The CoC Source - April 30, 2012
(Print All Articles)

CoC in the News

There have been several articles published in recent journals and publications highlighting the work of the Commission on Cancer (CoC).  The articles reference the new standards for accreditation and include the following:

New CoC Brochure Available

The CoC has created a new brochure, “Improving Cancer Care through CoC Accreditation”, detailing the benefits of, and quality reporting tools for, CoC-accredited cancer programs.  This brochure will primarily be distributed at conferences and trade shows, targeting audiences unfamiliar with the CoC, however, it can be downloaded electronically and distributed to new staff members and other parties within your facility interested in learning more about the value of CoC accreditation.  The brochure can be accessed through this link found on the “About the CoC” page on the CoC website:  

CoC Exhibits

The CoC is scheduled to exhibit at the following national meetings:

Oncology Nursing Society
May 3 - 6
Ernst N. Morial Convention Center
New Orleans, LA

National Patient Safety Foundation
American College of Surgeons Booth
May 23 - 25
Gaylord National Hotel and Convention Center
Washington, DC

Association of Oncology Social Work
May 30 - June 1
Westin Boston Waterfront
Boston, MA

If you are attending these meetings, stop by the CoC or American College of Surgeons booths and view the new CoC materials. 

To learn more about the CoC, visit

Compendium of 2012 Cancer Program Standards

The CoC Flash has been publishing a series of articles each month that highlight important information about each standard and the eligibility requirements. These summary articles are targeted to assist cancer programs with understanding the requirements and implementation of the new 2012 standards. The Flash articles began in June 2011 with the Eligibility Requirements and will continue to appear monthly through July 2012, ending with standards from Chapter 5—Data Quality.

We have now made available a compendium encompassing all of the monthly articles highlighting the 2012 standards.  Each month, the 2012 standards article from the latest CoC Flash will be appended to the compendium until all standards and eligibility requirements have been reviewed. The compendium provides convenient access to the highlights in one location. Watch future issues of the Flash for continuation of the series.

The compendium is now available on the CoC website at:

Change is Coming to Survey Application Record

The current Survey Application Record (SAR), available to all CoC-accredited cancer programs, includes cancer program activity and documentation for 2009, 2010, and 2011.  This SAR is based off of the 2009 Standards and is being used for all surveys conducted in 2012.  Compliance with the new 2012 standards is not recorded in this version of the SAR.

All accredited programs must complete ALL fields throughout the SAR with program activity and required documentation for 2009, 2010, and 2011.  Most programs should be up-to-date and only need to enter activity and documentation for the last six months of 2011.  If you need to edit fields or upload documents from 2009 or 2010, you can still make changes, deletions, and/or additions at this time.

Around July, the SAR will change to a ‘read-only’ format for cancer programs not scheduled for survey in 2012 and for those cancer programs whose 2012 survey has already taken place.  For those programs whose 2012 survey has not yet taken place, the SAR will remain accessible until three business days post survey.

Also in July, as part of the Annual Update, the Facility and Staff Contact Information and Eligibility Requirements sections will be accessible from the newly designed SAR in accordance with the 2012 standards. All programs will need to complete these sections by October 2012.  Only 2012 activity will be required.  NOTE:  activity and documents from 2011 and earlier will NOT be copied over to the new SAR.  The remainder of the new application, to document compliance with the 2012 standards, will become available later in the fall of 2012. 

Additional information will be communicated in future issues of the CoC Flash.


CAnswer Forum Monthly Highlight: Thread Tools

Our goal for these articles is to make the CAnswer Forum user aware of the many helpful functions of the system.  This month we are highlighting Thread Tools.  What are thread tools?  Thread tools are options that allow users to take different actions.  For example, Show Printable Version, Email this Page, Subscribe (or Unsubscribe) from this Thread, and Adding a Poll.  Find the Thead Tools by clicking on the “Thread Tool” link located at the top of each thread post (question).  Let’s discuss each of the options and how they are used.

Show Printable Version:  This will show a page with the thread post content in a reduced graphics format that is more printer friendly.  The printable version includes the title, thread (question) and all posts (answer and comments) related to the thread.  Some users report that they print useful threads and add them to their abstracting manuals for quick reference.

Email this Page:  If you think a thread (question) may be of interest to someone else, you can click on this link where a box will open so that you can enter their email address.  The box includes a message and link to the thread (question). The recipient would open the email and click on the link which will take them to the question.  If they are not logged in to the CAnswer Forum, the link will take them to the log in screen first then to the question.

Subscribe (or Unsubscribe) from this Thread (question):  Subscriptions are a way of keeping track of different threads or forums.  For example if you are reading an unanswered question and want to be notified when the question is answered, simply subscribe to the question.  By subscribing you will receive email update when the question is answered. To subscribe to a thread (question) click the Thread Tools link at the top of the list of posts then click subscribe to Thread.  You can then choose the subscription mode that you wish to use for that thread.

