FALL 2021
Welcome to NCRA’s
Strategic Alliances & Advocacy News

Recognizing NCRA’s work with its strategic partners requires timely communications with members, NCRA has established the e-brief to highlight key updates and news from its work with industry partners.

The content covered will be from NCRA’s formal liaisons to partner organizations and Adam Ebbin, NCRA’s Public Policy and Strategy Consultant. NCRA may also include information from its federal partners at the CDC and NCI on occasion.

If you have any questions or need additional information about issues outlined in this issue of the Strategic Alliances & Advocacy News, email policystaff@ncra-usa.org.
NCRA Strategic Alliances
High-Level Strategic Group (HLSG) and Mid-Level Tactical Group (MLTG) 
NCRA's HLSG Liaison: Nadine Walker, MS, CTR
NCRA's MLTG Liaison: Jennie Jones, CTR, MSHI-HA, CHDA

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 already begun collecting information around changes planned for v23 to ensure any updates align with essential timelines.

One of the highest priorities this year has been around the NCDB surgery code changes. The 2022 STandards for Oncology Registry Entry (STORE) manual is posted on the National Cancer Database (NCDB) Call for Data website. It is effective for all cases diagnosed January 1, 2022 forward.

Important changes to breast surgery codes can be found starting on page 29. Four new custom data items/User Defined Fields (UDFs) will be collected for breast for diagnosis year 2022 only.
The two breast surgery data items listed below record the breast surgical procedure performed at this facility [10104] and at any facility [10105]. These codes have been created to be pulled directly from the Breast Synoptic Operative Reports, while using a new 4-digit alphanumeric coding structure. All reconstruction procedures have been pulled out of this code set and have been included in the two new data items described in the next section. In 2023, all surgery codes in Appendix A will be converted to the new 4-digit alphanumeric code sets.
  • Rx Hosp—Surg Breast [10104] – Coding Instructions, page 223
  • Rx Summ—Surg Breast [10105] - Coding Instructions, page 226

The two breast reconstruction data items listed below record the immediate reconstruction procedure performed the same day as the surgical procedure at the reporting facility [10106] and at any facility [10107]; breast reconstruction was previously collected within the breast surgery codes. The NCDB is collecting these data items to support the Synoptic Operative Reports, and to allow for more descriptive reconstruction codes. This is being collected in anticipation of a breast reconstruction Site-Specific Data Item (SSDI) in 2023.
§    Rx Hosp—Recon Breast [10106] - Coding Instructions page 229
§    Rx Summ—Recon Breast [10107] - Coding Instructions page 231
Additional changes to surgical procedures can be found in the STORE 2022 Manual Summary of Changes chapter (p.33) and in the NAACCR Implementation Guidelines.

Additional STORE Surgery Code Changes
The following surgery codes (in Appendix A) from Site-Specific Surgery Codes for Colon, Rectosigmoid, Anus, and Rectum have been removed as obsolete treatment for these primary sites:
  • 11 and 21 Photodynamic Therapy (PDT);
  • 13 and 23 Cryosurgery;
  • 14 and 24 Laser Ablation;
  • 25 Laser Excision.
The word Wedge was removed from Rectum and Rectosigmoid Surgical code 30. The Miles Procedure was removed from Rectum Surgical code 50 and Anus Surgical code 60. The phrase Total mesorectal excision (TME) was removed from Rectum Surgical code 30. All changes are effective with cases diagnosed January 1, 2022 and forward.

A December 15 CAnswer Forum LIVE training webinar will be focused on the 2022 STORE changes. Registration for this webinar can be found here.

