Collaborative Stage Transition Newsletter August 18, 2014

Transcription

1 Introduction Collaborative Stage Transition Newsletter August 18, 2014 This is the third in the series providing communication updates from organizations within the cancer surveillance community to Table of Contents share with their members and other constituents. It addresses the processes and ongoing efforts to coordinate and effectively Introduction transition from the Collaborative Staging v2 system to use of the Agency Updates AJCC TNM staging standard with related biomarkers and prognostic factors. Shortly after the decision was made to transition from CS Q & A Collaborative Stage, a CS Transition Group was formed as an information sharing and planning forum. This group brings together the four data collection agencies/organizations (Statistics Canada/Canadian Council of Cancer Registries, CDC/NPCR, NCI/SEER and CoC), the agency responsible for staging rules (AJCC), the cancer surveillance umbrella organization (NAACCR) and the organization representing cancer registry professionals (NCRA) and the American Cancer Society. The CS Transition Group provides a collaborative opportunity to identify the issues involved in the transition and to share the tasks involved in developing best practices for both the overall surveillance community and the individual agencies/organizations in addressing this change. The agencies and organizations participating in this communication recognize that the transition away from CS is a major change and are committed to working with stakeholders to develop appropriate implementation plans and processes. This transition is a work in progress, and there are many questions that have yet to be fully addressed. As answers become available they will be shared and communicated to the surveillance community, and opportunities will be provided for members to identify issues and concerns. If you have ideas that you feel are important for the partners and/or the CS Transition Group to consider, please them to Patricia Murphy (Murphy, Patricia (NIH/NCI)) who will collate and disseminate. There are a number of areas of confusion within the surveillance community that this communication will address. One of those areas relates to the use of the terms directly coded or directly assigned AJCC stage. These terms were intended to distinguish between the derived AJCC stage obtained through the use of the Collaborative Staging System versus the collection of AJCC Stage following the AJCC 7 th edition manual. We have learned that the terms directly coded and directly assigned may have created some confusion. Moving forward we will refer to the collection of AJCC Stage and SEER Summary Stage to mean the collection of stage without 1

2 the use of the CS System. As you know, the CS System will not be used for staging cases diagnosed in 2016 and thereafter. A new question related to this topic has been added to the end of the newsletter and will be maintained in our database. As a reminder, the initial change in 2016 for CDC and NCI registries will be focused on the transition to directly assigned TNM stage, but will not eliminate all CS variables. In particular most of the Site Specific Factors (SSFs) will continue to be required as they are a) either a critical component of stage assignment or b) are essential to understanding the cancer (predictive or prognostic factors). Thus the initial transition will be focused on assignment of T, N, M, and the AJCC TNM stage group. As the coordinating bodies, we will clarify which additional variables and which SSFs will continue to be required, but our intent is to carefully evaluate which are essential and which are feasible to be collected by the registrar. The methods/studies and processes that will be used to make these determinations are described below. It is worth noting Item 4 in the NCI project list (NCI coordinating with NPCR and NAACCR to assess needs for changes in algorithms, and other IT needs related to the transition). One important aspect to the move to AJCC TNM stage and the maintenance of the SSFs is that the data warehouse and API will eliminate obsolete variables and obsolete values, simplifying what registrars must consider in their abstraction. Each participating entity continues to perform specific and coordinated tasks related to assessing the needs for the transition, determining the impact of the transition and coordinating the logistical components for implementing the changes. Updates to these are described below with the organization and task leader responsible for that activity. Agency Updates The following is a collection of activity summaries written by the respective agency/organization in follow up to the original newsletter to provide a current status of the activities of each partner organization. We intend to continue providing regular updates on these activities. In some cases you will note that agencies are working independently on specific issues, while in other cases shared project work is underway. We have identified several common questions and provided responses from NCI/SEER, CDC/NPCR and the COC at the end of the document. We have included the original questions and answers as well as new questions. The latter are highlighted in italics. Current and planned activities by the partner organization in relation to the CS Transition: A. American Cancer Society 2

