Cancer Liaison Physicians Cancer Registry Professionals Partners in Cancer Control

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Cancer Liaison PhysiciansCancer Registry
ProfessionalsPartners in Cancer Control

• Commission on Cancer
• February 13, 2007

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Introductions

• Phillip Y. Roland, MD FACS FACOGFlorida State
  Chairman CoCCancer Liaison Physician
• Roxanne Kelley, CCS, CTRCancer Registry
  CoordinatorRogue Valley Medical Center
• Kate Phair, MPHCancer Liaison Program
  AdministratorAmerican College of Surgeons,
  Commission on Cancer

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Goals

• Roles of Cancer Liaison Physicians (CLPs) and
  Cancer Registry Professionals
• Commission on Cancer Mission
• Challenges Shared by CLPs and Registrars
• Examples of CLP and Registrar Collaboration

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Commission on Cancer Mission

• The CoC is a consortium of professional
  organizations dedicated to improving survival and
  quality of life for cancer patients through
  standard-setting, prevention, research,
  education, and the monitoring of comprehensive
  quality care.

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Commission on Cancer

• Established in 1922
• Standing committee of the ACoS
• 100 members, 40 organizations
• Multidisciplinary
• Surgeons
• Non-surgeons
• Medical personnel
• CoC receives some financial support from the
  American Cancer Society

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Cancer Programs in United States Hospitals
Treated elsewhere
Hospitals w/ approval
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80
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Dx and treated in approved programs
Hospitals w/o approval
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CoC Cancer Liaison Program

• A grassroots network of physician volunteers
  willing to manage clinically-related cancer
  activities in their local facilities and
  surrounding communities.

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Program Membership

• 65 State chairs
• Selected by College Chapters
• Surgeons
• 1,600 physician volunteers
• Selected by Cancer Committee
• 55 surgeons 45 other specialties
• Program funded by American Cancer Society

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Liaison Key Activities

• Serve as the Physician Champion within the cancer
  program.
• Serve as the liaison between the CoC and the
  cancer program.
• Serve as an agent of change within the community.
  

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Physician Champion within the Cancer Program

• Promote CoC Approval
• Serve on the facility cancer committee
• Advocate for the cancer registry
• Ensure accurate physician staging
• Support compliance with guidelines
• Promote participation in clinical trials
• 60 of CLPs enroll patients in clinical trials

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Liaison between the CoC and the Cancer Program

• Regularly report to the cancer committee
• Review and act on CP3Rs
• Support participation in FIPS
• Ensure quality submission of NCDB data
• Play a role in the CoC survey

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Cancer Registry Professionals Roles and
Responsibilities

• Cancer Program Management
• Cancer Committee Member
• Provide benchmarks for quality comparison
• Data Analysis for Studies
• Compiling Cancer Program Annual Report
• Assess referral patterns
• Participate in cancer prevention
• Present information to cancer committee,
  physicians, administration

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National Cancer Registrars Association

• Premier Education, Credentialing Advocacy
  Resource
• Cancer Registry Professionals
• Certified Tumor Registrars
• 7,280 registrar workforce
• 800 additional registrars will be needed in
  future
• Limited job and applicant pool

Improving Lives Through Quality Data Management
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Certified Tumor Registrar

• Establishing a standard of knowledge and
  experience required for professional registry
  practice.
• CTR Application Requirements
• One of more years registry experience
• Specialty training
• examination

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Cancer Registry Professionals--Time Commitment
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NCRA 2005
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The Tumor Board and Cancer Registry Staff

• Cancer Conference / Tumor Board
• Major time commitment
• Identify cases, pathology, x-rays, CMEs
• Cancer Liaison Physicians
• Recruit enthusiastic pathologists, radiologists
  to participate
• Relieve burden from Cancer Registry Staff

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Overview of Cancer Databases

• State Cancer Registries
• SEER
• National Cancer Database

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State Cancer Registries

• Cancer Incidence
• Treatment / Follow-up
• Identify cancer trends, patterns, and variation
• directing cancer control efforts
• conducting research
• public health policy-making
• Assesses suspected cancer clusters / hazards in
  local communities

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State Cancer Registries

• hospital cancer registries
• ambulatory surgical centers
• physician offices
• vital statistics
• pathology laboratories
• hospital medical record departments
• death certificates

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Surveillance, Epidemiology, and End Results
Program (SEER)

• Program of the National Cancer Institute
• Cancer Incidence and Survival Data
• Abstracted from population based cancer
  registries representing approximately 26 of the
  U.S. population

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SEER Data Collection Sites
http//seer.cancer.gov/about/SEER_brochure.pdf
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SEER Goals

• Report on U.S. cancer burden as it relates to
  incidence, mortality, and survival
• Describe changes over time in cancer incidence
  mortality
• Identify changes unusual patterns of cancer
  occurrence, and possible iatrogenic cancers

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National Cancer Database

• Facility-based, oncology data set that captures
  75 of all new cancer cases in the U.S. every
  year
• 15 million cases between 1985 and 2002
• Prospective, including information on first
  course of treatment, recurrence, and survival
• Interactive, web-based tools