Thanks to all of the diligent cancer registrars for your continued efforts in keeping up with changes and clarifications. Thanks to the many cancer surveillance organizations for your continued efforts in keeping the community updated to ensure the capture of high-quality data. We are all working towards a common goal of capturing high-quality data for utilization as the cornerstone of many crucial efforts in reducing the burden of cancer.
American College of Surgeons (ACoS) Cancer Surgery Standards Program (CSSP) 
NCRA’s CSSP Liaison: Nadine Walker, MS, CTR

Updates on Educational Resources from the CSSP: CoC Operative Standards 5.3–5.8

With 2022 fast approaching, Commission on Cancer (CoC)-accredited programs should be well on their way to integrating the required elements/responses in synoptic format into operative reports for Standards 5.3–5.6 (Sentinel Node Biopsy for Breast Cancer, Axillary Lymph Node Dissection for Breast Cancer, Wide Local Excision for Primary Cutaneous Melanoma, and Colon Resection) from the Optimal Resources for Cancer Care (2020 Standards). In addition to the technical requirements, Standards 5.3, 5.4, 5.5, and 5.6 require operative reports to include specific elements and responses in synoptic format, and programs must achieve 70% compliance starting January 2023. Compliance with Standards 5.7 and 5.8 (Total Mesorectal Excision and Pulmonary Resection) will be assessed starting with 2022 site visits, and programs must achieve 70% compliance in 2021. Programs are strongly encouraged to conduct internal audits of applicable cases to identify and resolve gaps in compliance for the operative standards.

The Cancer Surgery Standards Program (CSSP) will hold a webinar on Wednesday, November 17 from 3:00-4:00pm CT on CoC Standards 5.3 and 5.4 for breast cancer. During this webinar, a multidisciplinary panel will review the requirements and purpose of CoC Standards 5.3 and 5.4, the role of evidence-based standards in improving outcomes for patients with cancer, and best practices for achieving compliance with these standards. Registration is required and all are welcome to attend. For those unable to join the live event, the recording and slides will be posted to the Operative Standards Toolkit.

The CSSP continues to develop educational resources to support CoC programs in achieving compliance with the CoC Operative Standards. We recommend that all registrars at CoC-accredited cancer programs review and share the following resources with their staff.

We encourage you to visit the Operative Standards Toolkit for the most up-to-date list of resources. New resources and upcoming events will also be shared through the Cancer Programs News as they become available. Questions can be sent to cssp@facs.org. 
American College of Surgeons Commission on Cancer (COC)
NCRA’s CoC Liaison: Cheryl Sheridan, RHIT, CTR 

Reminder to Complete QPort Site Profile and Site Contact Pages

CoC-accredited programs now have access to the Site Profile and Site Contact pages in the QPort. Baseline information has been copied over as part of the conversion process.

The Site Profile is used to capture key information about your hospital/cancer program to facilitate the accreditation process. Site Contact provides access to QPort and the Rapid Cancer Reporting System (RCRS) for key roles in your cancer program.

Programs should log into QPort at their earliest convenience and review both sections to confirm that all information is current and complete any new fields. You will use the same login credentials you used for CoC Datalinks. Please note: Only the primary contact may make edits to user access.
All programs must review and update information in the Site Profile and Site Contact pages by December 10, 2021.
 
NCDB Surgery Code Changes: November 2021 Update
The 2022 Standards for Oncology Registry Entry (STORE) manual is posted on the National Cancer Database (NCDB) Call for Data website and can be found under “New Data Standards for 2022.”
The 2022 STORE manual is effective for all cases diagnosed January 1, 2022, forward.
 
COC 100th Anniversary Celebration
We invite accredited programs and member organizations to join our celebration by promoting the CoC 100th Anniversary. To help you with those efforts, the COC has developed anniversary-themed marketing materials, including template newsletter articles, posters, and social media graphics (#CoC100). The materials can be downloaded from the COC website. CoC-accredited programs also can access the materials in QPort (click on Resources and scroll to the bottom of the page for marketing resources).
In addition, we welcome your perspectives on the CoC’s 100th Anniversary. Let us know what it means to you to be part of a CoC-accredited cancer program, how the accreditation process has benefited your program and your patients, or why CoC membership is important to your organization. Please send your brief (up to 500 words) perspective to mleeb@facs.org for possible inclusion in a future issue of Cancer Programs News.
 