There are a number of different subscription modes available:

  • No email Notification – lists the subscription in your user control panel only
  • Daily Email Notification – sends one email a day with updated threads
  • Weekly Email Notification – sends one email per week in the same way as the Daily Email Notification
  • Instant Email Notification – sends an email as soon as a post (answer) is added to the thread

Thread subscriptions can be sorted into folders for easy management.  You can also manage your individual subscriptions by clicking ‘List Subscriptions’ under ‘Subscribed Threads’ in your User control panel.  Please click the Help button on the home page to get more information on managing subscriptions and folders.

Adding a Poll:  If you started a thread, you can add a poll which will allow those who read the thread to cast their vote for the best answer to the thread.  At this time, the CoC does not use this option. Take the time to investigate and use one or more of these Thread Tools the next time you access the CAnswer Forum.


Highlighting the 2012 Standards Chapter 4: Patients Outcomes

The new patient outcomes chapter has grown to include new standards that enhance patient centered functions and define performance criteria in quality measurement and outcomes.  However, we have retained two standards from the previous manual, prevention and screening programs, which have been revised to separate their activities.  They should be very familiar to you.

Standard 4.1 – Prevention Programs

Cancer prevention programs identify risk factors and use multiple strategies to change behaviors to reduce the chance of developing cancer.

At least once per year, the cancer committee will identify the cancer prevention needs of the community and, in response, provide at least one cancer prevention program that is focused on decreasing the number of patients with a specific type of cancer.  The prevention program(s) selected should be consistent with evidence-based national guidelines for cancer programs.  

There are resources available for evidence-based national guidelines, some of which we have listed here:

Prevention programs may be provided on-site or coordinated with other facilities and/or local agencies.

Possible cancer prevention programs may include:

  • Chemoprevention
  • Education/cancer awareness
  • Skin cancer prevention
  • Smoking cessation
  • Smoking prevention in adolescents
  • Weight loss programs

Most cancer programs currently offer one or more of these prevention activities.  Documentation is required to demonstrate compliance.  Remember to document the planning and discussion by the cancer committee for providing at least one annual cancer prevention program annually.

Compliance, a rating of 1, for this standard is demonstrated by fulfilling all of the following:

  • The cancer committee assesses the prevention needs of the community.
  • The cancer committee provides at least one cancer prevention program.
  • The cancer prevention program is consistent with evidence-based national guidelines and evidence-based interventions.

Standard 4.2:  Screening Programs

Similar to prevention, cancer screening programs apply screening guidelines to detect cancer at an early stage, improving likelihood of increased survival and decreased morbidity.

The cancer committee will provide at least one cancer screening annually, based on the needs of the community.  The screening program(s) selected should be consistent with evidence-based national guidelines for cancer programs.  

In addition to the list above, you may also refer to the American Society of Clinical Oncology at for evidence-based national guidelines.

Cancer screening programs may be provided on-site or coordinated with other facilities and/or local agencies such as the American Cancer Society.  Below we have listed just a few examples of common cancer screening programs.  Your program is not limited to implementing the items on this list.

Examples of cancer screening programs may include:

  • Breast (radiographic and physical examination)
  • Colonoscopy, flexible sigmoidoscopy or fecal occult blood testing
  • Papanicolaou testing
  • Prostate examinations with or without prostate-specific antigen testing
  • Skin surveys

Again, cancer programs usually offer more than one of these screening activities.  Documentation is required to demonstrate compliance and should be based on the screening needs of the community and include the planning and discussion activities by the cancer committee.

Compliance, a rating of 1, for this standard is demonstrated by fulfilling all of the following:

  • The cancer committee assesses the prevention needs of the community.
  • The cancer committee provides at least one cancer prevention program.
  • The cancer prevention program is consistent with evidence-based national guidelines and evidence-based interventions.

Next month –Chapter 4: Patient Outcomes, Standards 4.3 – 4.5.


July 1, 2012 Expiring Terms for Cancer Liaison Physicians

Cancer Liaison Physicians (CLPs) serve a three-year term and are eligible to serve an unlimited number of terms based on performance and evaluation data collected at the time of survey. The terms of more than 207 CLPs will expire in July 2012 and each cancer committee must determine whether the current CLP is appropriately serving in this role or if another candidate would better suit the position. 

In June, the CoC will e-mail letters to the programs with a CLP whose term is expiring. The letters will include details on how a facility can either reappoint the CLP to another three-year term or recommend a replacement to fill the role.

If you reappoint your CLP, please use this time to update and confirm your CLPs contact information in the CoC’s database. We also accept assistants’ e-mail addresses to add to our CLP's record.