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Distribution of CoC Approved Programs by State
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Cancer Programs Standards

• Model for organizing managing cancer program
• Self-assessment based on recognized standards
• Ability to meet demands for oncology data by
  health care providers, public, third-party
  payers, and managed care organizations

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Collaborative Efforts
Cancer Registry Professionals
Cancer Liaison Physicians

• Commission on Cancer Standards
• NCDB Data Tools

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CLP CTR Collaboration

• Data Reporting
• Staging
• Cancer Committee
• Quality Improvement
• American Cancer Society Collaboration

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Data Reporting

• Standard 3.6
• Complete data for all analytic cases are
  submitted to the National Cancer Database (NCDB)
  in accordance with the annual call for data.
• Standard 3.7
• Annually, cases submitted to the NCDB for the
  most recent accession year meet the established
  quality criteria and resubmission deadline
  specified in the annual call for data.

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Annual Call for Data

• Cancer Registry obtains software update from your
  hospitals database software vendor
• Submit data from hospital cancer database to NCDB
• Requires your hospitals IT department priority
  for installation and maintanence
• CLP assistance ? prompt IT attention

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Annual Call for Data

• Cancer Registrar will run data reports
• edits problems with data that require
  attention / correction
• Run additional reports until edits resolved
• Cancer Liaison Physicians
• Registry staff able to meet deadlines
• Appeal to administration for additional registry
  staffing, as needed

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CLP CTR Collaboration

• Data Reporting
• Staging
• Cancer Committee
• Quality Improvement
• American Cancer Society Collaboration

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Standard 4.3 Staging

• Staging is assigned by the managing physicians,
  or other approved medical professional, and is
  recorded in a standardized location in the
  medical record for 90 of eligible analytic cases.

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Standard 4.3 Staging

• Your Cancer Committee develops and documents a
  Staging Policy and Procedure
• Definition of managing physician who participates
  in staging
• Designated locations for staging to appear in the
  medical record
• Quality control of completeness and accuracy
• Process to resolved staging differences

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Standard 4.3 Staging

• Staging System
• American Joint Committee on Cancer
• AJCC Cancer Staging Manual
• T N M staging
• Standard 4.3 Requires both
• TNM, and
• Group Stage

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Standard 4.3 Staging

• Standardized location(s) for staging to be
  recorded in the medical record
• Determined by your Cancer Committee
• AJCC Staging forms highly recommended
• Documented in staging policy and procedure

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Standard 4.3 Staging

• Standardized location(s) for staging to be
  recorded in the medical record
• Determined by your Cancer Committee
• AJCC Staging forms highly recommended
• Documented in staging policy and procedure

-AJCC Staging Form -Discharge Summary -Pathology
Report -Consultation Report -Medical Record Face
Sheet ? Must Be Signed
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Standard 4.3 Staging

• Staging is assigned by the managing physicians,
  or other approved medical professional, and is
  recorded in a standardized location in the
  medical record for 90 of eligible analytic cases.

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Standard 4.3 Staging

• Staging is assigned by the managing physicians,
  or other approved medical professional, and is
  recorded in a standardized location in the
  medical record for 90 of eligible analytic cases.

Defined by Cancer Comm. -One or more
MDs -Fellows -Physician Assistants -Nurse
Practitioners -Residents
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Standard 4.3 Staging

• Staging is assigned by the managing physicians,
  or other approved medical professional, and is
  recorded in a standardized location in the
  medical record for 90 of eligible analytic cases.

The following may not assign TNM Group
Stage -Pathologist -Cancer Registrars -Medical
Students
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Staging Systems

• AJCC (TNM) Assigned by Treating MD
• Collaborative Staging
• Basis for Data Entry by Cancer Registrar
• Formed in 1998 as a translation between the AJCC
  TNM staging system and the SEER Extent of Disease
  (EOD) / Summary Staging System
• Eliminate duplicate data collection by cancer
  reporting to clinical (facility-based) and
  epidemiologic (central) registries.

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Collaborative Staging

• Tumor Size
• Tumor Extension
• Regional lymph node involvement
• Number of involved lymph nodes
• Metastasis at diagnosis
• Tumor type specific factors

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CLP CTR Collaboration

• Data Reporting
• Staging
• Cancer Committee
• Quality Improvement
• American Cancer Society Collaboration

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Cancer Committee Leadership
Cancer Committee Chairperson
Agenda
Cancer Registrar
Program Director
Cancer Liaison Physician
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NCDB Hospital Comparison Reports

• Use upcoming cancer related events (local /
  national) as an opportunity to review your
  hospitals data with the cancer committee
• Cancer Awareness Months can be helpful in
  planning agenda

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National Health Observances Calendar

• January
• Cervix Health
• Thyroid Health
• March
• Colorectal Cancer
• May
• Melanoma / Skin Cancer
• Clean Air Month
• June
• National Cancer Survivors Day
• September
• Childhood Cancer Month
• Leukemia and Lymphoma Awareness
• Ovarian Cancer / Gynecologic Cancer

• October
• Breast Cancer Awareness
• November
• Lung Cancer
• Pancreatic Cancer
• Great American Smoke-out

http//www.healthfinder.gov/library/nho/nho.asp
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Hospital X
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Hospital X
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CLP CTR Collaboration

• Data Reporting
• Staging
• Cancer Committee
• Quality Improvement
• American Cancer Society Collaboration

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Use NCDB Data to Drive Quality at Your
Cancer Program
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Standards 8.1 and 8.2

• 8.1 ? Each year the cancer committee completes
  and documents studies that measure quality and
  outcome
• 8.2 ? Annually, the cancer committee implements
  two improvements that directly affect cancer care.

