APPENDIX D: ASCR REQUIRED DATA ELEMENTS (Version 13)

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1 APPENDIX D: ASCR REQUIRED DATA ELEMENTS (Version 13) New Required Item by ASCR R - Required Fields, S - Supplemental Fields, * - When available CR Only - only need for Central Registry Data NPCR Collect Data Item Name Item Default Value Recommendation Code Number Record Type 10 R A CR Patient ID Number 20 R (Central Registry) Patient System ID-Hosp 21. Registry Type 30. FIN Coding System 35. Reserved Registry ID 40 R NPI--Registry ID 45. NAACCR Record Version 50 R Tumor Record Number 60. Addr at DX--City 70 R Addr at DX--State 80 R County at DX 90 R Addr at DX--Postal Code 100 R New Addr at DX--Country 102 R USA Census Tract 1970/80/ RH* Census Cod Sys 1970/80/ RH* Census Tract R CR Census Tract R Census Tract Cod Sys--Alt 140 CR (new) Census Tr Poverty Indictr 145 Marital Status at DX 150. Race R Race R Race R Race R Race R Race Coding Sys--Current 170. Race Coding Sys--Original 180. Spanish/Hispanic Origin 190 R NHIA Derived Hisp Origin 191 D CR IHS Link 192 R* Page 32

2 Race--NAPIIA(derived API) 193 R Computed Ethnicity 200 R Computed Ethnicity Source 210 R Sex 220 R Age at Diagnosis 230 R Date of Birth 240 R Date of Birth Flag 241 R Birthplace 250 RH New Birthplace--State 252 R* New Birthplace--Country 254 R* USA Religion 260 Census Occ Code R* CR (New) Census Ind Code Census Ind Code R* CR (New) Census Occ Code Occupation Source 290 R* Industry Source 300 R* Text--Usual Occupation 310 R* Text--Usual Industry 320 R* Census Occ/Ind Sys R* Tobacco History 340 Alcohol History 350 Family History of Cancer 360 CR Census Block Group CR Census Block Group Census Tr Cert 1970/80/ RH* CR Census Tr Certainty R CR GIS Coordinate Quality 366 R* CR Census Tr Certainty R CR Census Block Grp Reserved Sequence Number--Central 380 R Date of Diagnosis 390 R Date of Diagnosis Flag 391 R Primary Site 400 R Laterality 410 R Morph Type &Behav ICD-O Histology (92-00) ICD-O RH Behavior (92-00) ICD-O RH Page 33

3 Date of Mult Tumors Flag 439. Grade 440 R Grade Path Value 441 R* Ambiguous Terminology DX 442. Date Conclusive DX 443 R* Mult Tum Rpt as One Prim 444. Date of Mult Tumors 445 R* Multiplicity Counter 446. Number of Tumors/Hist 447 Date Conclusive DX Flag 448. Grade Path System 449 R* Site Coding Sys--Current 450 R 5 Site Coding Sys--Original 460. Morph Coding Sys--Current 470 R 8 Morph Coding Sys--Originl 480. Diagnostic Confirmation 490 R Type of Reporting Source 500 R Casefinding Source 501 R Screening Date 510 Screening Result 520 Morph--Type&Behav ICD-O Histologic Type ICD-O R Behavior Code ICD-O R Reserved Reporting Hospital FAN 538 Reporting Facility 540 R NPI--Reporting Facility 545 R* Accession Number--Hosp 550. Sequence Number--Hospital 560. Abstracted By 570. Date of 1st Contact 580 R Date of 1st Contact Flag 581 R Date of Inpt Adm 590. Date of Inpt Adm Flag 591. Date of Inpt Disch 600. Date of Inpt Disch Flag 601. Inpatient Status 605. Class of Case 610 R Year First Seen This CA 620 Page 34

