Lesson 1: Case Eligibility

Question 1

Casefinding / case ascertainment

Answer 1

the systematic method of identifying all eligible cases that are to be included in the cancer registry database

Question 2

case

Answer 2

the occurrence of a separate, independent diagnosis of cancer

Question 3

If a patient has a case of cancer in the cancer registry database, and if the casefinding process identifies another case of cancer for that same patient, then…

Answer 3

→ a separate abstract must be prepared for that case

(That patient will then have two cases in the database)

Question 4

Who is required to participate in casefinding?

Answer 4

All cancer registries and facilities that report cancer cases, including hospital and central registries

*Depending on the type of registry, the cases that must be reported and the available casefinding sources can vary

Question 5

Casefinding resources

Answer 5

should encompass all departments within the facility where a cancer patient may have received services

Question 6

CoC specifies that the registry should utilize multiple key resources for casefinding:

Answer 6

• core sources will identify most eligible cases
• No single source will identify all potential cases for the registry (Hence, the necessity to use multiple sources to ensure thorough and complete casefinding)
• Includes → the Health Information Management (HIM) disease indices, pathology reports, and medical/radiation oncology logs if these are kept

Question 7

CoC eligibility requirement for reporting cases

Answer 7

• apply to all registries in CoC accredited cancer programs
• ​states that all cases diagnosed and/or initially treated at the facility be included in the database – The patient may be seen in any part of the facility operating under the facility’s license, inpatient or outpatient
• requires that all cases, either pathologically diagnosed or clinically diagnosed, be included
• Criteria that make a case reportable comprise many different factors, including → histology, primary site, the reason the patient was seen by the facility, when the cancer was diagnosed
• Any one of these factors that does not meet the eligibility requirements may make the case not reportable (Ex: The patient may have a reportable histology but was seen at the facility for an unrelated reason)
• Eligibility requirements are specified in the STORE Manual

Question 7

pathologically diagnosed

Answer 7

it was determined to be cancer through a pathology specimen review (histology or cytology)

Question 8

clinically diagnosed

Answer 8

it was determined to be cancer by a physician based on clinical findings
(which can include physical examination, symptoms, radiology/imaging, laboratory findings, or a combination of any of these)

** Clinically diagnosed cases are often missed because there is no pathology report – Careful review of the disease index and the medical record is required to identify these cases and to be sure they are not missed

Question 9

When abstracting a clinically diagnosed case…

Answer 9

• You are abstracting the case based on a physician’s statement in the medical record
• Statements should be coded in the discharge diagnoses

Question 10

Once a case is determined to be eligible for inclusion into the database, the CoC requires that the case be:

Answer 10

• Accessioned
• Abstracted
• Followed

Question 11

Accessioned

Answer 11

assigning the patient a unique number

Question 12

Abstracted

Answer 12

completing all of the required data items for that cancer

Question 13

Followed

Answer 13

keeping the abstract up-to-date with the current disease status, vital status and last date of contact

Question 14

histology

Answer 14

the type of cancer

** includes carcinoma, melanoma, sarcoma, lymphoma, and leukemia

Question 15

To report histology…

Answer 15

The appropriate histology code for each case is determined by looking up the histologic term in the ICD-O-3 manual

(Each reportable histologic term is given a code)

Question 16

All malignancies for all sites of the body with an ICD-O-3 behavior code of 2 or 3 are…

Answer 16

required to be included in the registry database

Question 17

Structure of the codes in the ICD-O-3 manual:

the first four digits of the code represent…

Answer 17

the cell type

(followed by a / )

Question 18

Structure of the codes in the ICD-O-3 manual:

the fifth digit of the code represents…

Answer 18

the behavior code

Question 19

The _____ code is one of the major criteria in determining if a case is reportable

Answer 19

behavior

Question 20

The only way to know the behavior code for a particular histologic term is to…

Answer 20

look up the term in the ICD-O-3 manual

** The best place to start looking up histologic terms in the ICD-O-3 manual is the alphabetic index. In this index, topography and morphology terms are listed in alphabetical order

Question 21

ICD-O-3 behavior codes of /6 and /9 are…

Answer 21

• never to be used by the hospital cancer registry
• reserved for use by CCRs only

Question 22

ICD-O-3 behavior code(s) that mean the case is reportable and must be abstracted

Answer 22

/2 or /3

Question 23

ICD-O-3 behavior code /1

Answer 23

uncertain behavior, uncertain if benign or malignant, is usually not a reportable diagnosis

Question 24

When reviewing the medical record to determine if a case is reportable, what basic questions about the cancer should you ask yourself

Answer 24

1. Does the case meet: a. CoC requirements and/or b. The state's central cancer registry requirements and/or c. The facility requirements? 2. What is the histology? 3. What is the primary site? 4. Is it an exception to the general case eligibility rules? 5. How was the patient diagnosed? 6. Why was the patient seen at my facility? 7. When was the cancer diagnosed? 8. Does the patient have more than one primary?