3 A project led by the ACS in collaboration with CoC and NCI is to directly compare for recent years the stage assigned through Collaborative Stage version 2 versus AJCC pathologic TNM or AJCC clinical TNM stage. A preliminary report will be provided in the next edition of this newsletter. A summary of the objectives and specific proposed analyses are listed below. These are directed towards assisting the partners in understanding the areas where direct assignment of AJCC TNM stage may be problematic. Objectives: 1. Evaluate the matching between the CS derived TNM and directly assigned TNM data for cases diagnosed in 2011 NCDB data for breast, colon, lung and prostate cancers, particularly acknowledging the contrasting rules for the two systems; 2. Provide information and identify issues to support a smooth transition from CS to TNM AJCC staging; 3. Identify staging challenges to provide guidance for registrar training in the use of TNM stage. Primary analyses include: 1. Detailed and major level percent matching by site, clin/path and stage, combined and separately for surgical and non-surgical patients 2. Subset analysis to show matching data items with very good or very poor matching percent ( e.g. matching >90% -good or <70%- poor) Sub-analyses will include: 3. Special issues, such as the sample size in prostate path cases, big difference in sample size of breast clint, clinn and clinm, clinical measures, failure to use clinm for path stage, differences in rules, etc 4. In particular evaluate the matching of CS TNM NOS rows with directly assigned TNM by site 5. Evaluate the frequency with which the TNM stage is directly assigned by the registrar vs. the clinician in Status: ongoing - estimated completion for initial analysis August Contact person: Anna Lin (ACS) - lead/kathy Cronin (NCI), Jerri Linn Phillips (ACoS), Ahmedin Jemal (ACS) B. AJCC No new updates C. Statistics Canada and the Canadian Council of Cancer Registries No new updates 3

4 D. Centers for Disease Control and Prevention 1. CDC-NPCR has formed an internal transition workgroup. The major focus of this workgroup is to implement a smooth, timely staging transition. The NPCR internal workgroup collaborates with partner organizations in the cancer surveillance community and provides NPCR specifics to state cancer registries. 2. Communication a. CDC-NPCR will continue to schedule regional calls with NPCR Cancer Registries to provide information on the transition and to answer questions. CDC is holding its Program Directors meeting August where additional input from NPCR registries on the collection of AJCC staging by central registries will be collected during round table discussions. Status: Information will be sent to NPCR Program Directors Contact Person: Mary Lewis, CDC-NPCR b. CDC has established a specific address for NPCR registries to submit transition questions. Questions and answers will be posted on the NPCR SharePoint. Status: Ongoing Contact Person: Mary Lewis, CDC-NPCR 3. Guidelines for Implementation Purpose: An implementation guide for NPCR required data items through the transition. These guidelines may serve as a foundation for a complete implementation guide and will address details of data definitions, collection and editing requirements, plans for submission of TNM data, and other issues of concern to NPCR participants. Status: The document is in draft stage. Opportunities to comment on a draft version will be provided to NPCR registries. Contact Person: Joe Rogers, CDC-NPCR 4. Education a. Purpose: Provide education and education materials to all cancer reporters. The first education offering of AJCC and Summary Stage took place at the NCRA Annual Meeting in May. The training was attended by approximately 100 people. 4

5 The complete presentations, with speaker s notes are available on the NPCR SharePoint. Status: Complete b. CDC-NPCR is developing site specific training presentations with speaker s note for both AJCC Staging 7 th Edition and SEER Summary Stage Status: Available this summer Contact Person: Mary Lewis, CDC-NPCR c. CDC-NPCR revised the cooperative agreement with AJCC from support of CS stage to transition activities for AJCC stage. The expanded cooperative agreement with AJCC includes the following: Production of effective training materials Mechanisms to disseminate training (classroom, on-line, webcasts, etc.) Establishment and maintenance of a mechanism to respond to staging questions Status: AJCC is developing a training plan that will include staging tips that may not be explicitly explained in the AJCC Staging Manual 7 th Edition. Contact Person: Mary Lewis, CDC-NPCR 5. IT Needs CDC-NPCR has started a dialog with providers of central registry software for NPCR states. The software providers were asked to communicate their needs to CDC-NPCR in May. Status: The responses are being collated in preparation for a teleconference between the providers and CDC staff to be held in early summer. Contact Person: Joe Rogers, CDC-NPCR E. Commission on Cancer Staff from the CoC, the National Cancer Data Base (NCDB) and AJCC held their first meeting to identify areas needing attention as movement to phase out CS continues. Among the issues identified are: need to evaluate whether any required SSFs should be discontinued from the requirements or revised, consideration of new biologic measures for collection, consideration of changes in CoC Standards with respect to these items, and recognition that there will be necessary IT work due to changes in transmission file layout in