Download CoC 100th Anniversary Commemorative Booklet
Throughout the past century, the work of the CoC (and its predecessors, starting with the Committee for the Treatment of Malignant Diseases in 1922) has been featured in the pages of the Bulletin of the American College of Surgeons. The CoC has created a downloadable commemorative booklet that highlights the major Bulletin articles from each decade, along with a forward from CoC Chair Timothy Mullett, MD, FACS. You can find the booklet on the CoC 100th Anniversary website.
 
Save the Date: 2022 ACS Cancer Accreditation Programs Conference
Save the date for the ACS Cancer Accreditation Programs: Continually Advancing Quality Cancer Care conference on May 20–22, 2022. This will be a hybrid event, offering live in Denver, CO, and virtually across the country.

The conference will include education on CoC and National Accreditation Program for Rectal Cancer (NAPRC) standards, implementation, and best practices. In addition, there are plans for a full day of content on the new standards for NAPBC programs.
National Cancer Database (NCDB)
NCRA’s NCDB Liaison: Vicki Hawhee, MEd, CTR
 
The NCDB Steering Committee is a panel of multi-disciplinary experts including clinicians, a CTR, a health policy researcher, and several quantitative data analysts. The committee meets at minimum on a quarterly basis to set NCDB governance, research policy, and to evaluate best practice for special data requests and special studies including data capture. To date, the committee has reviewed several research collaboratives including appropriate-use agreements. In addition, an evaluation of the impact of follow-up > 15 years was reviewed by the committee.  A manuscript regarding long-term follow-up in the NCDB has been accepted to Annals of Surgical Oncology. The paper discusses the value of long term follow up as measured by data completeness versus follow up effort.
 
The tentative citations are as follows:
Brajcich BC, Palis BE, McCabe R, Nogueira L, Boffa DJ, Lum SS, Harris JB, Hawhee V, Mullett TW, Bilimoria KY, Nelson H. Twenty-five Years of Cancer Follow-up; Is the Data Worth the Effort? Ann Surg Oncol. In Press, 2021.
National Accreditation Program for Breast Cancers (NAPBC)
NCRA’s NAPBC Liaison: Cynthia Boudreaux, LPN, CTR
 
NAPBC - Timeliness to Care Projects Task Force

NAPBC leadership is steadily focused on ways to enhance the quality-of-care Breast cancer patients receive from the time of diagnosis through survivorship.

The taskforce will work to advance three timeliness to care projects/studies to identify best practices that can enhance the quality of care provided by NAPBC accredited centers.

Overall, the taskforce has outlined a few focus areas which include:
  • Establish best practice timelines concerning diagnosis and treatment
  • Examine centers performance concerning best practice timelines established around diagnosis and treatment
  • Examine the impact timeliness of care has on short term (cancer stage, treatment) and long-term care outcomes (survival). 
North American Association of Central Cancer Registries (NAACCR) 
NCRA's NAACCR Liaison: Heather Stabinsky, MS. Ed, CTR

While registrars are in the grips of reporting diagnosis year 2021, several NAACCR work groups have their eyes on the future. The NAACCR Implementation Guidelines Task Force posted the “NAACCR 2022 Implementation Guidelines and Recommendations, Version 1.0” to the NAACCR website: www.naaccr.org/implementation-guidelines in July 2021. Updates to the document were added in August and September. These guidelines provide an overview regarding changes in cancer surveillance reporting standards the various stakeholders will need to consider for 2022 diagnoses.
 