4 Primary Payer at DX 630 R* Inpatient/Outpt Status 640 Presentation at CA Conf 650 Date of CA Conference 660 RX Hosp--ASA Class 665. RX Hosp--Surg App RX Hosp--Surg Prim Site 670. RX Hosp--Scope Reg LN Sur 672. RX Hosp--Surg Oth Reg/Dis 674. RX Hosp--Reg LN Removed 676. RX Hosp--Surg Timing 678. Reserved RX Hosp--Radiation 690. RX Hosp--Chemo 700. RX Hosp--Hormone 710. RX Hosp--BRM 720. RX Hosp--Other 730. RX Hosp--DX/Stg Proc 740. RX Hosp--Screen/BX Proc1 742 RX Hosp--Screen/BX Proc2 743 RX Hosp--Screen/BX Proc3 744 RX Hosp--Screen/BX Proc4 745 RX Hosp--Surg Site RX Hosp--Scope Reg RX Hosp--Surg Oth Reserved SEER Summary Stage R+ SEER Summary Stage RH Loc/Reg/Distant Stage 770 Extent of Disease 10-Dig 779. EOD--Tumor Size 780. EOD--Extension 790. EOD--Extension Prost Path 800. EOD--Lymph Node Involv 810. Regional Nodes Positive 820 R Regional Nodes Examined 830 R EOD--Old 13 Digit 840. EOD--Old 2 Digit 850. EOD--Old 4 Digit 860. Page 35

5 Coding System for EOD TNM Path T 880. TNM Path N 890. TNM Path M 900. TNM Path Stage Group 910. TNM Path Descriptor 920. TNM Path Staged By 930. TNM Clin T 940. TNM Clin N 950. TNM Clin M 960. TNM Clin Stage Group 970. TNM Clin Descriptor 980. TNM Clin Staged By 990. TNM Other T 1000 TNM Other N 1010 TNM Other M 1020 TNM Other Stage Group 1030 TNM Other Staged By 1040 TNM Other Descriptor 1050 TNM Edition Number Other Staging System 1070 Date of 1st Positive BX 1080 Site of Distant Met Site of Distant Met Site of Distant Met Pediatric Stage Pediatric Staging System Pediatric Staged By Tumor Marker Tumor Marker Tumor Marker Reserved Lymph-vascular Invasion 1182 RS Reserved RX Date Surgery 1200 R RX Date Surgery Flag 1201 R RX Date Radiation 1210 RS RX Date Radiation Flag 1211 RS RX Date Chemo 1220 RS Page 36

6 RX Date Chemo Flag 1221 RS RX Date Hormone 1230 RS RX Date Hormone Flag 1231 RS RX Date BRM 1240 RS RX Date BRM Flag 1241 RS RX Date Other 1250 RS RX Date Other Flag 1251 RS Date of Initial RX SEER 1260 R# Date of Initial RX SEER Flag 1261 R# Date of 1st Crs RX CoC 1270 R# Date of 1st Crs Rx CoC Flag 1271 R# RX Date DX/Stg Proc RX Date Dx/Stg Proc Flag RX Summ--Treatment Status 1285 RS# RX Summ--Surg Prim Site 1290 R RX Summ--Scope Reg LN Sur 1292 R RX Summ--Surg Oth Reg/Dis 1294 R RX Summ--Reg LN Examined Reserved RX Summ--Surgical Approch RX Summ--Surgical Margins RX Summ--Reconstruct 1st Reason for No Surgery 1340 R RX Summ--DX/Stg Proc 1350 RX Summ--Radiation 1360 RS RX Summ--Rad to CNS 1370 RX Summ--Surg/Rad Seq 1380 RS RX Summ--Chemo 1390 RS RX Summ--Hormone 1400 RS RX Summ--BRM 1410 RS RX Summ--Other 1420 RS Reason for No Radiation 1430 RS Reason for No Chemo 1440 Reason for No Hormone 1450 RX Coding System--Current 1460 R 06 (FORDS) Protocol Eligibility Stat 1470 Protocol Participation 1480 Referral to Support Serv 1490 Retired First Course Calc Method 1500 Page 37

7 Rad--Regional Dose: CGY Rad--No of Treatment Vol Rad--Elapsed RX Days 1530 Rad--Treatment Volume Rad--Location of RX Rad--Intent of Treatment 1560 Rad--Regional RX Modality 1570 RS Rad--RX Completion Status 1580 Rad--Local Control Status 1590 Chemotherapy Field Chemotherapy Field Chemotherapy Field Chemotherapy Field RX Summ--Systemic/Sur Seq 1639 RS RX Summ--Surgery Type RX Summ--Screen/BX Proc RX Summ--Screen/BX Proc RX Summ--Screen/BX Proc RX Summ--Screen/BX Proc RX Summ--Surg Site RX Summ--Scope Reg RX Summ--Surg Oth Reserved Subsq RX 2nd Course Date Subsq RX 2ndCrs Date Flag Subsq RX 2nd Course Codes Subsq RX 2nd Course Surg Subsq RX 2nd Course Rad Subsq RX 2nd Course Chemo Subsq RX 2nd Course Horm Subsq RX 2nd Course BRM Subsq RX 2nd Course Oth Subsq RX 2nd--Scope LN SU Subsq RX 2nd--Surg Oth Subsq RX 2nd--Reg LN Rem Subsq RX 3rd Course Date Subsq RX 3rdCrs Date Flag Subsq RX 3rd Course Codes Subsq RX 3rd Course Surg Page 38