Important Reminders for Accredited Programs:

Following a new CLP appointment, the facility must update the staff contact information in the Survey Application Record (SAR) located within the CoC Datalinks application.

CLPs can be replaced at any point during their three-year term. A facility’s cancer committee that would like to replace its CLP should complete a CLP Membership Application Form.  An electronic or printable application can be found at

Please note:  A facility cannot appoint a new CLP by simply changing contact information within the SAR; the CoC must receive an application.

Cancer Liaison Physician Webinar Series

If you haven’t done so already, please be sure to view the five-part webinar series that has been developed to support you in your role as CLP. These webinars provide information to assist you in fulfilling your role under the new 2012 Standards for Accreditation. Webinar topics are as follows:

1. Orientation to the Cancer Liaison Physician Role: Focus on Improving the Quality of Cancer Care after every appointment and reappointment to the role (Duration: 12:53)

2. Becoming an American Cancer Society Liaison (Duration 8:21)

3. How to Navigate the National Cancer Data Base Tools: A Primer (Duration 11:53)

4. Putting the National Cancer Data Base Tools to Work (Duration 16:43)

5. Analyzing and Reporting Your Cancer Program's Quality Data (Duration 11:08)

More details and instructions may be found on our website at

Save the Date

October 1, 2012
Cancer Liaison Physician Breakfast
Chicago, IL

Details will be e-mailed to all Cancer Liaison Physicians in June.

Three Important NCDB Edits Announced

1.    Two edits used in the recent NCDB Call for Data cycle were discovered to yield erroneous error messages for specific rare circumstances.  The problem edits and their resolutions are identified below.

Lacrimal gland carcinomas and AJCC T, N and M.  The American Joint Committee on Cancer 7th edition defines T, N and M staging schemes for lacrimal gland carcinomas, but the edits that were posted for hospital use generated the message that those values must be 88 (not stageable). The corrected form of the edit was used by the National Cancer Data Base (NCDB) when the cases were submitted, so that registries that had changed their values to 88 failed the edit.  NCDB will contact the small number of registries that submitted a lacrimal gland carcinoma with 88 in any of these three fields during the coming weeks.  Those registries will be asked to resubmit the cases with the correct values without penalty, and notations will be made in the Survey Application Record for affected programs. Pathologic and clinical stage groups for lacrimal gland carcinomas are correctly coded 88, so those items were not affected.

CS SSF2, Lower GI Schemas.  This edit compared CS Site-Specific Factor 2 (nodes not clinically evident) and Regional Nodes Positive to CS Lymph Nodes for lower GI sites, requiring the latter to be 0 when the first two were 000 and 00, respectively. Cases that had tumor deposits coded but no lymph nodes failed the edit used by NCDB.  The corrected edit allows CS Lymph Nodes to be either 000 or 050.  After all NCDB cases submitted during the recent Call for Data have been processed, the files that had cases fail for this reason will be re-edited and the “error” will be resolved.  Four CS schemas were potentially affected: Colon, Rectum, NETColon and NETRectum.

2.    A new NCDB edit metafile for use by registries that have updated their registry software to the North American Association of Central Cancer Registries (NAACCR) version 12.2 (CSv02.04) has been posted at No new edits are included in this posting, but some corrections to logic and documentation have been made. Most of the changes are to Collaborative Stage edits and to the Clinical Checks. No programs submitting to NCDB during the recent Call for Data cycle had converted their data to version 12.2, although some Rapid Quality Recording System (RQRS) submissions are now arriving in the new layout.

This metafile is applicable for

  • RQRS submissions;
  • Programs that need to submit cases to NCDB to resolve deficiencies; and
  • Pending CoC programs submitting NCDB data in order to qualify for their initial survey

3.    Two coding rule changes published in FORDS: Revised for 2012 will result in edit modifications later this year.

Scope of Regional Lymph Node Surgery. The new rules for coding Scope of Regional Lymph Node Surgery beginning with 2012 diagnoses will necessitate revisions to some edits.  That is because the new rules require use of code 2 (sentinel lymph node biopsy) if the attempt at finding sentinel lymph nodes failed, and no nodes are removed. The edits that presume lymph nodes are removed if the code is 2 will require revision.  The new edits will be incorporated in a metafile update later this year and primarily will affect RQRS submissions during 2012.

Grade Items.  FORDS: Revised for 2012 introduced simplified rules for coding registry grade items that will affect some edits. The edit that requires Grade/Differentiation be known when Grade Path System and Grade Path Value are known will be removed. Edits that currently require Grade/Differentiation to have particular values will be modified to permit that information to be coded in Grade Path System and Grade Path Value or in Grade/Differentiation. The new rules for grade coding do not apply for pre-2012 diagnoses, and the edit modifications will only affect RQRS submissions this year.