6 The Commission on Cancer project on updating its data items through the FORDS Manual Update survey has collected well over 500 responses to date. Please remember to add suggestions to The goal is to assure that data collected are clinically relevant, current, available to registrars, and flexible for use. While this is not directly related to the transition away from CS, it is complementary. Direct questions about the project to Contact Person: Jerri Linn Phillips/Ryan McCabe F. NAACCR UPDATE: NAACCR will continue to work with all of the partner agencies to facilitate a smooth transition to TNM staging with the following tasks accomplished since the prior communication newsletter: 1. On June 17, the CS Transition Group agreed to continue collecting Site Specific Factors using the current NAACCR data layout and definitions at least through This approach will continue to use the programming and logic structure established in Collaborative Stage to collect those variables. The CS Transition Group felt that this would be the least disruptive way to proceed for The intention is to maintain the SSFs as they are until there is an opportunity to carefully evaluate the SSFs and to make decisions on how to structure the collection of these variables within the NAACCR record layout. In addition, any changes that will be needed to accommodate prognostic indicators in the AJCC 8 th edition will be better known in Excerpt from the SSF Data Structure Task Force Summary Option 3: Maintain current CS data structure and definitions. Standard setters would continue to specify requirements. Continue to collect required CS data items in their current CS locations. The existing CS DLL could continue to be used for site group determination, valid code definitions and documentation. Once the AJCC 8th edition is published, the structure will need to be altered to accommodate this change. 2. A task force was formed to identify milestones that need to be achieved for the transition to be complete and tie these milestones to a timeline in order to monitor progress. Contact Lori Havener (lhavener@naaccr.org) for the 2016 Implementation Timeline. The following is an abbreviated form of the timeline: NAACCR Standards Volume II 2016 Timeline 6

7 Activity Proposals for new and/or changed data items submitted to the Change Management Board (CMB) Requests for change final review/approval by CMB and other groups as needed (e.g., UDS) NAACCR Deadlines October 1, 2014 December 1, 2014 Convene Volume II Task Force January 2015 Finalize NAACCR Standards Volume II and submit to NAACCR Board for review/approval June 1, 2015 NAACCR Standards Volume II Released July 1, 2015 Implementation January 1, A short term task force is evaluating consolidation for AJCC stage. 4. NAACCR will provide expertise on central cancer registry operations, data analysis, IT issues etc. by engaging its members in discussions of best practices and feasibility analysis, formulating recommendations and modifying standards if necessary. 5. After review by the Change Management Board, which is composed of the standard setting organizations, the Uniform Data Standards will review proposed new and revised data items and provide feedback concerning the feasibility of data collection, recommendations regarding the standardization and consistency of data items, and finalize coding structures. 6. NAACCR will coordinate the various implementation guidelines and try to incorporate recommendations into standards and a universal implementation guide if feasible. 7. NAACCR will work with partners to ensure that proper edits are in place to maintain the integrity of high quality surveillance data. 8. NAACCR currently includes and will continue to include TNM and Summary Stage training in site-specific webinars that are part of the Cancer Registry and Surveillance Webinar Series. Training on TNM and Summary Stage will be included in the NAACCR comprehensive training plan that is being developed. Contact person: Betsy Kohler G. NCI 1. Evaluation of the frequency of ptnm in the surgical pathology report Purpose: To determine how often the registrar would need to directly assign ptnm if it were not present in the pathology report to direct training efforts. This includes using software with NLP to evaluate the frequency of e-pathology reports including TNM. 7