8 Subsq RX 3rd Course Rad Subsq RX 3rd Course Chemo Subsq RX 3rd Course Horm Subsq RX 3rd Course BRM Subsq RX 3rd Course Oth Subsq RX 3rd--Scope LN Su Subsq RX 3rd--Surg Oth Subsq RX 3rd--Reg LN Rem Subsq RX 4th Course Date Subsq RX 4thCrs Date Flag Subsq RX 4th Course Codes Subsq RX 4th Course Surg Subsq RX 4th Course Rad Subsq RX 4th Course Chemo Subsq RX 4th Course Horm Subsq RX 4th Course BRM Subsq RX 4th Course Oth Subsq RX 4th--Scope LN Su Subsq RX 4th--Surg Oth Subsq RX 4th--Reg LN Rem Subsq RX 5th Course Date 1720 Subsq RX 5th Course Codes 1730 Subsq RX 5th Course Surg 1731 Subsq RX 5th Course Rad 1732 Subsq RX 5th Course Chemo 1733 Subsq RX 5th Course Horm 1734 Subsq RX 5th Course BRM 1735 Subsq RX 5th Course Oth 1736 Subsq RX 5th--Scope LN Su 1737 Subsq RX 5th--Surg Oth 1738 Subsq RX 5th--Reg LN Rem 1739 Reserved Subsq RX--Reconstruct Del Date of Last Contact 1750 R Date of Last Contact Flag 1751 R Date of Death--Canada Date of Death--CanadaFlag Vital Status 1760 R Cancer Status Page 39

9 Quality of Survival Follow-Up Source 1790 R* CR Follow-up Source Central 1791 R Next Follow-Up Source Addr Current--City Addr Current--State Addr Current--Postal Code New Addr Current--Country 1832 USA Reserved County--Current Follow-Up Contact--City Follow-Up Contact--State Follow-Up Contact--Postal New Follow-Up Contact--Country 1847 Changed to 2 digital Unusual Follow-Up Method characters ( ) Recurrence Date--1st Recurrence Date--1st Flag Recurrence Distant Sites 1870 Recurrence Distant Site Recurrence Distant Site Recurrence Distant Site Recurrence Type--1st Recurrence Type--1st--Oth 1890 Reserved Cause of Death 1910 R 0000 (live) ICD Revision Number 1920 R 0 (live) Autopsy 1930 R 0 (live) Place of Death 1940 RH New Place of Death--State 1942 R Column New Place of Death--Country 1944 R* Column Site (73-91) ICD-O Morph (73-91) ICD-O Histology (73-91) ICD-O Behavior (73-91) ICD-O Grade (73-91) ICD-O ICD-O-2 Conversion Flag Over-ride SS/NodesPos Over-ride SS/TNM-N Page 40

10 Over-ride SS/TNM-M Over-ride SS/DisMet Over-ride Acsn/Class/Seq Over-ride HospSeq/DxConf Over-ride CoC-Site/Type Over-ride HospSeq/Site Over-ride Site/TNM-StgGrp Over-ride Age/Site/Morph 1990 R Over-ride SeqNo/DxConf 2000 R Over-ride Site/Lat/SeqNo 2010 R Over-ride Surg/DxConf 2020 R Over-ride Site/Type 2030 R Over-ride Histology 2040 R Over-ride Report Source 2050 R Over-ride Ill-define Site 2060 R Over-ride Leuk, Lymphoma 2070 R Over-ride Site/Behavior 2071 R Over-ride Site/EOD/DX Dt Over-ride Site/Lat/EOD Over-ride Site/Lat/Morph 2074 R Reserved CRC CHECKSUM Date Case Initiated Date Case Completed Date Case Completed--CoC Date Case Last Changed Date Case Report Exported 2110 R CR Date Case Report Received 2111 R CR Date Case Report Loaded 2112 R Date Tumor Record Availbl 2113 R Future Use Timeliness Future Use Timeliness ICD-O-3 Conversion Flag 2116 R SEER Coding Sys--Current D Coding Manual SEER Coding Sys--Original CoC Coding Sys--Current CoC Coding Sys--Original Subsq Report for Primary 2160 Page 41