RQRS Now in CAnswer Forum

Have a question about RQRS and wondering where to find the answer?  An RQRS Forum is now available in the CAnswer Forum to allow both current users and non-users to post questions and comments about the system.  Sub-forums include: Enrollment, Registry Operations, Data Submissions, Performance Rates, Alerts & Case Lists, Comparison Reports and Impact on Patient Care.  CoC Staff encourage you to use this resource to communicate with your peers and staff experts about your questions and experiences using RQRS.

For more information on the RQRS system, please visit the RQRS webpage:  

FORDS: Revised for 2012, Version B Posted

Shortly after the announcement that FORDS: Revised for 2012 was available, a revision was posted that corrected two major errors.  Registries that downloaded FORDS for 2012a.pdf are encouraged to replace it with FORDS for 2012b.pdf that is currently posted. 

The following corrections were made:

1.    Collaborative Stage items are required for Class of Case 00-22, not 10-22 as originally stated.

2.    The examples for the new instructions for coding Scope of Regional Lymph Node Surgery identified code 0 for an example that should have been coded 2.  Besides correcting that code, a correct 0 example was added and a minor wording change was made for clarity in the code 9 example.

If you printed the original “A” version, please swap in pages 18 and 208 from the “B” version. Appendix C was replaced in its entirety in version “B” because adding the information about the changes affected its pagination.

Besides correcting information on these two pages, the updated version has new bookmarks that point specifically to the 2012 updates listed in Appendix C.

FORDS: Revised for 2012 is posted at  No printed copies are available, but copies may be printed for registry use.

CS and FORDS Grade Codes: Special Note for Abstractors

FORDS: Revised for 2012 offers the opportunity for CoC accredited programs to code grade in the Grade Path System (NAACCR Item #449) and Grade Path Value (NAACCR Item #441) items, setting Grade/Differentiation (NAACCR Item #440) equal to 9.  The Collaborative Stage Data Collection System uses the code for Grade/Differentiation for calculating derived items for seven CS schemas.  Grade/Differentiation must be coded for these cases, even if Grade Path System and Grade Path Value are also coded, in order for CS to derive the correct staging information.  The schemas are the following:


Swimming with the FINs

In registry jargon, a FIN is a “Facility Identification Number”.  It is the key to communicating to NCDB which hospital’s case is reported in a file record.

The two data items inserted into registry records at the time of submission that carry this information.  The FIN (NAACCR #540) is the current FIN assigned to the individual hospital reporting the case.  The Archive FIN (NAACCR # 3100) differs from it only for some merged programs, and under no other circumstances.  In most software, these values are entered by the registrar in a general “profile” screen (it may be called something else), and are not keyed into individual records.  The Archive FIN can be blank for cases diagnosed prior to 2003.  NCDB is seeing a number of problems with these values when they are submitted.

  • Hospitals that are neither part of a merger nor part of a network.  For these hospitals, which constitute the majority of CoC programs, the only valid value for the Archive FIN is the hospital’s FIN. 
  • Hospitals that are part of a network.  Networks are formally acknowledged by CoC as Integrated Network Cancer Programs (INCP).  Both the FIN and the Archive FIN must equal the respective hospital-level FIN.  The network-level FIN is not submitted in cases sent to NCDB.  Network cases are consolidated internally by NCDB for reports based on the full network.
  • Merged hospitals.  A merger occurs when one hospital buys another, or two or more form a single legal entity.  They may operate as multiple campuses or consolidate into one location.  Programs planning a merger should contact Jerri Linn Phillips ( in NCDB for instructions for reporting new and historic cases in the future based on their operations.

The FIN is the current FIN belonging to the hospital reporting the case.  The Archive FIN is defined as the FIN the hospital was using at the time it first accessioned the case.  It is not the FIN for an unrelated program that referred the patient, though at least some programs used it that way in this year’s NCDB data submissions.  Bad FINs or Archive FINs also may result from typos or other problems. 

  • Cases submitted with bad FINs or Archive FINs are blocked from processing, so in effect they were not submitted.  When that happens, NCDB requests the program to correct the problem and resubmit.  Assuming the correction is made, this will not result in any problems at survey because it is not possible to edit for FINs that fail to point to a particular program (edits can only check that they “look like” FIN numbers). 
  • To avoid the problem in the first place, NCDB recommends obtaining a frequency count of all FIN and Archive FIN values before each submission.  In nearly all instances, only a small number of cases have bad numbers assigned and they will be made quite evident through this process.

When a data file is submitted to NCDB, a validation program checks that the person who submitted the file is a registrar, co-registrar or cancer program coordinator affiliated with the FIN under which the file was submitted (or a software provider approved by one of them), and that the FIN(s) and Archive FIN(s) in the file are part of the same CoC program.  Any mis-match will be handled as a bad FIN problem and will terminate processing of the cases involved.

