Public Policy and Strategy

NCRA’s Public Policy and Strategy Consultant: Adam Ebbin

NCRA Partners with NAACCR in Support of Counting Veterans' Cancer Act

NCRA achieved a longstanding goal with the mid-June introduction of the Counting Veterans Cancer Act (S.1994) sponsored by Senator Mark Kelly of Arizona and Thom Tillis of North Carolina.  The bill would ensure that veterans’ cancer cases are fully accounted for in state and national cancer registries. We co-issued a press release with the North American Association of Central Cancer Registries (NAACCR) saluting the sponsors.

It is estimated that each year, tens of thousands of cancer cases among veterans are missed by the central registries that form the foundation of U.S. national cancer research. “Senators Kelly and Tillis’ legislation will help identify cancer-related disparities among veterans, improve the understanding of the cancer-related needs of veterans and increase opportunities for veterans with cancer to be included in clinical trials, cancer-related research, and analysis,” said Lori Swain, Executive Director of NCRA.

Next steps include enlisting support from other organizations and generating emails from NCRA members who live in home states of Senators who serve on the Veterans Affairs Committee. 



Stay up to date with all NCRA advocacy activities at www.ncra-usa.org/advocacy.

College of American Pathologists (CAP)

NCRA’s CAP Liaison: Mildred Jones, CTR

Cancer Protocols

CAP Cancer Committee continues their diligent work on Cancer Protocols, which are released on a quarterly basis. The March 2023 release encompassed updates on 10 cancer protocols. Highlights of the content included various changes to the thyroid and ovarian protocols; biomarker notes and clarification for breast and GYN; histologic grade requirements for stomach resection; and explanatory notes for adrenal resection. The breast invasive biopsy now reflects the size of the largest invasive focus in a limited biopsy sample. The cervical resection and excision protocols were also revised to include content clarification, updates to LVI text, and TNM modifiers. In April 2023 an errata was released for the cervical resection regarding the incorrect section text for pTNM classification to AJCC v9. Please note that the staging classifications were not affected. 

The next release is scheduled for June 2023. This update will include content changes to five head and neck cancer protocols. The modifications impact histology types, grades and explanatory notes for oral, pharynx, major salivary glands, nasal, and paranasal sinuses. Also in this release, the protocol for breast invasive resection features changes to residual cancer burden following neoadjuvant therapy. The protocols revisions reflect the WHO 5th edition blue books. 



For summary of revisions and the current protocols, please go to Cancer Protocol Templates | College of American Pathologists (cap.org).

Cancer PathCHART

NCRA’s Cancer PathCHART Liaison: Janet Reynolds, BA, CTR 

Cancer PathCHART Continued Efforts

The Cancer PathCHART collaborative continues efforts to produce an integrated, relational database that links histology terminology with tumor topography, morphology, behavior and histologic grade codes and descriptions across versions of the WHO Classifications of Tumors, ICD-O, CAP cancer protocols and checklists, AJCC, SNOMED and ICD-10 CM.

The Implementation Workgroup recently selected several CTR volunteers to participate in two activities. The initial group will be involved in the review of possible, not likely/rare, or impossible combinations of site and histology as initially assigned through pathologist review.

Dr. Alison Van Dyke, Co-Chair of the Core Management Team, presented an update at NCRA’s annual conference, outlining the problems being addressed through this initiative, visions, and goals, planned work products and timelines, and the impacts on the daily work of the cancer registrar. Cancer PathCHART will have no impact on who does what on a daily basis in your registry but will provide a more streamlined process for implementation of this information within your cancer registry software. Cancer PathCHART will be aligned with the Solid Tumor Rules and Hematopoietic Database.

This multi-organizational collaboration has established a framework for interdisciplinary review of new entities and products as they are released, which will reduce the timeline to implementation. Cancer PathCHART is performing the first extensive update in over 15 years and identified outdated terms still being used in clinical practice. This standardization of terminology and histology coding will impact statistics and should improve public health data quality by reducing differences between WHO, pathology and cancer registration. 

American College of Surgeons Commission on Cancer (CoC)

NCRA’s CoC Liaison: Cheryl Sheridan, RHIT, CTR

Two valuable resources I do recommend you review frequently are:

#1- Cancer Program News email that is received monthly. For past publications you can review on this link: Cancer Programs News | ACS (facs.org).

In the most recent Cancer Program news email the ACS Quality Program asked for your assistance in preparation for a campaign that will roll out this summer. Please see the content below, in preparation for this campaign.