11 Vendor Name SEER Type of Follow-Up SEER Record Number Diagnostic Proc Reserved State/Requestor Items Name--Last 2230 R Name--First 2240 R Name--Middle 2250 R Name--Prefix Name--Suffix Name--Alias 2280 R Name--Spouse/Parent Medical Record Number 2300 R Military Record No Suffix Social Security Number 2320 R Addr at DX--No & Street 2330 R Addr at DX--Supplementl 2335 R Addr Current--No & Street CR Latitude 2352 R* CR Longitude 2354 R* Addr Current--Supplementl Telephone DC State 2370 DC State File Number 2380 R Name--Maiden 2390 R Follow-Up Contact--No&St Follow-Up Contact--Suppl Follow-Up Contact--Name Reserved Institution Referred From NPI--Inst Referred From Institution Referred To NPI--Inst Referred To Last Follow-Up Hospital 2430 Following Registry NPI--Following Registry Reserved Physician--Managing Page 42

12 NPI--Physician--Managing Physician--Follow-Up NPI--Physician--Follow-Up Physician--Primary Surg NPI--Physician--Primary Surg Physician NPI--Physician Physician NPI--Physician Reserved Text--DX Proc--PE 2520 R^ Text--DX Proc--X-ray/Scan 2530 R^ Text--DX Proc--Scopes 2540 R^ Text--DX Proc--Lab Tests 2550 R^ Text--DX Proc--Op 2560 R^ Text--DX Proc--Path 2570 R^ Text--Primary Site Title 2580 R^ Text--Histology Title 2590 R^ Text--Staging 2600 R^ RX Text--Surgery 2610 R^ RX Text--Radiation (Beam) 2620 R^ RX Text--Radiation Other 2630 R^ RX Text--Chemo 2640 R^ RX Text--Hormone 2650 R^ RX Text--BRM 2660 R^ RX Text--Other 2670 R^ Text--Remarks Text--Place of Diagnosis CS PreRx Tumor Size CS PreRx Extension CS PreRx Tum Sz/Ext Eval CS PreRx Lymph Nodes CS PreRx Reg Nodes Eval CS PreRx Mets at DX CS PreRx Mets Eval CS PostRx Tumor Size CS PostRx Extension CS PostRx Lymph Nodes CS PostRx Mets at DX Page 43

13 CS Tumor Size 2800 R CS Extension 2810 R+ CS Tumor Size/Ext Eval 2820 R+ CS Lymph Nodes 2830 R+ CS Lymph Nodes Eval 2840 R* CS Mets at DX 2850 R+ CS Mets at Dx-Bone CS Mets at Dx-Brain CS Mets at Dx-Liver CS Mets at Dx-Lung CS Mets Eval 2860 R* CS Site-Specific Factor RS* CS Site-Specific Factor RS CS Site-Specific Factor RS CS Site-Specific Factor RS CS Site-Specific Factor RS CS Site-Specific Factor RS CS Site-Specific Factor RS CS Site-Specific Factor RS CS Site-Specific Factor RS CS Site-Specific Factor RS CS Site-Specific Factor RS* CS Site-Specific Factor RS* CS Site-Specific Factor RS* CS Site-Specific Factor RS* CS Site-Specific Factor RS* CS Site-Specific Factor RS* CS Site-Specific Factor RS* CS Site-Specific Factor RS* CS Site-Specific Factor RS CS Site-Specific Factor RS CS Site-Specific Factor RS CS Site-Specific Factor RS CS Site-Specific Factor RS* CS Site-Specific Factor RS* CS Site-Specific Factor RS* CS Version Input Original 2935 R CS Version Derived 2936 R+ CS Version Input Current 2937 R Page 44

14 Derived AJCC-6 T Derived AJCC-6 T Descript Derived AJCC-6 N Derived AJCC-6 N Descript Derived AJCC-6 M Derived AJCC-6 M Descript Derived AJCC-6 Stage Grp Derived SS Derived SS D+ Derived AJCC--Flag Derived SS1977--Flag Derived SS2000--Flag 3050 D+ Archive FIN NPI--Archive FIN Comorbid/Complication Comorbid/Complication Comorbid/Complication Comorbid/Complication Comorbid/Complication Comorbid/Complication Comorbid/Complication Comorbid/Complication Comorbid/Complication Comorbid/Complication ICD Revision Comorbid RX Date Most Defin Surg RX Date Mst Defn Srg Flag RX Date Surgical Disch RX Date Surg Disch Flag Readm Same Hosp 30 Days Rad--Boost RX Modality Rad--Boost Dose cgy RX Date Radiation Ended RX Date Rad Ended Flag RX Date Systemic RX Date Systemic Flag RX Summ--Transplnt/Endocr 3250 RS Pain Assessment 3260 RX Summ--Palliative Proc Page 45