Take Advantage of CoC Webinars to Ensure Compliance with the New 2012 Patient-Centered Standards

Eligibility Requirements: The Cancer Committee’s Role in Evaluation and Reporting

Are you making the transition to the 2012 standards?  Are you struggling with where to begin and how to delegate responsibilities?  We recommend that you view this webinar to gain information about each Eligibility Requirement, the documentation needed to support compliance and, especially, the cancer committee’s role to evaluate and improve performance in these important areas. 

All members of the cancer committee can benefit from viewing this webinar.  But, it is particularly important that the audience include the cancer committee chair, cancer program administrator, Cancer Liaison Physician, cancer registrar, and committee members representing diagnostic and therapeutic radiology, medical oncology, social services, nursing, rehabilitation, and nutrition.

Important Accreditation Facts: New Program Categories, Accreditation Awards, and the OAA

Do you know how your new cancer program category will affect your program?  Are you getting ready for survey in 2013 under the new standards?  Do you want to know what to expect?  We recommend that you view this webinar to learn more about why the cancer program categories were changed and what is now required for each category.  You will also learn why and how the Accreditation Awards and OAA criteria were revised and how this may affect your program at the next survey. 

All members of the cancer committee can benefit from viewing this webinar.  But it is particularly important that the audience include the cancer committee chair, cancer program administrator, Cancer Liaison Physician, cancer registrar, and committee members representing clinical research, pathology, and nursing.

We encourage you and your team to visit the CoC Online Education Portal to learn more and purchase these webinars at the low cost of $50 each.  Get your team started on the road toward compliance with these new patient-centered standards.  




New CS Moments on YouTube: Neoadjuvant Therapy

Five new videos were recently added to the AJCC YouTube Channel.  The five CS Moments presentations focus on the often confusing topic of coding Neoadjuvant Therapy for cancer registrars in Collaborative Stage. The first video, Definition and Use, seeks to define neoadjuvant therapy and address some of the common misconceptions. It explains the reasons why a physician might choose neoadjuvant therapy for their patients.

The other four videos present all the possible combinations a registrar might face when coding neoadjuvant therapy: Neoadjuvant Response and Known Info, Neoadjuvant Response and Unknown Info, Neoadjuvant No Response and Known Info, and Neoadjuvant No Response and Unknown Info.

Please take a few minutes to view these videos on the AJCC YouTube Channel. They can either be viewed individually or, as a playlist where all five videos play in order.  Please be sure to comment on the videos, give a thumbs up, and share with friends and colleagues.

The Neoadjuvant Therapy Videos can be viewed here.



Registration is NOW OPEN – Pursuing Excellence through Accreditation

The National Accreditation Program for Breast Centers (NAPBC) has scheduled another workshop, Pursuing Excellence through Accreditation, which will be held at the American College of Surgeons headquarters in Chicago, IL, on Friday, June 29, 2012. This workshop will provide detailed information related to the NAPBC components and standards, survey process, and the new quality measures and related requirements. The workshop will provide attendees with the skills to assist centers applying for accreditation, as well as centers due for reaccreditation in 2012 and beyond.

NAPBC board members, surveyors, and staff will present information at the workshop. Most importantly, a presentation specific to the NAPBC components and standards, including an outline of the requirements for meeting compliance with each standard, will leave participants with vital information to take back to their centers. The workshop will also incorporate any changes to the standards so that there is a clear understanding of the expected performance and how it will be measured. Another detailed presentation titled, What to Expect on the Day of Survey, will walk you through a site visit from a surveyor’s perspective. Learn about what the surveyor is looking for during the survey.   

Pursuing Excellence through Accreditation is designed for individuals involved in the delivery of multidisciplinary breast health care, including physicians, nurses, administrators, cancer registry professionals, and others involved in the day-to-day operations of the breast center.

Registration is NOW OPEN at    

These workshops are always well-attended and seating is limited.  Enrollment is on a first-come, first-served basis.

Webinar: The Importance of Quality Improvement: The National Accreditation Program for Breast Center’s Data Collection Tool

This 60-minute webinar will provide an overview of the national quality improvement landscape and discuss how the NAPBC is working toward developing a quality measures repository. The moderator will also discuss NAPBC Standard 6.2—Quality  Improvement—and the associated data collection requirement.

Date: Tuesday, May 22, 2012, at 11:00 am (EDT)

Target Audience:
This webinar is intended for NAPBC accredited centers and centers working toward NAPBC accreditation, including Breast Program Leadership, Cancer Registry Staff, and other staff involved in quality performance measurement.