The NAACCR Uniform Data Standards (UDS) Workgroup is currently discussing the issues surrounding additions and changes to data fields for 2023. Several data items were approved for retirement including a number of Data Flag fields, SEER Record Number (#2190), SEER Coding System- Original (#2130), SEER Coding System Current (#2120), ICD-02 Conversion Flag (#1980) and SEER Follow up Source (#2180). Additional approvals were made to add new abbreviations to Appendix C (http://datadictionary.naaccr.org/default.aspx?c=13&Version=22 ). The removal of “Oriental NOS” (Race code 96) will occur for 2023 also and a sub-work group was initiated to review all Race codes. The UDS Workgroup continues to review options for additional surgery codes and codes for “nonbinary” in the Sex data field.
 
Are you interested in volunteering at a national level? NAACCR continues to look for cancer registry professionals interested in make connections with other members who share the same interests. If you are interested in finding out more about NAACCR’s volunteer opportunities, please submit your information at https://www.naaccr.org/member-ambassador-program/. You can also send an email to info@naaccr.org.
Cancer PathCHART
NCRA’s Cancer PathCHART Liaison: Janet Reynolds, BA, CTR
 
To date, there is no globally unified resource across varying tumor classifications and coding systems, components of which are generated by different standard setting organizations. To address these gaps, the College of American Pathologists (CAP) and the National Cancer Institute’s Surveillance Research Program (NCI/SRP) that oversees the Surveillance, Epidemiology, and End Results (SEER) cancer registry system have developed collaborations with other organizations involved with the creation and utilization of tumor classifications; tumor morphology and behavior coding schemes; topography codes; default grading systems; and diagnostic, prognostic, and predictive biomarkers to produce an integrated, relational database that links histology terminology with tumor topography, morphology, behavior and histologic grade codes and descriptions across versions of:
  • WHO Classifications of Tumours
  • WHO International Classification of Diseases for Oncology
  • CAP protocols and electronic Cancer Checklists (eCCs)
  • Histology terms and codes included in AJCC Cancer Staging Manual editions
  • SNOMED
  • ICD-10 CM

The Cancer Pathology Coding Histology and Registration Terminology collaborative effort will coordinate the data products of participating organizations drawing from the database as a standard; decrease the timeline for implementation of changes in histologic diagnosis by the registry community; improve public health data quality obtained through cancer surveillance; and bridge the gap between clinical language and surveillance codes.

The three main work products planned for the initial 12-18 month phase are:
  • histology lookup table including updates for 2023 and going back through time across diagnosis years
  • updated site/histology combination lists (valid, unlikely/rare, inaccurate and impossible combinations)
  • download designs and functionalities to provide content to software vendors.  
Public Policy and Strategy 
NCRA’s Public Policy and Strategy Consultant: Adam Ebbin 

NCRA Confronts VA Reporting Issue
NCRA is continuing its advocacy for a legislative solution to the lack of reporting of cancer statistics by Veterans Affairs healthcare facilities to many states’ central cancer registries. According to 2017 data, the estimated number of veterans diagnosed with cancer each year is more than 26,000. The Centers for Disease Control (CDC) estimates that data on as many as 7% of those cases of cancer among veterans are not reported, with the most significant numbers of unreported cancers being prostate, lung and colorectal.
 
Reporting all veteran’s healthcare facility (VHF) data to state cancer registries will provide more complete data for healthcare providers, public health officials, and researchers to measure cancer occurrence and trends at the local and national level as well as inform and prioritize cancer educational and screening programs, evaluate efficacy of prevention efforts and treatment, determine survival rates, conduct research, ensure quality and equity in cancer care and plan for health services.
 
We have briefed several congressional offices on this issue and are happy to report that one senator's office is working with us on drafting a bill to make all VHF's mandatory reporters. We are hopeful that this will be a hot topic during our 2022 NCRA "Walk on the Hill." Slated for April 7, in conjunction with NCRA's Annual Educational Conference, the Walk on the Hill is a chance to help amplify our priorities by meeting with your senators' and representative's officers. You can sign up when registering for the 2022 conference. Be on the look-out for the conference registration brochure in mid to late December.
Stay up to date with all NCRA advocacy activities at www.ncra-usa.org/advocacy