AJCC CANCER STAGING MANUAL, HOW 8 TH EDITION DID THEY DO THAT? NOVEMBER 5, 2018 CHARLESTON, SC Introduction 1. About the MANUAL not about stage 2. Short History 3. People and Teams 4. Manual Organization 5. Overall and Universal Changes 6. What s next 7. About the MANUAL not about stage 2 SECTION 1 31Short History of the AJCC and TNM Stage 1
SHORT HISTORY AJC is formed American Joint Committee for Cancer Staging and End Results Reporting AJC becomes the AJCC American Joint Committee on Cancer 3 rd Edition is published 5 years later. 1959 AJC is formed 1977 Edition 1 1980 AJC become AJCC 1983 2 nd Edition 1988 3 rd Edition 1990 s AJCC TNM is Standard AJC Cancer Staging Manual is published. AJCC Cancer Staging Manual, 2 nd Edition is published. 6 years In 1991, ACS/CoC required TNM Stage on all sites. In 1995, CoC required TNM Stage form to be completed & signed by the attending physician in the patient medical record. Per Vicki Chiappata and Donna Gress 4 SHORT HISTORY Four years after the publication of the 3rd Edition, the 4 th Edition is published. And another 5 years later, here comes the 6 th Edition. In 2016, the 8 th Edition was published. 1992 4th Edition 1997 5th Edition 2002 6th Edition 2010 7th Edition 2016 8th Edition Published 8 th Edition Effective Date 1/1/2018 Five years later, the 5 th Edition is released. It took 8 years between the 6 th and 7 th Editions as stage is becoming more complex. Initially slated to be come effective in 2017, the effective date was delayed to 1/1/2018 to allow the cancer registry community more time to prepare. 5 62S ECTION 2 The People and the Teams of AJCC, 8 th Edition 2
INTERNATIONAL COLLABORATION UICC Union for International Cancer Control 1000+ members 163 countries represented 48 partner organizations UICC TNM Stage AJCC AJCC United State and Canada 33 members represented 22 member organizations Including NCRA, NAACCR, NCI/SEER, CDC/NPCR Source: AJCC Cancer Staging Manual, 8 th edition; www,uicc.org; cancerstaging.org 7 TEAMS AJCC Editorial Board & Staff 16 Volunteers 6 Staff Core Teams Content Harmonization Evidence Based Medicine & Statistics Precision Medicine Imaging Data Collection (9 CTRs) Expert Panels 18 Expert Panels 8 PEOPLE BY THE NUMBERS Volunteers 550+ volunteers Many serving multiple roles Measurable Volunteer Hours 10/1/14 9/20/16: 5102 volunteer hours, includes only meeting time 9 Unknown hours: literature reviews and searches special projects and reports research writing, reading, editing time 3
ECTION 3 The Manual s Organization 103S WHICH PRINTING DO I HAVE? HOW CAN I TELL IF I HAVE THE 3 RD PRINTING? Check the Editorial Page for that information Page 7 11 EIGHTH EDITION 12 4
13 PREFACE The AJCC Cancer Staging Manual, 8 th Edition: Continuing to build a bridge from a population based to a more personalized approach. INTRODUCTION AND HISTORICAL OVERVIEW 14 PART 1: General Information on Cancer Staging and End Results Chapter 1: Principles of Cancer Staging Chapter 2: Organization of the AJCC Cancer Staging Manual Chapter 3: Cancer Survival Analysis Chapter 4: Risk Models for Individualized Prognosis in the Practice of Precision Medicine 15 5
Part II XVIII Each Part covers a Body System Expert Panels 10/18 panels had CTR representation (55.56%) Chapters site or disease specific Chapter Authors Similar look chapter to chapter Staging forms are NOT included AJCC Cancer Staging Form Supplement https://cancerstaging.org/referencestools/deskreferences/pages/cancer Staging Forms.aspx 16 CHAPTER FORMAT Chapter Summary Cancers that are staged AND not staged by that chapter Changes from 7 th Edition to the 8 th Edition Topography and Morphology Codes included in that Chapter Introduction 17 18 6