Learning Objectives:
Participants of this webinar will be able to:

  • Recognize the importance of quality improvement and its relationship to clinical care.
  • Understand the current national quality improvement landscape and the movement toward collaboration.
  • Understand the requirements of NAPBC Standard 6.2—Quality Improvement.

Mahmoud El-Tamer, MD, FACS
Chair, NAPBC Quality Improvement and Information Technology Committee

Cindy Burgin
NAPBC Manager

Cost: $50

Register today at:

NAPBC Releases 2011 Annual Report

The NAPBC posted its 2011 Annual Report to the NAPBC website at

This report highlights the activities and initiatives undertaken in 2011 in support of the NAPBC mission, to improve the quality of care for patients with diseases of the breast.  It outlines the characteristics of the centers applying for NAPBC accreditation and illustrates overall performance for select standards. Current results show that overall breast care observed to date in the U.S. is very good, but that there is still room for improvement.    
For more information on the NAPBC, call 312-202-5185 or e-mail

2012 NAPBC Standards Manual NOW Available!

The 2011 NAPBC Standards Manual is now available as a free download or a hard copy may be purchased for a nominal fee at Compliance with these standards will be required for centers applying for accreditation after June 1, 2012.

NAPBC Exhibit Schedule

The NAPBC is scheduled to exhibit at the following national meetings:

American Society of Breast Surgeons
May 2–6
JW Marriott Desert Ridge Resort and Spa
Phoenix, AZ

American College of Oncology Administrators
June 21-22
American College of Surgeons Headquarters
Chicago, IL
Breast Cancer Coordinated Care
July 19-21
JW Marriott
Washington, DC

Stop by the exhibit hall at any one of these meetings and pick up an NAPBC Information Kit or additional information about the program.


Preparing for the CTR Credential

The Certified Tumor Registrar (CTR®) credential demonstrates a requisite knowledge and professional competence needed within the cancer registry. The credential is nationally recognized in the recruitment and retention of cancer registry personnel, so those interested in pursuing a career in the field are encouraged to seek certification as a way to distinguish themselves in the marketplace.  The National Cancer Registrars Association’s certification board — Council on Certification — develops and administers the CTR exam. The first exam was offered in 1983. Over 5,000 individuals have attained the CTR credential.

Eligibility requirements for candidates interested in taking the CTR exam include an education minimum and experience. (Visit for more details.) Once eligibility requirements are met, candidates can take the exam during two, two-week-long testing periods.  Applications must be submitted by the deadline for the desired exam date.  Test questions are prepared by persons in the cancer registry profession from diverse backgrounds and job descriptions.  The bi-annual CTR exam is composed of 250 multiple-choice items in the areas of registry organization and operations; concepts of abstracting, coding and follow-up; data analysis and interpretation; and application of coding and staging principles.  The next exam period is September 8-22, 2012; applications are due by July 31, 2012.

Candidates receiving a passing score will be entitled to use "CTR" after their name and will receive a certificate from the Council on Certification. To maintain a certified status, a credentialed professional must complete 20 hours of continuing education credits every two years, plus pay an annual fee.

To help prepare candidates, NCRA offers a CTR Exam Prep Workshop. The workshop is a day-and-a-half program facilitated by Donna Gress, RHIT, CTR, and Louise Schuman, MA, CTR — two knowledgeable and experienced instructors who have developed an agenda to provide a comprehensive and thorough understanding of all exam topics. Participants will review the definitions of key terms and vocabulary, identify the critical knowledge areas, and self-identify areas of strength and weakness. Participants also receive free registration to NCRA’s three-part CTR Exam Readiness Webinar Series, exclusive access to online mentoring from the instructors, and online networking with other workshop attendees to share tips and ideas for studying for the exam. The next workshop is scheduled for August 11-12, 2012, in Baltimore, MD. NCRA provides a three-part CTR Exam Readiness Webinar Series that mirrors the instruction and the topics from the workshop. Topics and dates are: Computer Principles (August 16), Statistics & Epidemiology (August 23) and Exam Tips (August 30).

For more information on the CTR exam, visit or e-mail For a list of NCRA-accredited formal education programs, go to  For details on the CTR Exam Prep Workshop and CTR Exam Readiness Webinar Series, visit


Register TODAY - American College of Oncology Administrators (ACOA) Oncology Annual Update Conference

June 20 – 22, 2012 – American College of Surgeons headquarters in Chicago, IL

It is 30+ days and counting to one of the premier oncology continuing education programs in the nation:  the ACOA 2012 Oncology Update

The ACOA Education Committee has crafted educational sessions to meet the challenges that oncology leaders face in delivering cost-effective quality care but delivering it with unparalleled compassion. The program provides a survivor’s perspective of cancer care.  After this two and half day education update, participants should have the skills to position their cancer program for the challenges of providing cost effective, compassionate care.

