide feedback for improving patient care

235
Q

clinical trial where ONLY the RESEARCHER doing the study knows which tx or intervention the particpant is receiving until trial is over

A

single blind study

236
Q

exploratory study often using only a few small doeses of a new drug in a few paties

A

phase 0 clinical trial

237
Q

study is done to find the highest dose of new tx that be given safely without serious side effects

A

phase 1 clinical trial

238
Q

if tx if found to be reasonably safe, it can now be tested for effectiveness in this trial

A

phase 2 clinical trial

239
Q

if tx works, researchers compare safety and effectiveness of new tx against current tx standards in this trial

A

phase 3 clinical trial

240
Q

this trial type looks at drugs already FDA approved - with important questions still needing to be answered

A

phase 4 clinical trial

ODS (2 decks)

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