The ACS Surgical Quality Partner designation will be officially rolling out this summer. To launch the communications toolkit successfully, we need contact information for accredited programs’ marketing/ communications team and leadership.

Participants in an ACS Quality Program—including the Commission on Cancer (CoC), the National Accreditation Program for Breast Centers (NAPBC), and the National Accreditation Program for Rectal Cancer (NAPRC)—have earned the novel distinction of Surgical Quality Partner. Designation as a Surgical Quality Partner means that your institution is dedicated to surgical quality and is committed to maintaining high standards in surgical care.

To help showcase participation in ACS Quality Programs to your patients and community, a Surgical Quality Partner communications toolkit will soon be available. Programs will be able to use this online toolkit to highlight participation and display the ACS Surgical Quality Partner diamond in their hospitals. When patients see this distinctive mark, they will know they are receiving care at an institution that is committed to quality.

In order to keep the marketing contacts and CEOs at accredited programs informed about the Surgical Quality Partner designation rollout, the primary contact from each accredited program should:

1. Log in to the Quality Portal (QPort).
2. Navigate to “Site Contacts” using the left-hand side menu.
3. Add a new contact (or update an existing contact) and designate that person’s role as “Marketing Contact” or “CEO,” then click “Save.”

#2- A valuable resource for all accreditations is the QPort portal- I encourage you to review your QPort portal for all information regarding the Commission on Cancer accreditation. Click on resources (left-hand column); this has many documents, templates, instructions, and videos that will assist you in preparing for a successful accreditation.

Save the Dates:

ACS 2023 Quality and Safety Conference- July 10th-13th- Minneapolis, MN

ACS 2023 Clinical Congress- October 22nd-25th- Boston, MA 

ACS 2024 Cancer Conference- February 22nd-24th- Austin, TX 

National Cancer Database (NCDB) Special Studies Committee

NCRA's CoC Special Studies Group Liaison: Vicki Hawhee, M. Ed, CTR

Reviewing Proposals for PUF files and R01 Grant requests 

The NCDB Steering Committee continues to meet monthly and reviews proposals for modified PUF files, R01 grant data requests and Special Studies from a variety of investigators. The NCDB Steering Committee reviewed six requests for modified research files since January 1st, in addition to reviewing an R01 grant submission that will make use of NCDB data. Of those requests, all but two were approved by Steering to move forward.  

Cancer Surgery Standards Program (CSSP)

NCRA’s NAPBC Liaison: Nadine Walker, MS, CTR

New Resources from the Cancer Surgery Standards Program

The Cancer Surgery Standards Program (CSSP) is continually producing resources to support increased program compliance with the CoC Operative Standards. It’s recommended that all registrars at CoC-accredited cancer programs review and share the recently released resources below with their colleagues. 

• Educational Videos
• The CSSP recently completed its series of brief videos summarizing the requirements for best practices and compliance with CoC Standards 5.3-5.8. 
• CoC Standard 5.3: Sentinel Node Biopsy for Breast Cancer & CoC Standard 5.4: Axillary Lymph Node Dissection for Breast Cancer video
• CoC Standard 5.5: Wide Local Excision for Primary Cutaneous Melanoma video
• CoC Standard 5.6: Colon Resection video
• The CSSP is also developing videos focused on the technical aspects of cancer surgery. The following videos are focused on lung cancer surgery and will help providers achieve compliance with CoC Standard 5.8.
• Lymph Node Station Identification for Right-Side Chest Cancer Surgery video
• Lymph Node Station Identification for Left-Side Chest Cancer Surgery video
• Educational Articles
• An article recently published in Surgery article “Operative standards for sentinel lymph node biopsy and axillary lymphonodectomy for breast cancer: review of the American College of Surgeons commission on cancer standards 5.3 and 5.4” provides a review of CoC Standards 5.3 and 5.4.
• In an article recently published in Clinical Lung Cancer, “A National Survey of Surgeons Evaluating the Accuracy of Mediastinal Lymph Node Identification,” authors from the ACS Cancer Research Program (CRP) surveyed cardiac, thoracic, and general surgeons assessing implementation of CoC Standard 5.8.
• In an editorial recently published in the Journal of the American College of Surgeons, “Setting the Standard for Cutaneous Melanoma Wide Local Excision: An Overview of the American College of Surgeons Commission on Cancer Standard 5.5,” authors from the CSSP review the objectives of CoC Standard 5.5.
• 
  

The Cancer Surgery Standards Program works to educate surgeons on the technical aspects of surgery and operative report documentation. Registrars are encouraged to share the following resources with the surgeons on staff at their facility.