8 Status: The study protocol has been finalized in collaboration with Artificial Intelligence in Medicine (AIM). They are working to build and refine the system for filtering and extracting data from the HL7 reports. A manual review of the cases will be conducted to provide a gold standard for comparison. Estimated completion date: December 2014 Contact person: Carol Kosary/Annie Noone 2. Comparison of cases restaged with AJCC TNM Purpose: This study will ask registrars to re-stage existing cases with known CSv2 stage to compare the agreement between CS and TNM staging. This will provide information to direct training, but will also allow us to understand the potential impact of implementation of TNM stage on incidence trends over time. Status: Over 225 participants have completed the study which will NOW remain open until August 22. Analysis of the TNM and staging information extracted from the original medical records is currently underway. Multiple instances of the same TNM data element are often present in the record and so we are evaluating which types of documents contain the most reliable information. These results will be used to establish a hierarchy of documents to use when assigning stage. AJCC is a collaborator on this project and will use the study results to target training. In addition, in collaboration with the surveillance partners a new analysis is being performed that will assess the availability and accuracy of physician assigned AJCC TNM stage according to the data source (e.g. surgical pathology report, operative note, clinical dictation, hospital discharge summary etc) from the data sources that are represented in the study. The goal is to assign a data-driven hierarchy based on accuracy to the documents to provide guidelines to the registrars. In addition to evaluating the ability of registrars to assign AJCC TNM stage, and determining the frequency (and accuracy) with which the information is available in the hospital medical record, we are considering how to calculate a "best stage" from a combination of the ptnm and ctnm AJCC Group Stage. Dr. Kevin Ward is leading that project. Ongoing analysis and algorithms are being developed and will be shared in subsequent issues of the newsletter. Timeline remaining: 2 months Contact person: Carol Kosary/Annie Noone/Kevin Ward 3. Evaluation of SSFs 8

9 Purpose: Develop a formal process for assessing whether or not to include/maintain SSFs as part of required data collection. This process entails a formal review of all SSFs (with a particular emphasis on biomarkers) to determine when they should be required as part of the cancer abstraction process. Components of this assessment will include: 1) evaluation of whether or not there is either evidence or guidelines for the use of factor, 2) whether it is a component necessary to assign stage, 3) when in the cancer course the factor is assessed, 4) whether or not the registrar has access to the information (i.e. feasibility) and 5) are there existing data sources that might be tapped for automated data collection. Other aspects for evaluation include 1) frequency of a SSF in the population of interest, 2) where a SSF can be found in the medical records and 3) how it is reported/referent ranges. In addition to the current SSFs, predictive and prognostic biomarkers that are not part of CSv2 SSFs but which have become a standard of care are identified and reviewed for potential future consideration. This process is being established for ongoing evaluation of newly developed predictive and prognostic biomarkers. Although the NCI will serve as the lead on this, we will include (and welcome) participation from clinical experts representing expertise for specific cancer sites and partners from across the cancer surveillance community. In addition to a focus on the biomarkers, there will be a formal evaluation of the SSFs that are not essential for staging or are not biomarkers. This will be led Dr. Petkov in coordination with the Surveillance Systems Branch personnel. Status: A formal process for review of SSFs is in place. The assessment is based mainly on current guidelines recommendations (such as NCCN, ASCO, FDA, CAP). If there are not any guidelines on particular cancer/ssfs, a literature review is conducted to determine the current evidence regarding the clinical utility of a particular SSF/biomarker. The preliminary review of the SSFs for 11 schemas including: colon, rectum, breast, prostate, lung, bladder, kidney (renal parenchyma and renal pelvis), and pancreas (three schemas) were completed previously. A preliminary review has also been completed for the following sites/schemas: Neuroendocrine tumors - 5 schemas; Hepatobilliary cancers - 6 schemas; Mesothelioma, Gastrointestinal Stromal tumors - 7 schemas; and Genitourinary cancers-3 schemas. In addition to the previously outlined evaluation process, several new components were included. The availability (% of cases that had a particular SSF assessed) is calculated in SEER data for 2010, 2011 and 2012 (partial data for 2012). This is performed for all SSFs (including those that were never required). Identified problems with data quality or need for instructional aids/codes are captured in the database and will be used in quality 9

