Dare to Compare Vicki Hawhee, MEd, CTR March 27, 2019 Objectives - - PDF document

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Dare to Compare

Vicki Hawhee, MEd, CTR March 27, 2019

Objectives

Upon completion of the education, the participant will be able to:

• Delineate some of the major differences between 2018 and

pre-2018 data

• Identify some of the data items have not changed and are still

easily compared.

• Identify some of the data items may need to be redefined in
• rder to compare pre-2018 to 2018 and later.

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It all depends on how you look at it

2018 was a year of change

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What do we do first?

• Get down to the basics to find out what things have in

common – identify the commonality and differences

• We can compare and report, but knowing your data and what

is available is key

• ***Disclaimer – these are findings based on the population at

Moffitt Cancer Center, your results may vary

What has not changed

• DOFC, DOD
• Class of Case
• Address/race
• Primary Sites/laterality
• Systemic therapy
• Institution referred to/from
• Surgery codes
• Mets at dx

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Perspective

• 2017:
• Analytic [coc 00-22, 34, 36]

7856

• Non-analytic [including hx]

6450

• Total: 14306
• 2018 so far:
• Analytic [coc 00-22,34,36]

7774

• Non-analytic [including hx]

5666

• Total YTD: 13440
• (Currently we are working on the first week of September

2018, so these numbers will continue to rise)

How many new breast cancer cases did we see in 2018 compared to 2017

• In 2017, we saw 1287 NEW analytic breast cancer cases (from

the 7856 total new analytic cases) = 16.38%

• In 2018, cases abstracted so far we saw 1282 NEW analytic

breast cases (from the 7774 total new analytic cases) = 16.49%

• Date of First Contact
• Primary site Breast
• Class of case </= 22

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How many of our analytic pancreas cases had chemotherapy at our facility

• 2017 – 235 new analytic pancreas cases (new 7856 = 3%)
• 142 received chemo at our facility (60.4%)
• 2018 - 255 new analytic pancreas cases (new 7774 = 3.3%)
• 138 (SO FAR) received chemo at our facility (54.1%)
• Date of First Contact
• Pancreas Primary Site
• Chemotherapy at our facility
• Class of case </= 22

Solid Tumor Manual

• Many changes that will affect:
• New cases/recurrence
• Histology
• There is no blanket rule for comparisons; you must consider

the rules based on the site specific instructions

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Malignant Brain Tumors

• MPH
• Rule M6 Abstract as a single primary when a patient has a

glioblastoma multiforme (9440) following a glial tumor.

• STM
• Rule M6 Abstract multiple primaries when a patient has a

glial tumor and is subsequently diagnosed with a glioblastoma multiforme 9440 (GBM).

• 2017 2018
• Analytic brain cases 94 100 (19 not abstracted)
• GBM 60 (64%) 67 (67%)

Histology

• There were many new ICD-O-3 codes added in 2018 (171 new

terms, 63 new codes), as well as some major changes to the histology rules in the solid tumor manual.

• Two of the biggest histology changes in the STM were:
• No longer coding the polyp as part of the histology for colon

adenocarcinomas

• No longer using ambiguous terms to assign the histology for

breast invasive ductal carcinoma

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Colon adenocarcinoma in a polyp

• 2018
• 8140 Colon Adenocarcinoma - 153 cases (so far) (2% of total cases)
• 8210 – 6
• 8263 – 9
• 8261 - 0
• 2017
• 8140 – Colon adenocarcinoma - 73 cases (0.93% of total cases)
• BUT add the polyp diagnoses
• 8210 – 30
• 8263 - 33
• 8261 - 4
• Total of 140 cases (1.8% of the total cases)

8500 – Ductal Carcinoma/Carcinoma NST

• In 2017, we saw 1287 NEW analytic breast cancer cases
• 826 were coded to 8500 (64.18%)
• In 2018, cases abstracted so far we saw 1282 NEW analytic breast cases
• 1043 were coded to 8500 (81.36%)
• To compare <2018 ductal carcinomas of the breast, you would have to include all

the possible histologies

• 2007 MPH Rules for Breast: The specific histology may be identified as type,

subtype, predominantly, with features of, major, or with ____ differentiation, architecture or pattern. The terms architecture and pattern are subtypes only for in situ cancer.

• 2018 – Solid Tumor Rules -
• Subtypes/variant, architecture, pattern, and features ARE NOT CODED. The

majority of in situ tumors will be coded to DCIS 8500/2.

• The invasive subtype/variant is coded ONLY when it comprises greater than 90%
• f the tumor. This change has been implemented in both the WHO and in the

CAP protocols.

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Grade

• Old grade was 1 data item, now 3
• Generic grade categories, which refer to the grade definitions that have been

used by the cancer registry field for many years, are used for:

• • AJCC chapters where the preferred grading system is not available and the

generic grade categories are available o e.g., Breast, Prostate, Soft tissue

• • AJCC chapters that do not have a recommended grade table o e.g.,

Nasopharynx, Merkel Cell, Melanoma, Thyroid

• • Primary sites that do not have an AJCC chapter o e.g., Digestive other, Middle

ear, Trachea

• In years past, these categories were assigned code numbers 1-4. Beginning with

cases diagnosed in 2018, registrars will use codes A-D. Numeric codes are being reserved to record grades recommended by AJCC. However, code 9 will continue to be used for unknown for all cases.