CHAPTER FORMAT Anatomy Rules for Classification 19 20 21 7
CHAPTER FORMAT Prognostic Factors Risk Assessment Models 22 23 CHAPTER FORMAT Definitions for AJCC TNM AJCC Prognostic Stage Groups Registry Data Collection Variable Histologic Grade Histological Type 24 8
25 26 CHAPTER FORMAT Survival Data (sometimes) Illustrations (sometimes) Bibliography 27 9
28 ECTION 4 Overall and Universal Changes 294S OVERALL AND UNIVERSAL CHANGES 30 Chapter Harmonization Prognostic Factors Included Post Neoadjuvant Stage in included Imaging Role Expanded Art / Photos no more Atlas needed 10
OVERALL AND UNIVERSAL CHANGES Chapter One Please reprint Chapter 1 from the AJCC Website for 1 st & 2 nd printings only There have been changes/clarification to the General Rules 31 The Breast Chapter Rewrite of the Breast Chapter done Please reprint Chapter 48 from the AJCC Website for 1 st & 2 nd printings only Multigene Panels, Genomic Profiles, etc Medical evidence OncoTypeDx Controversy Internal and External Other products available Medical evidence sunrising OVERALL AND UNIVERSAL CHANGES The Breast Chapter, cont. Prognostic Stage Tables Highly complex Initially some misses that revealed themselves Tables were revised and corrected Anatomic vs. Prognostic Stage Tables International staging and patient care issue Medical Deprived and Economically Deprived Countries Medical Appropriate and Medically Advanced Countries No Stage Grouping available for post neo adjuvant T N M 32 OVERALL AND UNIVERSAL CHANGES Staging Forms no longer included Documentation on forms not required Documentation anywhere in patient record EHR have built in forms available Available in the staging form supplement Errata 1 st and 2 nd printings share an errata 3 rd printing has a separate errata Updates will be available for Kindle Version for critical revisions 33 11
ECTION 5 The Editorial Process 345S EDITORIAL PROCESS Team of authors wrote and did the first run through of editing their sections. Editorial Board read and made recommendations to authors. AJCC Staff was also able to read and participate in the editorial process. Authors Expert Panels Editorial Board Back and Forth Staff Publisher Expert Panel members read and had a chance to provide editorial suggestions. This process went back and forth, sometimes multiple times. Publisher also had influence on the final outcome of the maual. 35 What s Next 366 12
NEWEST PRODUCT ebook Version Built on the Kindle Platform Kindle Compatible Devices Kindle app available for FREE download for Mac, PC s, Android and Apple Phones Available from Kindle, Amazon, COC website List $99.99 Access on multiple devices with same user name and password magic of syncing 37 NEWEST PRODUCT ebook Version Same look and set up of hard copy manual All errata to date of publication are included Updates will be available for Kindle Version for critical revisions Features Table of Contents click and forward Bookmarks, Notes > Notebooks Flashcards > Decks 38 39 13
40 41 FUTURE PLANS Staging Calculator to be announced Caution: Staging calculator are available in the electronic market Licensed Users vs Unlicensed Users Single Source of Truth Verify Verify Verify 42 14
THE ELEPHANT IN THE ROOM COURTESY OF PINTEREST 43 MISTAKES / LESSENS Mistakes were made Lessons have been learned Silos need deconstructing 44 Conclusion 1. About the MANUAL not about stage 2. Short History 3. People and Teams 4. Manual Organization 5. Overall and Universal Changes 6. What s next and ELEPHANTS 45 15
Our data has the power and strength to save these children s lives. 46 QUESTIONS???? theresa.vallerand@cioxhealth.com 910 939 9362 47 Thank you 48 16