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Survey Savvy, Save the Date!

Survey Savvy is back for 2011!  The next Survey Savvy Workshop will be held in Chicago, IL on Thursday, March 3, 2011 and Friday, March 4, 2011.  The registration fee will be $600 per person for this two-day workshop and the hotel rate will be $149 per night plus applicable taxes.  Registration is not open at this time.  More details and registration information will be available in upcoming issues of the CoC Flash.

News from the American Joint Committee On Cancer (AJCC)
Modification of the CS Testis Schema

Since the publication of the AJCC 7th edition, important information related to the capture of serum tumor markers has been brought forward to the AJCC chapter authors.  There is consensus among the experts in testicular cancer that serum tumor markers should be measured AFTER orchiectomy to assign the S category in all stages of disease. The experts offer the following explanation:  Since AFP and hCG are cleared from the blood at half-lives of 5-7 days and 1-3 days respectively, post-orchiectomy levels of AFP and hCG need to be serially measured until they either return to normal, plateau, or rise. If marker levels before orchiectomy were used, then many patients would be misclassified as having greater than S0 disease, when they have actually a lower S stage (even S0) including many who will be misdiagnosed with clinical stage IS disease. Misclassification of Stage IA or IB as IS would mean that the patient would get chemotherapy when they may well need no further intervention of any kind after orchiectomy.
An erratum to the testis chapter has been issued as follows:

Serum tumor marker levels should be measured prior to orchiectomy, but levels after orchiectomy are used for assignment of S category, taking into account the half life of AFP and hCG. Stage grouping classification of Stage IS requires persistent elevation of serum tumor markers following orchiectomy.
The Serum Tumor Markers (S) category comprises the following:
•    Alpha fetoprotein (AFP) – half life 5-7 days
•    Human chorionic gonadotropin (hCG) – half life 1-3 days
•    Lactate dehydrogenase (LDH)

Based on this information, the CSv2 Testis schema requires modification which will be completed for the next release (late 2010). It will include more site-specific factors to capture post-orchiectomy serum tumor marker information. In the meantime, the following recommendations are being made for registrars when capturing testis cases with CSv2:

•    Continue to enter the PREorchiectomy lab values and interpretations (SSFs 6-10) and the Persistence of Elevated Serum Tumor Markers (SSF 11).
•    Document in text fields in the abstract the POST-orchiectomy lab values and interpretations for the corresponding serum tumor markers (if available) using the same values currently listed in SSF 6-10. Regarding serum tumor marker half-lives, if the first post-orchiectomy serum tumor marker remains elevated, it may be necessary to locate subsequent tests to see if the marker normalizes. One month post-orchiectomy is usually sufficient time in order for normal half-lives to occur but it is also dependent upon other personal medical factors and how high the original test value was.
o    Example: Feb. 20  Pre-orchiectomy AFP 276 ng/ml (normal < 9 ng/ml)
Pre-orchiectomy hCG 1934 mIU/ml (normal < 5 mIU/ml)
Pre-orchiectomy LDH 168 (normal 100-225)
March 26 Orchiectomy performed
April 17 Post-orchiectomy AFP 14 ng/ml (normal < 9 ng/ml)
Post-orchiectomy hCG < 5 mIU/ml (normal < 5 mIU/ml)
Post-orchiectomy LDH 134 (normal 100-225)
April 25 2nd Post-orchiectomy AFP 6 ng/ml (normal < 9 ng/ml)
The serum half-life of AFP = 5-7 days; therefore, we should expect the 276 value to “halve” in that timeframe to approximately 138 or less. Then, in another 5-7 days, we should expect the 138 value to “halve” to approximately 69 or less, etc. Since the post-orchiectomy AFP in the above example was first performed 3 weeks after surgery, it may have been too soon for the level to normalize. Therefore, the second post-orchiectomy AFP value (normal) would be used to assign the “S” category and stage.
•    In addition to the post-orchiectomy lab values and interpretations, other items to document in text fields include:
o    the corresponding date and source of information (lab report, clinician’s note, etc.) that each post-orchiectomy serum tumor marker test was performed until normalization, plateau or increase
o    physician statement about each post-orchiectomy serum tumor marker (normalized, remains elevated, plateaued, etc.) and/or physician assignment of “S” category
o    indication that post-orchiectomy serum tumor markers are not in medical record for those cases that this holds true
•    Review the medical records of all testis cases already coded with CSv2 and follow above procedure.

As part of the next release, testis cases previously coded in CSv2 will require review to code the post-orchiectomy serum tumor marker values correctly.  Having the required information in text within each abstract will facilitate efficient review and recoding of affected cases.

General CSv2 questions may be emailed to  Technical questions or specific coding questions should be submitted to the Inquiry and Response System (

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June 30, 2010
In This Issue
CoC News
National Partnership for Comprehensive Cancer Control Leadership Institute
Accreditation Program
CoC Will Notify Facilities for 2011 Survey by E-mail
Survey Application Record (SAR) Annual Update Process
Standards 3.3 and 4.6 SAR Revision
National Cancer Data Base (NCDB)
Effects of the 2011 NCDB Submission Cycle on Standards 3.6 and 3.7
Questions Answered about Changes in NCDB’s Data Submission Cycle
Revised version of Hematopoietic DB and 2010 Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual Now Available
NewsCLiPs: News for Cancer Liaison Physicians
Cancer Liaison Physician Terms Expiring July 1
Newly Appointed State Chairs
Educational Activities
Upcoming CoC Live Webinars
On-Demand Webinars Now Available
"Group View" Now Available For On-Demand Webinars
News from the American Joint Committee On Cancer (AJCC)
Modification of the CS Testis Schema
User-Friendly Electronic CS Manual to be Released in 2011
CS is Coded According to the Date of Diagnosis
NCRA's CSv2 Printed Package
News from the National Accreditation Program for Breast Centers (NAPBC)
NAPBC Schedules Future Workshops
NAPBC Offers Priority Scheduling to CoC Programs for 2011
NAPBC to Run Banner Ad on US News & World Report Website
News from CoC Partners
Current SRGS Issue Reviews Oncology
American College of Oncology Administrators
Spotlight on Member Organizations
Monthly Spotlight: American College of Surgeons Young Fellows Association
Upcoming Programs
Thursday, August 5, 2010, 1:00 PM Central, Making Peace with the NCDB Call for Data
Thursday, August 26, 2010, 1:00 PM Central, Introduction to the NCDB Tools: Real Life Examples on How to Use NCDB Comparison Benchmark, Survival, CP3R and RQRS Reports
Wednesday, September 15, 2010, 9:00 AM Central, The Genetic Information Nondiscrimination Act (GINA): What Does This Mean for My Patients?

Thursday, October 14, 2010, 10:00 AM Central, Introduction to the Rapid Quality Response System (RQRS): What it means for your Cancer Program

Thursday, November 4, 2010, 12:00 PM Central, EGAPP Recommendations for Lynch syndrome Genetic Testing: Impact on Colorectal Cancer Care
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