10 improvement projects and revisions to the manuals and instructional aids. Questions regarding the quality of data are identified and discussed to determine if the inconsistencies or issues represent recording errors (issue with decimal point) or coding rule interpretation errors etc. Starting in August, a formal process for review of instructional aids/codes for SSFs will be added to the SSFs evaluation process. As a part of this process, relevant discussions from CAnswer Forum and SEER Squish will be reviewed to further inform the revision process. Timeline for completion: February 2015 Contact person: Valentina Petkov 4. NCI coordinating with NPCR and NAACCR to assess needs for changes in algorithms, and other IT needs related to the transition. IMS and NCI SEER staff continue working with partners including CDC, COC and NAACCR subject matter experts to determine the IT needs and timeline that will be required for the change to TNM. IMS is working to develop software to capture AJCC TNM 7 th Ed. The outcome will include a vendor communication plan to assure that the broader IT needs are met for the transition from CSv2 to TNM stage. As part of this effort, the NCI SEER Program is moving forward with the concept of creating one warehouse of information that contains: 1) rules for schema selection, 2) data items required for staging with their permissible values and AJCC TNM rules, 3) prognostic and predictive data items with their permissible values, and 4) the algorithms for calculation of both AJCC 7th edition stage group and Summary Stage This warehouse will be readily adaptable to the AJCC 8th edition and other changes to data collection as they become necessary. The proposed system will simplify the change process with new versions of AJCC staging as well as for changes to the collection of predictive or prognostic factor data. The goal is to have the data (AJCC TNM stage and predictive and prognostic factors) in one warehouse agreed to by all standard setters. Vendors and users will be able to access the information in this warehouse in a variety of ways: on a public facing website, via an API, via a CDLL, and via a Java library. Discussions are ongoing with the AJCC regarding site licensing for permission to access the copyrighted AJCC TNM Staging information. Presentations on the functionality of the proposed software/database have been done for the CS to TNM Transition Workgroup of surveillance partners, and to a larger audience at NAACCR in June. The long term goals in developing this software include the following: Simplify cancer coding collect less data items 10

11 Facilitate the maintenance and enhancements of TNM coding as they evolve for Introduction of new histologies Incorporation of new prognostic and predictive factors as the science changes Utilization of a data driven approach to automatically update documentation as changes are released Modify existing predictive and prognostic factors to better reflect the science Clean up SSF data (remove obsolete codes, remove obsolete references, etc.) Collapse schemas Provide a tool that will allow rapid and efficient modification of software once reviewed and approved by the appropriate subject matter experts and/or governing bodies. (latest public facing version) V 1.2 Subject Matter Expert Data Entry Tool Adds, modifies, deletes data via the S&PP API requires internet put get access Staging and Prognostic and Predictive Factors API (S&PP API) Get Put Calculate AJCC7 TNM Stage Calculate Summary Stage 2016 Calculate Best Stage (Plan for AJCC8 TNM Stage) get Public facing S&PP website requires internet access get Vendors directly using the S&PP API, such as SEER*DMS Talks to (public facing version) V 1.1 (public facing version) V 1.0 S&PP Warehouse Dev version (Not yet public) Schema selection Clinical and Path T, N M with coding instructions P&P data item definition Data items required for staging AJCC7 Staging algorithms Summary Stage 2016 algorithms Best Stage algorithms (Plan for AJCC8 Staging algorithms) Assumes agreement with AJCC is reached over use of copyrighted information The slide represents the 4 key elements of the software. These are: 1) the Staging and Predictive/Prognostic Factor (S&PP) API (which will be available for use by vendors outside NCI); 2) the S & PP Warehouse which stores all the key information that is used in the API and allows for versioning as appropriate; 3) the Subject Matter Expert Data Entry Tool- which permits rapid modifications and testing that can then be automatically integrated into the warehouse and API once approved; and 4) the public facing website and vendor accessibility to the API. Ongoing reports and updates will be provided in subsequent newsletters. Contact person: Carol Kosary/Jean Cyr IMS 5. Development of training aids to help registrars assign TNM No new updates 11

12 6. Evaluation of a training tool: TNM Training - Does it work? YES. As the transition from Collaborative Stage to TNM approaches, the time for central registries to start TNM stage training is now. What approach should be used? The AJCC Cancer Staging Manual, 7 th Edition, was written with physicians as the primary audience. How do we as registrars, not physicians, learn to apply both the general principles and the site specific staging criteria? One method is to learn these concepts by doing a little bit of training every day. This brief describes one successful method and tool that might help registrars improve their ability to assign AJCC TNM stage. Recognizing their need for TNM training, one registry has implemented an incremental training program for their staff. The approach was as follows: small periods of incremental training were performed, allocating 10 to 15 minutes of time on a daily basis. This small amount of time every day enabled registrars to absorb the concepts of TNM and to develop consistency in applying TNM guidelines. A different case scenario is selected every day. The first assignment of the day is for each member of the staff to assign TNM stage for that case scenario. This training program includes an immediate feedback loop to the trainee. Reports were generated to identify individual issues related to assigning TNM and pinpointing issues associated with a lack of consistency among all staff members. The eighteen registrars in this registry had little to no experience assigning TNM. The associated graph represents the average percent correct among the first set (blue bars) and second set of five cases (red bars) according to registry role. Breast - Assigning Clinical TNM Stage Group Comparison of Percent Correctly Assigned Staging between the First and Second Set of Five Cases for a set of 18 registrars. This example illustrates the ability of registry staff to quickly learn and apply new skills, with minimal effort and time commitment. A critical feature of this successful training is the incorporation of an immediate feedback loop in which one quickly identifies the type and number of errors made so change can be implemented to improve future performance. One additional finding in this example is that training must be ongoing so that the skills, once learned, are retained. When there was a hiatus in the daily training 12