15 RX Hosp--Palliative Proc RuralUrban Continuum D RuralUrban Continuum D Derived AJCC-7 T 3400 D* Derived AJCC-7 T Descript 3402 D* Derived AJCC-7 N 3410 D* Derived AJCC-7 N Descript 3412 D* Derived AJCC-7 M 3420 D* Derived AJCC-7 M Descript 3422 D* Derived AJCC-7 Stage Grp 3430 D* Derived PreRx-7 T Derived PreRx-7 T Descrip Derived PreRx-7 N Derived PreRx-7 N Descrip Derived PreRx-7 M Derived PreRx-7 M Descrip Derived PreRx-7 Stage Grp Derived PostRx-7 T Derived PostRx-7 N Derived PostRx-7 M Derived PostRx-7 Stge Grp Derived Neoadjuv Rx Flag SEER Site-Specific Fact SEER Site-Specific Fact SEER Site-Specific Fact SEER Site-Specific Fact SEER Site-Specific Fact SEER Site-Specific Fact Over-ride CS R Over-ride CS R Over-ride CS R Over-ride CS R Over-ride CS R Over-ride CS R Over-ride CS R Over-ride CS R Over-ride CS R Over-ride CS R Over-ride CS R Page 46

16 Over-ride CS R Over-ride CS R Over-ride CS R Over-ride CS R Over-ride CS R Over-ride CS R Over-ride CS R Over-ride CS R Over-ride CS R Secondary Daignosis Secondary Daignosis Secondary Daignosis Secondary Daignosis Secondary Daignosis Secondary Daignosis Secondary Daignosis Secondary Daignosis Secondary Daignosis Secondary Daignosis Path Reporting Fac ID Path Reporting Fac ID Path Reporting Fac ID Path Reporting Fac ID Path Reporting Fac ID Path Report Number Path Report Number Path Report Number Path Report Number Path Report Number Path Order Phys Lic No Path Order Phys Lic No Path Order Phys Lic No Path Order Phys Lic No Path Order Phys Lic No Column Column Column Column Column Column Column Column Column Column Page 47

17 Path Ordering Fac No Path Ordering Fac No Path Ordering Fac No Path Ordering Fac No Path Ordering Fac No Path Date Spec Collect Path Date Spec Collect Path Date Spec Collect Path Date Spec Collect Path Date Spec Collect Path Report Type Path Report Type Path Report Type Path Report Type Path Report Type FupUnusual - Unusual F-up Methods - use to indicate whether patients want the medical record to be released for other purpose 00 - OK to release 01 Not release Out of State 02 - Do not release (HIPPA) (Example: For use when a patient request that their medical record information not be released.) 03 Do not release (Interstate Data Exchange Cases + HIPAA) 04 - Do not release (VA) 05 - Do not release (Interstate Data Exchange Cases + VA) 06 - Do not release (VA + HIPAA) 07 - Do not release (Interstate Data Exchange Cases + HIPAA+VA) Page 48

18 ASCR continue collecting these retired data items or AL specific items Name Position Item Number Length Follow-up Contact--Phone Column Tobacco History Column Alcohol History Column Family History of Cancer Column Religion Column Site of Distant Site 1 Column Site of Distant Site 2 Column Site of Distant Site 3 Column Recurrence Distant Site 1 Column Recurrence Distant Site 2 Column Recurrence Distant Site 3 Column Over-ride SS/DisMel1 Column Date of 1st Positive BX Column Date of 1st Positive BX Flag Column Code Fam Hist of CA Tobacco History Alcohol History 0 No Never Used No history of alcohol use 1 Yes Cigarette smoker, current Current use of alcohol 2 Cigar/pipe smoker, current Past history of alcohol use, does not currently use 3 Snuff /Chew/smokeless, current 4 Combination use, current 5 Previous Use 9 Unknown Unknown Unknown Page 49

ASCR Data Items for V14 ASCR Requirement: R - Required Fields, S - Supplemental Fields, * - When available CR Only - only need for Central Registry

ASCR Data Items for V14 ASCR Requirement: R - Required Fields, S - Supplemental Fields, * - When available CR Only - only need for Central Registry Data Item Name Data Item Number NPCR Collect Recommendation