Network with academic and community peers from across the country, and hear from leading experts in the field on quality metrics and value-based purchasing, integrative palliative care programs, drug shortages, CoC accreditation updates, and the ins and outs of using consultant groups. 

New this year:  Pre-conference session on demystifying quality metrics for cancer programs!
2012 ACOA Oncology Update: Compassion and the Numbers promises to be a “must attend” event.

To learn more about the conference and register, go to:

NCCN Collaboration to Develop Enlightened Cancer-Related Employer Benefits

The National Comprehensive Cancer Network® (NCCN®) is partnering with the National Business Group on Health on a three-year project to develop An Employer’s Guide to Cancer Treatment and Prevention. The Guide addresses issues related to cancer across the continuum of care, including prevention and screening, medical and pharmaceutical benefit plans, disability plans, family medical leave, and caregiver needs. Recommendations in the Guide are supported by evidence and knowledge from a wide range of sources, including NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Employers that use the Guide can be confident that their cancer-related benefit dollars are being invested wisely and will meet the needs of beneficiaries.  Cancer is a high priority for employers, as the disease is typically among the top three medical and pharmacy expense categories, and is a leading cause of absence and disability.

Key recommendations related to medical and pharmacy benefits include the following:

  • Medical plan network should include a wide range of cancer care providers, both in community settings and in academic centers.
  • Medical plan should provide access and benefit coverage for second opinion services.
  • Medical plan should cover routine costs of care when a beneficiary is enrolled in a clinical trial at the same level of coverage as services provided outside of a clinical trial.
  • Medical plan should cover hospice coverage for individuals with an estimated life expectancy of 12 months or less.
  • Medical plan should cover biomarker and molecular testing based on recommendations in NCCN Guidelines.
  • Medical plan should cover genetic testing and counseling based on recommendations in NCCN Guidelines.
  • Pharmacy plan should have a reasonable out-of-pocket threshold so that cost is not a significant barrier for patients to obtain needed medications.
  • Pharmacy and medical plans should adopt the NCCN Drugs & Biologics Compendium (NCCN Compendium®), Category 1, 2a, and 2b levels of evidence, as the basis for coverage for drugs and biologics in cancer care.
  • Benefit plan should establish parity of patient cost sharing between the medical and pharmaceutical benefits.

This project has achieved a high level of interest among employers, benefit consultants, managed care organizations, and pharmacy benefits managers  Adoption of these and other benefit recommendations is already occurring, which will benefit employers, patients, and cancer care providers. To view the entire toolkit associated with this project, go to and click on “cancer” in the Hot Topics list. You may also contact Liz Danielson, NCCN director of payor relations ( Liz is a member of the project’s working group.

Contact information: Joan McClure, Senior Vice President of Clinical Information and Publications;, 215-690-0237

Monthly Spotlight: Oncology Nursing Society

The Commission on Cancer regularly collaborates with over 50 member organizations in its mission to provide quality cancer care. This month we introduce the Oncology Nursing Society (ONS) .

The ONS is a professional association with more than 35,000 members committed to promoting excellence in oncology nursing and the transformation of cancer care. Since 1975, ONS has provided a professional community for oncology nurses, developed evidence-based education programs and treatment information, and advocated for patient care, all in an effort to improve quality of life and outcomes for patients with cancer and their families.

Under the direction of President Mary Gullatte, PhD, RN, ANP, BC, AOCN®, FAAN, (effective May 2012) and CEO Paula T. Rieger, RN, MSN, CAE, FAAN, ONS’ strategic direction focuses on four pillars: knowledge, quality, leadership, and technology.  

ONS continues to deliver top-notch educational products and services to its members and others in the health care community through live conferences, virtual meetings, and online programming. ONS connects globally by leading nursing initiatives in countries such as Turkey, Israel, Jordan, and Oman. 

ONS’s health policy efforts are focused on promoting cancer symptom management and pain control, ensuring access to quality cancer prevention and care, and bolstering the nation’s nursing workforce. These efforts also include working with members of Congress to pass “Improving Cancer Treatment Education Act of 2012, HR 3790.”

Other strategic initiatives focus on lifelong learning, quality measurements, and quality improvement, as well as health information technology as electronic health records become more the norm in health care organizations.

Event Information
The ONS 37th Annual Congress will be held May 3-6, 2012, in New Orleans, LA. Educational sessions will cover clinical practice, research, education, survivorship, administration, and safe practice. Highlights this year include a session on health information technology, clinical trials, nurse navigation, and health policy.

A new groundbreaking advanced-level conference, Connections: Advancing Care Through Science, will debut in November 2012, in Phoenix, AZ. Oncology nursing experts and leaders will focus on making the connection between evidence and practice to improve outcomes for patients and their families.