13 of 4 weeks scores were lower, but quickly improved once these short daily training episodes were restarted. It is clear and a very positive finding that small investments in routine training can prepare the registry community for a smooth transition (and accurate data collection) to TNM in Develop and lead focus groups consisting of hospital and central registrars (who perform abstraction) Purpose: Determine the needs as identified by the individuals who are performing the abstraction process. The groups will identify issues, comment on proposed changes and assist in determining the impact and feasibility of what is being proposed at the organizational level. The format will be similar to that used for assessing the MPH rules. The timeline includes three focus groups via teleconference with the following categories of participants: Focus Group I: 10 new registrars who use CSv2 on a daily basis. A new registrar is one who has been using the CSv2 coding manual for two years or less as well as minimal experience with AJCC TNM staging. (Completed) Focus Group II: 10 experienced registrars who use CSv2 on a daily basis. An experienced registrar is one who has used the SEER rules and manual and/or Collaborative Staging for five years or more as well as experience with AJCC TNM staging. (completed) Focus Group III: 10 Central Registry registrars whose primary activity is performing editing, quality control, and/or case consolidation tasks. These registrars should be experienced with SEER rules, CSv2 and at least minimal experience with AJCC TNM staging. (August 2014) Five questions were discussed in the 1.5 hour teleconference-based focus groups: 1. How do you feel about collaborative stage coding? a. Are you confident in doing it? b. How easy or difficult is this coding? c. How easy or difficult are coding the site specific factors (SSF s)? 2. How familiar or unfamiliar are you all with this coding scheme? a. Where did you find out about this coding scheme? b. Do you have a current copy of the AJCC 7 th Edition Manual? c. What methods do you recommend for training? What do you think about inperson workshops, interactive webinars, on-demand training modules? d. What about training aids or coding tools like cheat sheets? e. For those of you who are hospital based, do you think your administration can mandate how physicians complete the AJCC staging forms? 13

14 3. How familiar or unfamiliar are you all with this? a. Where did you find out about it? b. Do you have a current copy of the SEER Summary Staging Manual published in 2000? c. Do you use other manuals routinely? What about: The 2013 SEER Program and Staging Manual? What do you think about it? Do you use it? d. What about FORDS? 4. Can you think of any issues related to the change to directly coded TNM that will impact your software vendors? a. Have your vendors communicated any issues to you? 5. Are there other topics we should discuss that might be helpful for you in thinking about the proposed changes? A report summarizing the results of the discussions will be provided in a subsequent newsletter. The report will be qualitative as numbers and percentages are generally not appropriate for focus group research. Therefore, reporting will be descriptive and present the meaning of the data as opposed to a summary of data. Timeline: Report completed October 1, 2014 Contact person: Lois Dickie 8. Development of Summary Stage 2016 Purpose: To develop and test a system that will permit staging over time consistent with the change to TNM staging. The intent is to create a system that will allow post hoc recoding for the analysis of time trends since 1988 (and possibly further back). NCI SEER is currently thinking that without CS we will not be able to continue to collect older staging systems. We are therefore investigating the idea of a new summary stage that will be based on TNM and will not require a separate stage collection, but can be calculated by the software from the data elements. It is understood that when definitions of TNM change over time this would result in a (hopefully small) discontinuity in SS2016. The initial intent is for post hoc analytic purposes. Sixteen schema are currently under review by experts at NCI to assess impact of this new system on staging over time. The NCI continues to make progress in the development of Summary Stage 2016 with a goal of completion in time for the TNM transition in Besides continued work on the mapping of TNM components into SS2016 discussions are also ongoing on the development of SS2016 data collection aids and the incorporation of SS2016 into ongoing IT development. Lynn Ries presented the results of preliminary work at the 2014 NAACCR conference in Ottawa. This presentation can be viewed at: 14