• Prior to 2018

Description 2018 and forward

• 1

Well differentiated A

• 2

Moderately differentiated B

• 3

Poorly differentiated C

• 4

Undifferentiated, anaplastic D

• 9

Unknown 9

Example of Grade you can compare

• Nasopharynx
• Clinical Grade NAACCR #3843
• CODE

DESCRIPTION

• A

Well differentiated

• B

Moderately Differentiated

• C

Poorly Differentiated

• D

Undifferentiated, anaplastic

• 9

Grade cannot be assessed, unknown

• So you can compare a grade from 2014-2017 of moderately

differentiated (2) with the new code of (B).

• Additionally, you can use the conversion tables if you had an

intermediate differentiation or partially differentiated to convert this to a B and allow you to compare 2 to B.

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Example of grade you cannot compare

• Corpus carcinoma/carcinosarcoma
• 2018 Grade codes
• Code Description
• 1

G1; FIGO Grade 1, G1: Well differentiated

• 2

G2; FIGO Grade 2, G2: Moderately differentiated

• 3

G3; FIGO Grade 3, G3: Poorly differentiated or undifferentiated

• 9

Grade cannot be assessed (GX); unknown

• Grade instructions 2014-2017
• DO NOT USE FIGO GRADE to code grade

Radiation

• New data items:
• Phases
• Primary treatment volume
• Rad to draining LN
• TX Modality
• EB planning technique
• Although the 2018 implementation of new radiation data items and

terminology sounds extensive, the information being collected is very similar to what is already being collected in CoC-accredited facilities. As a result, conversion/mapping of values from historical radiation data items will occur upon upgrade to v18-compliant software, and once upgraded only the new data items will be displayed and abstracted within the v18-compliant software. Please find a link to the radiation conversion specifications below. https://www.naaccr.org/data-standards-data-dictionary/

• FORDS to STORE Radiation Data Item Conversion

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Radiation Data Items

• FORDS
• Rad tx volume (45 volumes)
• Reg Tx modality (29) – Mix of new modality and EB planning

technique

• STORE
• Tx volume (69 volumes)
• Modality (17)
• EB Planning technique (12)

Radiation

• FORDS 2016:
• Code IMRT or conformal 3D whenever either is explicitly

mentioned (so modalities of photons, electrons, etc., would not be available to compare)

• STORE
• Photons, electrons, etc. will be coded in modality
• IMRT/3D will be coded in EB planning technique

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Examples of comparisons

• FORDS 2016

STORE 2018

• Modality IMRT

EB planning technique IMRT

• Modality 3D conformal

EB planning technique 3D conf.

• Modality HDR intracavitary

Modality HDR intracavitary

• Modality I-131

Modality Radioisotopes

• Modality SRS (FSRT)

EB Plan technique SRS(FSRT)

• 2017 Analytic cases with:

2018 (so far)

• 1033 IMRT

867

• 596 3D conformal

592

• 32 Regional HDR intracavitary

72

• 55 Boost HDR intracavitary
• 53 I-131

40 (radioisotopes NOS)

• 105 SRT/FSRT

151

Summary Stage

• Per the Summary Stage 2018 implementation webinar:
• https://education.naaccr.org/2018-implementation
• Summary Stage designed to be as stable as possible over
• time (1973 forward)
• Lymphoma – 5 is no longer available, code now to 2
• Summary Stage is used to look at trends in rates overtime
• by stage (since AJCC changes)
• Can continue to compare Summary Stages for different years

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AJCC Stage

• Changes every time the edition changes
• AJCC every 7-8 years
• Consider using T, N or M instead of stage group
• You can still compare by T, N, M or stage group – it will just be

the classification or stage group that was determined at that point in time.

AJCC Breast Staging

• Breast Cancer - Pathological Stage
• 2017 (1287)

2018 (1282 so far)

• Stage 0

216 188

• Stage 1

475 (36.9%) 667 (52%)

• Stage 2

279 (21.7%) 105 (8.2%)

• Stage 3

94 (7.3%) 44 (3.4%)

• Stage 4

54 38

• NOTES:
• LCIS no longer is stage 0 (still reportable but not staged)
• Stage 1+2 = 58.6% (2017) and 60.2% (2018)

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Colon Cancer Staging

• Colon malignancy – Analytic cases
• Pathologic Stage Group

2017 2018

• I 19 17
• II 33 29
• III 33 50
• IV 52 48

SSF- SSDI

• From the SSDI Manual:
• Number of SSDIs compared to CS SSFs
• • Approximately 260 unique CS SSFs in CSv0205
• • 101 discontinued
• • 12 obsolete
• • 147 required
• • Of these, 27 are not required for 1/1/2018+
• • 120 SSDIs added to the NAACCR v18 layout

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NAACCR SSDI Manual; Appendix B

More Appendix B

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Comparable SSF/SSDI examples

• Colon - tumor deposits, MSI, CRM, PNI, KRAS
• Liver - AFP, fibrosis score, creatinine, bilirubin, INR
• Lung – separate tumor nodules, pleural invasion
• Sarcoma - bone invasion
• Melanoma – Breslow thickness, ulceration, LDH, mitotic rate
• Breast – ER/PR, HER-2, multigene panel
• Female sites – FIGO stage
• Prostate – Gleason score/patterns, PSA
• Urinary sites – WHO Grade (now a grade item, not an SSDI)

Examples of no matching SSDI

• Esophagus - Specific location of tumor
• Stomach - CEA, CA19-9
• Small intestine – Crohn disease, MSI
• Pancreas – CA19-9, CgA, mitotic count
• Brain – Ki-67, Karnofsky

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Mark Twain, author