AJCC-NCRA Education Needs Assessment Results

Transcription

1 AJCC-NCRA Education Needs Assessment Results Donna M. Gress, RHIT, CTR Survey Tool 1

2 Survey Development, Delivery, Analysis THANKS to NCRA for the following work Developed survey with input from partners Delivered survey with excellent participant response 1,157 hospital-focused 185 central-based Analysis of data Coordinated in-person facilitated meeting of experts Summary: key recommendations and important issues 3 Survey Content Demographics When CTR obtained Other credentials to compare A&P knowledge to CTR Abstracting timeframe to determine experience Central registry job duties related to staging Stage availability in medical record Pathologists: only based on specimen received, not complete Managing Physicians: clinical and pathologic What registrars record in abstract Data fields completed AJCC clinical AJCC pathologic Summary Stage Source of information 4 2

3 Survey Content Assess understanding of AJCC rules Two sets of five questions Staging rules Knowledge of rules Not synonymous with understanding and application Scenarios illustrating application of staging rules Knowledge of applying rules Consistent application or only recognize specific situations 5 Survey Content Assigning AJCC & Summary Stage for Case Studies Colon, Lung, Breast, Prostate, Bladder Basic cases, straight-forward Test entry level knowledge Assigning T, N, and M Assigning stage group Coding summary stage Learn to use AJCC manual Descriptions of anatomy and structures involved No laundry list of terms to match with medical record Do not use CS manual - defeats purpose of assessment 6 3

4 Survey Content Education and Training Rate their preference for various styles Interactive, ability for questions, focused materials In-person Live webinar Self-study with focused materials Archived webinar Online course YouTube Self-study with source materials Reading material & books 7 Survey Questions Sample Review 4

5 Survey Question Staging Rules What information is included in pathologic staging? A. Pathology report and operative report B. Pathology report C. Physical exam, imaging, and diagnostic workup D. Pathology report, operative report, physical exam, imaging, and diagnostic workup 9 Survey Results 10 5

6 Answer and Rationale Staging Rules 11 Survey Question Staging Rules If a patient has a biopsy of an enlarged neck node and a biopsy of the tongue during the workup for a tongue primary, what should be the staging basis for the N? A. Clinical B. Pathologic C. ypathologic D. yclinical 12 6

7 Survey Results 13 Answer and Rationale Staging Rules 14 7

8 Survey Question Case Study: Lung HISTORY Patient complained of being tired, loss of appetite with no weight loss. Sharp chest pain first noted three months prior to admission. Heavy smoker 2pk/day x 30 years, and a coal miner. PHYSICAL EXAMINATION Neck: No lymphadenopathy or masses palpable. IMAGING 7-5-CCXX 7-5-CCXX Chest x-ray: Mediastinal mass with no clearly demonstrated mass in either lung. There is a slight haziness in the left hilum area that is inconclusive for evaluation: suggest CT scan. CT chest: 2cm tumor LUL lung lobar bronchus, large left mediastinal mass. 15 Survey Question Case Study: Lung SURGICAL OBSERVATIONS 7-6-CCXX Left thoracotomy and biopsy of mediastinal lymph nodes Findings: Left upper lobe retracted and large, unresectable mass palpated beneath aortic arch; other masses noted in mediastinum. PATHOLOGY 7-6-CCXX Metastatic squamous cell carcinoma of one para-aortic lymph node and one subaortic lymph node. 16 8

9 Answer Choices Clinical T T1 - Tumor 3 cm or less in greatest dimension, surrounded by lung or visceral pleura, without bronchoscopic evidence of invasion more proximal than the lobar bronchus (i.e., not in the main bronchus) * T1a - Tumor 2 cm or less in greatest dimension T1b - Tumor more than 2 cm but 3 cm or less in greatest dimension T2 - Tumor more than 3 cm but 7 cm or less or tumor with any of the following features (T2 tumors with these features are classified T2a if 5 cm or less); Involves main bronchus, 2 cm or more distal to the carina; Invades visceral pleura (PL1 or PL2); Associated with atelectasis or obstructive pneumonitis that extends to hilar region but does not involve the entire lung T2a - Tumor more than 3 cm but 5 cm or less in greatest dimension T2b - Tumor more than 5 cm but 7 cm or less in greatest dimension 17 Answer Choices Clinical T T3 - Tumor more than 7 cm or one that directly invades any of the following: parietal pleural (PL3), chest wall (including superior sulcus tumors), diaphragm, phrenic nerve, mediastinal pleura, parietal pericardium; or tumor in the main bronchus (less than 2 cm distal to the carina * but without involvement of the carina; or associated atelectasis or obstructive pneumonitis of the entire lung or separate tumor nodule(s) in the same lobe T4 - Tumor of any size that invades any of the following: mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, esophagus, vertebral body, carina, separate tumor nodule(s) in a different ipsilateral lobe 18 9