May is Oncology Nursing Month to honor the work of nurses who care for patients with cancer. The Oncology Nursing Month website offers a number of exciting products to spread the word and recognize oncology nurses, and ideas for celebrating Oncology Nursing Month.   

Recent Publications and/or Products
ONS publications continue their longstanding tradition of excellence. Thirteen new books were published in 2011 including Safe Handling of Hazardous Drugs, 2nd Ed., A Patient’s Guide to Cancer Symptom Management, PEP Vol. 2, Nursing Management: Principles and Practice, 2nd Ed., and Cancer Rehabilitation and Survivorship.

New educational programs include regional conferences (Hematologic Issues in Cancer Care and Pain) that provide nursing education closer to home as well as a virtual conference on radiation.

For more information on this organization, please contact:
Oncology Nursing Society, 125 Enterprise Drive, Pittsburgh, PA 15275
Phone: 866-257-4ONS (866-257-4667) | 412-859-6100
Fax: 877-369-5497 (toll free)|412-859-6162
Website: | Email:

Annual Report to the Nation on the Status of Cancer, 1975-2008

A new study shows that death rates among men, women, and children from all cancers combined continued to decline in the U.S. between 2004 and 2008.  Mortality rates decreased, on average, 1.6 percent per year from 2004 through 2008.  During that same period, cancer incidence rates among men decreased by an average of 0.6 percent per year, while incidence rates among women declined 0.5 percent per year from 1998 through 2006, and leveled off from 2006 through 2008.

The data are included in the Annual Report to the Nation on the Status of Cancer, 1975-2008, published in the May issue of CANCER.  This year, as in previous years, the Centers for Disease Control and Prevention (CDC) conducted the study in collaboration with the American Cancer Society), the National Cancer Institute, and the North American Association of Central Cancer Registries.

This year’s report highlights a special section on cancers associated with excess weight and lack of sufficient physical activity. Esophageal adenocarcinoma, and cancers of the colon and rectum, kidney, pancreas, and endometrium, as well as breast cancer among postmenopausal women, are associated with being overweight or obese. Several of these cancers also are associated with not being sufficiently physically active.

Significant Study Findings
  • Overall cancer death rates have continued to decrease since the early 1990s among men, women, and children.
  • For the second consecutive year, there was a decrease in lung cancer mortality rates among women. Lung cancer death rates in men have been decreasing since the early 1990s.
  • Colorectal cancer incidence rates decreased among men and women from 1999 through 2008.
  • Breast cancer incidence rates among women declined from 1999 through 2004 and plateaued from 2004 through 2008. 
  • Incidence rates of some cancers – pancreatic, kidney, thyroid, and liver, as well as melanoma – increased from 1999 through 2008.
  • Among children aged 19 years or younger, cancer incidence rates increased 0.6 percent per year from 2004 through 2008, continuing trends from 1992, while death rates decreased 1.3 percent per year during the same period.
  • Among racial and ethnic groups, the highest cancer incidence rates between 2004 and 2008 were among black men and white women. Cancer death rates from 2004 through 2008 were highest among black men and black women, but these groups showed the largest declines for the period between 1999 and 2008, compared with other racial groups.

Click here for access to the Annual Report to the Nation on the Status of Cancer, 1975–2008, Featuring Cancers Associated with Excess Weight and Lack of Sufficient Physical Activity.

Cancer: It's Personal

Last year, Pfizer Oncology launched Cancer: It’s Personal, a program designed to educate people with cancer, their caregivers and health care professionals about the role personalized medicine may play in oncology. Since its launch, the Cancer: It’s Personal website has reached more than 75,000 unique visitors to help them better understand the role biomarkers play in the diagnosis, prognosis, and clinical treatment of cancer.   

Pfizer Oncology has added new content to its patient website, which can be found by visiting and clicking on the Resources tab, which connects to the Education Center on the dropdown menu. The Patient Education Center includes links to the following downloadable materials:

  • Personalized Medicine in Cancer: What I Need to Know video featuring Diane Blum, chief executive officer of the Lymphoma Research Foundation
  • Biomarker by Tumor Type Interactive Chart
  • Myths and Facts about Personalized Medicine
  • Biomarker Testing Process chart

What is Chartrounds? links community oncologists with the top disease site specialists in the country to peer review cases in a virtual setting.  Membership is free and funded by a grant from the ASCO Cancer Care Grant sponsored by Susan G. Komen for the Cure.  The group supports radiation oncologists and medical oncologists reviewing the following disease sites: breast, lung, head and neck, GI, GYN, prostate, and lymphoma.  

Members receive the following benefits:

  • Peer Review
  • CME Credits
  • MOC Credits
  • Stay current on new treatment technologies
  • Improved quality assurance
  • Virtual Clinical Trials Assistant

Membership is free. To find out more about the program, please visit