• CSSP Cancer Surgery Protocols
• New CSSP cancer surgery protocols on lung cancer, thyroid cancer, and pancreas cancer are available on the Amazon Kindle store. 
• Operative Standards of Cancer Surgery, Volume 3 – Individual disease sites sections.
• Individual copies of the Sarcoma, Adrenal, Neuroendocrine, Peritoneal Malignancies, Urothelial, and Hepatobiliary sections are available for purchase on the Amazon Kindle store.

Please visit the Operative Standards Toolkit for the complete list of resources. Reach out to  cssp@facs.org if you have any questions.

Acknowledgements: Submitted in partnership with CSSP staff.

High-Level Strategic Group (HLSG)/Mid-Level Tactical Group (MLTG)

NCRA’s HLSG Representative: Karen Mason, MSc, RN, CTR

NCRA’s MLTG Representative: Jennie Jones, MSHI-HA, CHDA, CTR

Changes to Data Items

The purpose of the HLSG and MLTG is to ensure high-level coordination among all cancer surveillance organizations regarding the development and implementation of significant changes in cancer data collection standards and procedures. 

The MLTG and HLSG ensure collaboration amongst standard setters to closely monitor and review release and completion dates for the NAACCR Standards Volumes implementation and other standard setters’ updates. This collaboration helps to ensure harmonization with updates and changes via a systematic process to ensure that they are implemented in a timely fashion. The MLTG has developed a new pilot process for efficient and effective field-testing process to help inform the group when evaluating new and revised data items. The MLTG has already begun collecting information around changes planned for v25 to ensure any updates align with essential timelines. 

As a result of the proactive work amongst the HLSG and MLTG, NAACCR has a Version 23 Reference page where you can find information related to data collection requirements for 2023. The link to the v23 reference page can be found here: https://www.naaccr.org/v23referencepage.

V23 Summary of Changes

Below is a brief summary of the changes approved by the High-Level Strategic Group (HLSG) for implementation beginning with 2023 diagnoses. More detailed instructions will be available in the NAACCR Implementation Guidelines at www.naaccr.org. Please note: All registrars should check with their state/central registry for additional information on reporting requirements. American College of Surgeons-Accredited cancer programs should refer to the appropriate program standards for additional requirements.

Changes to Existing Data Items

New Data Items

In addition to the changes listed above, all standard setters agreed to retire 41 data items, including all date flags (e.g., Date 1st Crs RX COC Flag). These data items will be removed from the NAACCR layout and will no longer be collected beginning with v23, regardless of year of diagnosis. 

This document is intended for informational purposes only and should not be used as a reference document. Always consult the appropriate standard-setter materials and manuals.

* Special thanks to Stephanie Hill at NAACCR for the v23 Summary of Changes and all the members of the HLSG and MLTG.

Technical Advisory Group (TAG)

NCRA’s TAG Liaison: Amy Kendall, CTR

The Link Between Registrars and Critical Decisions that Impact Cancer Registry

NCRA has volunteer liaisons serving on various committees with multiple partner organizations (e.g., AJCC, CAP, CoC, NAACCR, and NAPBC) working together on overarching matters of cancer surveillance, including the High-Level Strategic Group (HLSG), Mid-Level Tactical Group (MLTG), and the Technical Advisory Group (TAG). As your liaison to the TAG, I wanted to share more about this important group and NCRA’s historical involvement with TAG. 

The TAG is a group of individuals who represent the various standard setters within the cancer surveillance community. The focus of the group is to reconcile discrepancies in reporting or coding rules between standard setters. The group is comprised of representatives from CoC, NCI-SEER, CDC-NPCR, CCR (Canadian Cancer Registries), NAACCR, and NCRA. NCRA has had a TAG liaison since 2014, and I am in my fourth year serving in this role. The group meets via Zoom on a monthly basis to address questions and possible solutions to issues that are brought to the attention of the members, some of which include coding clarifications or data collection discrepancies. NCRA’s involvement with TAG serves as a linkage for registrars to be aware of and involved with critical decisions that impact the cancer registry community. Through my representation on TAG, cancer registrars and NCRA engage with various standard setters as the implementation of key decisions by standard setters are considered. My goal is to represent the abstracting community and help provide context on how we interpret rules and apply them to our goal of quality abstracting.