10 Survey Results 19 Answer and Rationale Clinical T 20 10

11 Answer Choices Clinical N N1 - Metastasis in ipsilateral peribronchial and/or ipsilateral hilar lymph nodes and intrapulmonary nodes, including involvement by direct extension N2 - Metastasis in ipsilateral mediastinal and/or subcarinal lymph node(s) N3 - Metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s) 21 Survey Results 22 11

12 Answer and Rationale Clinical N 23 Answer Choices Clinical M M0 - No distant metastasis M1 - Distant metastasis M1a - Separate tumor nodule(s) in a contralateral lobe tumor with pleural nodules or malignant pleural (or pericardial) effusion M1b - Distant metastasis (in extrathoracic organs) 24 12

13 Survey Results 25 Answer and Rationale Clinical M 26 13

14 Answer Choices Pathologic T, N, M Assign pathologic classification for T, N, and M categories Same choices as previously shown 27 Survey Results 28 14

15 Answer and Rationale Pathologic T, N, M 29 Answer Choices Summary Stage Localized Confined to carina Confined to hilus of lung Confined to the main stem bronchus >2.0 cm from carina Confined to the main stem bronchus, NOS Extension from other parts of lung to main stem bronchus >2.0 cm from carina Extension from other parts of the lung to main stem bronchus, NOS Single tumor confined to one lung 30 15

16 Answer Choices Summary Stage Regional by direct extension only Atelectasis/obstructive pneumonitis Extension to: Blood vessel(s) (major) Brachial plexus from superior sulcus Carina from lung Chest (thoracic) wall Diaphragm Esophagus Main stem bronchus <2.0 cm from carina Mediastinum, extrapulmonary or NOS Nerve(s) Pancoast tumor (superior sulcus syndrome) Parietal (mediastinal) pleura Parietal pericardium Pulmonary ligament Trachea Visceral pleura Multiple masses/separate tumor nodule(s) in SAME lobe Multiple masses/separate tumor nodule(s) in main stem bronchus 31 Tumor Copyright 2013 of AJCC main All Rights Reserved stem bronchus <2.0 cm from carina Answer Choices Summary Stage Regional IPSILATERAL regional lymph node(s) involved only Aortic: Peri/para-aortic, Subaortic (aortico-pulmonary window) Bronchial Carinal (tracheobronchial) (tracheal bifurcation) Hilar (bronchopulmonary) (proximal lobar) (pulmonary root) Intrapulmonary: Interlobar, Lobar, Segmental, Subsegmental Mediastinal: Anterior, Posterior (tracheoesophageal) Pericardial Peri/parabronchial Peri/paraesophageal Peri/paratracheal: Azygos (lower peritracheal) Pre- and retrotracheal: Precarinal Pulmonary ligament Subcarinal 32 16

17 Answer Choices Summary Stage Regional BOTH direct extension AND ipsilateral regional lymph node(s) 7 Distant site(s)/node(s) involved Distant lymph node(s): Cervical, NOS Contralateral/bilateral hilar (bronchopulmonary) (proximal lobar) (pulmonary root) Contralateral/bilateral mediastinal Scalene (inferior deep cervical), ipsilateral or contralateral Supraclavicular (transverse cervical), ipsilateral or contralateral Extension to: Abdominal organs Adjacent rib Contralateral lung or Contralateral main stem bronchus Heart Pericardial effusion (malignant or NOS) Pleural effusion (malignant or NOS) Skeletal muscle, Skin of chest, Sternum Vertebra(e) Visceral pericardium Separate tumor nodule(s) in different lobe Separate tumor nodule(s) in contralateral lung 9 Unknown if extension or metastasis 33 Survey Results 34 17

18 Answer and Rationale Summary Stage Next Steps 18

19 AJCC Plans Develop training modules Classification: c, p, yp Categories: T, N, M, and additional ones Stage groups Different levels of training Introductory Intermediate Advanced Delivering in variety of methods Self-assessments, quizzes 37 AJCC Training Needs Changes in AJCC rules over time Keep pace with medical practice New diagnostic techniques 38 19

20 AJCC Training Needs CS rules do not apply to AJCC Underlying principles are similar Detailed rules are not the same 39 AJCC Training Needs CS rules do not apply to AJCC AJCC Clinical and pathologic based on Different points in time Specific criteria Not exactly same as CS eval codes 40 20

21 AJCC Training Needs AJCC is the rootstock CS is EOD & Summary Stage grafted onto the AJCC rootstock 41 AJCC Training Needs Different levels of training based on Experience Job duties 42 21

22 AJCC Training Needs Survey results showed Everyone needs training Including experienced registrars 43 Partnership and Responsibility Registrars Update Skills AJCC Education Tools 44 22

23 Thank you Donna M. Gress, RHIT, CTR AJCC Technical Specialist p: f: N. Saint Clair, Chicago, IL cancerstaging.org 23