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Standards 8.1 and 8.2

• 8.1 ? Each year the cancer committee completes
  and documents studies that measure quality and
  outcome
• 8.2 ? Annually, the cancer committee implements
  two improvements that directly affect cancer care.

Studies may focus on structure, process, or
outcome. Examples -Chemotherapy clinic wait
times staffing -Use of Chemo in Stage III
Colorectal Ca -Use of AJCC Stage in determine
treatment -Disease recurrence of survival
rates -Success of pain management protocols
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Standards 8.1 and 8.2

• 8.1 ? Each year the cancer committee completes
  and documents studies that measure quality and
  outcome
• 8.2 ? Annually, the cancer committee implements
  two improvements that directly affect cancer care.

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Standards 8.1 and 8.2

• 8.1 ? Each year the cancer committee completes
  and documents studies that measure quality and
  outcome
• 8.2 ? Annually, the cancer committee implements
  two improvements that directly affect cancer care.

Actions Taken, Processes Implemented, or
Services Created, To Improve Patient Care
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Cancer Program Practice Profile Report (CP3R)

• Pilot study Stage III Colon cancer Receipt of
  chemotherapy
• CoC receives data from hospitals
• NCDB staff analyzes data and feeds back to the
  individual hospitals
• The aim is to achieve adherence to the quality
  indicator by data feedback

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E-QuIP

• Aims
• Feedback data to individual hospitals to
• Improve quality of data
• Improve quality of clinical care
• Provide educational opportunities

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Benefits of e-QuIP

• Unique opportunity to prepare for P4P measures
  from payor community
• Emphasizes the importance of the entire cancer
  programs role in the survey process
• Highlights collaborative, multidisciplinary
  efforts
• Moves responsibility beyond registry staff
• Links all departments of the cancer program

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Multidisciplinary Approach to Effectively Utilize
the e-QuIP
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Any breakdown ultimately affects
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User clicks on any of the underlined numbers to
access case information. Estimated Performance
Rate Concordance displayed for the 2003-2004
cases Column Counts Number of cases meeting
denominator criteria Column counts and
percentages WILL NOT sum to total (or 100) due
to case eligibility for multiple measures
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BRT Records
directions
measure
Sample BRT screen showing complete records and
records with incomplete Rx info. To edit, user
clicks on the blue edit link.
Cases complete and concordant with the standard
of care
Cases requiring review/update due to
questionable/incomplete treatment information
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edit
Tumor identification
Rx info
Clicking the edit button will display a set of
editable fields. This particular case
is concordant with the BRT measure, but fails the
HT measure, upon examination. A case must be
complete for both measures for it to be removed
from the red zone and move into the complete
green zone.
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The change was accepted and the record was
updated immediately. It appears in ascending
order, so the user can easily locate the case by
looking at the last update date and the
accession number. Also, due to this modification,
the estimated performance percentages on the
initial screen are also immediately updated (
instant gratification).
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What can be done with this information?

• Resubmit improved data
• Awareness to the importance of charting and
  coding accuracy
• Use data to improve quality of care
• Clinical management and coordination of patient
  care in multidisciplinary setting
• Initiate quality improvement projects
• Initiate educational programs

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Cancer Liaison Physician Role

• Take a lead role in disseminating information
  related to standard of care guidelines and
  facilitys data.
• Identify areas for improvement related to
  laboratory results and physician documentation.
• Work with the cancer registry to review data
  appearing on the online e-QuIP.

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National Cancer Data Base National Efforts

• CoC/NCDB submitted measures to the National
  Quality Forum (NQF) for endorsement are under
  final review

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CLP CTR Collaboration

• Data Reporting
• Staging
• Cancer Committee
• Quality Improvement
• American Cancer Society Collaboration

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Facility Information Profile System (FIPS)

• Data sharing activity with the ACS
• National Call Center 1-800-ACS-2345
• ACS Web site (www.cancer.org)
• Level I Data
• Information on facility resources and services
• Automatically shared with ACS
• Level II Data
• Cancer caseload as submitted to NCDB
• Voluntarily shared with ACS upon facility release

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CoC Hospital Locator
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CoC Hospital Locator
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CLP CTR Collaboration

• Data Reporting
• Staging
• Cancer Committee
• Quality Improvement
• American Cancer Society Collaboration

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Cancer Liaison PhysiciansCancer Registry
ProfessionalsPartners in Cancer Control

• Commission on Cancer
• February 13, 2007