11/3/2016. Outcomes Watching It Grow. What will we discuss? GATRA Annual Conference 2016 Lisa Connor, CTR

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1 Outcomes Watching It Grow GATRA Annual Conference 2016 Lisa Connor, CTR The abstract begins after case finding The abstract is in progress The abstract is complete The abstract is revisited and nurtured What will we discuss? What is Outcomes? Date of First Recurrence Type of First Recurrence Cancer Status Coding Examples Follow-up and the Impact of Cancer Status and First Recurrence Importance of Quality Text Subsequent treatment adding subsequent treatment provides treatment information for the recurrence or progression. Other sources for death dates Purpose in Outcomes 3 1

2 What is Outcomes? Clinical and vital status of the patient Valid information in regards to the patient s current cancer status Known Subsequent treatment Quality information provided in codes and in text Dead or Alive Date of last contact Cancer or no cancer evident on date of last contact Any recurrence? Any disease-free periods? This information can also help the state registry keep up with the patient as well, concerning vital status and date of last contact 4 What is Date & Type First Recurrence? Identifies the Type of First Recurrence after a period of documented disease-free intermission or remission. Page 298 of FORDS 2015 Date of First Recurrence Recording of the date the physician diagnoses the first progression, metastasis or recurrence of disease AFTER a period of documented disease free period. Type of First Recurrence Identifies the type of first recurrence AFTER a period of documented disease-free intermission or remission. FORDS 2015 page various code scenarios. If patient is disease free (00) If patient is never disease-free (70) If patient has a first recurrence what type? Please avoid 99 5 How to Document Details for Date of First Recurrence (DFR) Add a new follow-up any time DFR is updated Date of last contact / Death Cancer status Other fields required in your registry software follow-up (including followup source and next follow-up source) Comments: Provide text to document your reason for adding a recurrence. Remember a biopsy is not the only identifiable resource for determining recurrence, progression or no evidence of disease. If imaging is indicative of recurrence or progression (conclusive terminology) this would be your actual date of recurrence. 6 2

3 Cancer Status Cancer Status 01 No evidence of this tumor Cancer Status 02 Evidence of this tumor Cancer Status 09 Unknown (not recommended) Cancer status for each follow-up must reflect the cancer status for that particular date. Cancer status 09 Unknown This code is discouraged. If you plan to generate reports, and cancer status is a field you will use to compile data, the unknowns will not allow you to have true quality data in regards to cancer status. 7 Documenting Date First Recurrence and Type First Recurrence (Example #1) Example #1: Patient has been NED (no evidence of disease) from breast ductal carcinoma for two years. The patient had a CT scan suggestive of liver metastasis. The patient had a liver biopsy on 3/30/16 revealing metastatic carcinoma consistent with previously known breast carcinoma. Proper coding Date of First Recurrence is 3/30/16 and Type First Recurrence is (54) Liver. Recurrence Site 1 is (04) Liver Did the patient have subsequent treatment If the patient had treatment for this recurrence add to subsequent (02) treatment. In a case like the above scenario, where and how would you document your biopsy? Subsequent treatment under diagnostic procedures code (01) Biopsy other than primary site. DO NOT REMOVE this code and type recurrence if the patient becomes disease-free later on. Add another follow-up, coding cancer status 1 and text to support. Adding to follow-up & documentation - See next slide 8 Follow-up Documentation for Example #1 9 3

4 Follow-up Documentation for Example #1 continued DO NOT REMOVE this code and type recurrence if the patient becomes disease-free later on. Add another follow-up, coding cancer status 1 and text to support. This patient returned on 10/1/16 to her medical oncologist. She has had restaging workup and her physician now states she is NED (no evidence of disease). Date First Recurrence WILL NOT CHANGE. Reflect the cancer status change only in your follow-up. 10 Documenting Date First Recurrence and Type First Recurrence (Example #2) Example #2: Patient has been NDF (never disease-free) from Stage IV breast ductal carcinoma for 1 year. The patient had a CT scan on 3/1/16 revealing worsening liver metastasis compared to previous study. Proper coding (remains the same this is progression, not a recurrence) Did the patient have subsequent treatment add (02) subsequent treatment. Adding follow-up see next slide. 11 Follow-up Documentation for Example #2 12 4

5 Documenting Date First Recurrence and Type First Recurrence (continued) Example #3: Patient has been NED (no evidence of disease) from breast ductal carcinoma for two years. An office visit note from the medical oncologist dated 3/1/15 states that the patient is currently undergoing whole brain radiation for brain metastasis. No other details are offered in the medical record. This information is vital and needs to be added to the abstract. Proper coding Date of First Recurrence is estimated 02/01/15 and Type First Recurrence is (56) CNS (distant). Recurrence Site 1 is (06) Central Nervous System. Did the patient have subsequent treatment Yes the patient had subsequent treatment for this recurrence. Add to subsequent (02) treatment (whole brain XRT) estimated date, according to physician note and details. 13 Follow-up Documentation for Example #3 14 Tips to Remember Recurrence the disease has returned after a period of time during which the cancer could not be detected. The cancer may return to the same primary site or to another site in the body. Disease progression the patient was NDF and the disease continued to progress. The disease becomes worse or spreads. Be careful when you see the patient s disease is stable. This means the disease is still present, it has stabilized and has not progressed/worsened. Be careful when the physician says the patient is doing well. This tells nothing about the cancer status. A patient can have cancer and be doing well. Recurrence or new primary MPH rules, p10, item #

6 Expired Patients Vital status is very important and is an area you should have a process developed. If a patient is deceased, the last thing the family needs is a letter addressed to the patient. Expired Lists from your facility and your facility owned offices. State Death List distributed biannually, usually May and November. Registry software that offers SSDI (practice this on each case when you are done). Obituaries AJC link (be sure to check all dates for all of Georgia. Atlanta Journal Constitute Obituaries: 16 Purpose in Outcomes It is not just follow-up and vital status. It is so much more! Provides accurate information long after an abstract is complete Data Quality The latest and greatest update Tells the story of the patient s journey after the abstract is complete What is happening with the patient now Requires you to backtrack in time to see what information is missing and fill in gaps Assists in Quality Improvement studies your studies are as helpful as the information provided is accurate 17 Resources Outcomes: FORDS 2015 pages Date of first recurrence, recurrence date flag, type of first recurrence Date of last contact: FORDS 2015 page 304 Date of last contact flag: FORDS 2015 page 305 Vital status: FORDS 2015 page 306 Cancer Status: FORDS 2015 page 307 Following Registry, Follow-up Source, Next Follow-up source (when to use code) pages Recurrence or new primary: MPH, p 10, item #7 First course (FORDS 2015 page 22, ) and subsequent treatment FORDS 2015 : SEER page 94 Watchful Waiting: FORDS 2015 page 23 and pages 207, 210 Palliative treatment: FORDS 2015 page 30, Gleason (Grading Conversion): Click - For Cancer Registrars, click Grade Coding Instructions and then 2014 Grade Rule Conversion for Prostate 18 6