15 mid=783 Once the system is determined to be reliable and valid after internal and external review, the NCI will develop a user manual for direct assignment of SS2016 for use by registries. This will be a modification of the current Summary Stage 2000 Coding Manual. Status: in process of NCI internal evaluation Timeline: next step for evaluation by external partners August 2014 Contact person: Carol Kosary H. NCRA 1. Education NCRA began development and delivery of educational materials and programs to best prepare registrars for the transition through the NCRA 40 th Annual Convention. These presentations are now available for free through the link below. Contact person: Peggy Meehan (pmeehan@ncra-usa.org) Related Presentations at NCRA 40 th Annual Convention are available for free viewing at the NCRA Center for Cancer Registry Education: THE NATIONAL TRANSITION TO DIRECTLY CODED STAGE Presenters: Christie Eheman, PhD, MSHP; Carol Kosary, D.Mgt; and Jerri Linn Phillips, MA, CTR Description: Both hospital and central registries will transition to the direct coding of cancer stage for 2016 cases. The rationale for the change will be outlined and the plans to ensure success of the transition will be presented. RESULTS OF THE EDUCATIONAL NEEDS ASSESSMENT Presenter: Donna M. Gress, RHIT, CTR Description: To ensure the cancer surveillance community is prepared for the transition to AJCC TNM and Summary Stage coding scheduled to begin January 1, 2016, the AJCC asked NCRA to prepare an Education Needs Assessment. The goal of the assessment was to identify gaps in knowledge and skills to determine the training and education needed to prepare for the 2016 shift in staging process. The session will provide a review of the survey results. 15

16 THE CDC/NPCR EDUCATION & TRAINING COORDINATOR S WORKSHOP: PREPARING TRAINERS FOR STAGE TRANSITION Presenters: Fran Babcock, CTR; Lynda Douglas, CTR; Christie Eheman, PhD, MSPH; Mary Lewis, CTR; and Linda Mulvihill, RHIT, CTR Description: The Education and Training Coordinators from the CDC/ NPCR state cancer registries are the target audience for this breakout. Hospital registrars, however, may also find the full-day breakout of interest. It will provide an excellent refresher or good start for those who have never directly collected either staging system. All NPCR central cancer registries, starting with 2014 diagnoses, require the submission as available of directly collected AJCC Stage from all ACoS-CoC hospitals within their states. Starting with 2015 diagnoses, NPCR will require all state registries to collect directly coded SS 2000 from all facilities. In 2016, all facilities must submit AJCC and SS to their state registries (in NPCR states). To position the Education and Training Coordinators to conduct training and support directly coded stage, this full-day breakout will provide an overview of general staging rules for both staging systems and provide educational materials to meet training needs in the individual states. Day includes sessions on Overview of Transition Activities; General Rules for Summary Stage; Summary Stage 2000: Site-Specific Chapters; General Rules for AJCC; AJCC: Breast, Colon, Lung, Prostate interactive exercises; and Q&A. 2. Credentialing Council on Certification is actively monitoring the transition efforts and will post any CTR examination changes related to new content on its website Contact person: Michael Hechter (mhechter@ncra-usa.org) 3. Policy NCRA s President will be forming a Transition to Directly Coded Stage Task Force to work with all NCRA committees in identifying information, education, and all efforts where internal documents, products, and publications need editing or modification to support the transition. Contact person: Lori Swain (lswain@ncra-usa.org) 4. Social Media Created web page on the NCRA website dedicated to all things transition with the purpose of being a one-stop shop for NCRA members as the transition moves forward ( Contact person: Janice Ford (jford@ncra-usa.org) 16

17 Collaborative Stage to TNM Transition Q&A (New) Question: What do the terms directly coded and directly assigned stage mean? Answer: CDC NPCR/NCI SEER: These terms have been used to distinguish between the collection of stage through the Collaborative Staging System and the collection of stage based on the AJCC 7 th edition manual and the manual for SEER Summary Stage In the U.S., Collaborative Stage will NOT be used to stage cancer cases diagnosed in 2016 or after. 17