Question 25

ambiguous diagnostic terms that constitute a diagnosis (diagnostic)

Answer 25

- The CoC has developed a list of ambiguous diagnostic terms that they believe signifies that the patient does have cancer. - These terms constitute a diagnosis that is just as valid as one without the ambiguous terms. - The STORE Manual provides a list of terms that must be interpreted as a diagnosis of cancer. - Cases using these terms to describe the cancer must be reported.

Question 26

list - ambiguous terms that constitute a diagnosis (diagnostic):

Answer 26

- Apparent(ly) - Appears - Comparable with - Compatible with - Consistent with - Favors - Malignant appearing - Most likely - Neoplasm* - Presumed - Probable - Suspect(ed) - Suspicious (for) - Tumor* - Typical of * Additional terms for nonmalignant primary intracranial and central nervous system tumors only

Question 27

ambiguous diagnostic terms that do NOT constitute a diagnosis (non-diagnostic)

Answer 27

- Registries are provided with a list of ambiguous diagnostic terms that the CoC believes do NOT signify that the patient has cancer - These terms do not constitute a diagnosis of cancer - These cases are not to be included in the registry database, unless there are other statements elsewhere in the medical record meeting the criteria for inclusion - The STORE Manual provides a list of the terms that must not be interpreted as cancer. Cases using these terms to describe the cancer are not to be reported

Question 28

list - ambiguous terms that do NOT constitute a diagnosis (non-diagnostic):

Answer 28

- Cannot be ruled out - Equivocal - Possible - Potentially malignant - Questionable - Rule out - Suggests - Worrisome

Question 29

If an ambiguous term is not included on either list, then consider it as a...

Answer 29

‘do not include’ term

Question 30

The _____ Manual provides a list of the ambiguous terms that must NOT be interpreted as cancer, and a list of ambiguous terms that must be interpreted as a diagnosis of cancer

Answer 30

STORE

Question 31

Cases using _____ terms to describe the cancer are not to be reported

Answer 31

Non-Diagnostic

Question 32

Cases using _____ terms to describe the cancer must be reported

Answer 32

Diagnostic

Question 33

Reference Date

Answer 33

the effective date on which cancer registration began for the facility All reportable cases diagnosed on or after the registry’s reference date must be included. Based on the diagnosis date of the cancer, or on the date of first contact. ** It is NOT the date the registry was organized, or the date work actually began in the registry.

Question 34

The day and month for the reference date is always ______, however the year will vary depending on the registry.

Answer 34

January 1 ** Both hospital and central cancer registries define a reference date as January 1 of a given year.

Question 35

Multiple Primaries

Answer 35

The rules for determining multiple primaries include the following factors: - Site differences - Histology differences - Date of diagnosis (timing between diagnoses) - Laterality The multiple primary rules should be reviewed carefully before determining if the patient has one or more than one independent primary cancer -- Whether there will be one or more abstracts required depends on this determination.

Question 36

True or False? An abstract must be prepared for each independent primary cancer.

Answer 36

True

Question 37

An independent primary cancer

Answer 37

it is a new cancer for that patient and has no connection to the previously diagnosed cancer

Question 38

Non-analytic cases

Answer 38

Cases in which the reporting facility did not participate in either initially diagnosing the cancer or delivering any of the first course of treatment - Non-analytic cases are not included in analyses or reports on patient treatment, outcomes, or survival. - Non-analytic cases include some cases in which the patient actually received care at the facility, as well as cases where the patient did not physically appear at the facility.

Question 39

Non-analytic class of case categories include codes ____ and code ___

Answer 39

30-49; 99

Question 40

There are certain types of cases that are not required by the CoC. Some or all of these may still need to be included for reporting to the central cancer registry or other entity. What type of cases are these called?

Answer 40

Non-analytic cases

Question 41

Some of the other types of cases required by some central cancer registries are:

Answer 41

- Non-analytic cases - VIN II-III, VAIN II-III, AIN II-III - Patients with active cancer, even if not seen at the facility for a diagnosis or cancer treatment

Question 42

Reportable by agreement

Answer 42

- Reportable by agreement does not mean that the reporting is optional - means that even if a case is not required by the CoC, the CCR (which will include SEER and/or NPCR requirements) may still require you to include the case in your database.