The CoC Source - August 31, 2012
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2010 Annual Cancer Case Volume Data: There Is Still Time to Release!

Thank you to the 766 CoC-accredited facilities that have already reviewed and released their 2010 Annual Cancer Case Volume data to the CoC Hospital Locator.

The site and stage distribution data table of 2010 cancer cases has been posted to CoC Datalinks for access by CoC-accredited cancer programs since July 11.  The CoC originally requested that all accredited cancer programs review and release the 2010 Annual Cancer Case Volume data by August 31; however, the release decision can be made at any time throughout the year.

The CoC encourages cancer program staff to discuss these data at the next cancer committee meeting and to take action to release the data to the public via the CoC Hospital Locator.

To review and release the 2010 Annual Cancer Case Volume data:

  • Log into CoC Datalinks at 
  • Click on the link titled “CoC Hospital Locator: Annual Cancer Case Volume” on the Activity Menu
  • Review the data table for accuracy 
  • Secure permission from the cancer committee to release these data.
  • Indicate your facility’s decision by choosing one of the following:
Accurate Release to CoC
Accurate Do Not Release to CoC
Inaccurate Do Not Release to CoC

If you have questions specific to the 2010 data, please contact the National Cancer Data Base at

The CoC requests that you review and release your 2010 Annual Cancer Case Volume data at your next cancer committee meeting.

Questions?  Contact

Commission on Cancer Standards Featured in The Wall Street Journal

Laura Landro’s column in the August 27th online, and August 28th print issue of The Wall Street Journal featured an article titled To Treat the Cancer, Treat the Distress.  The article features Dr. Stephen Edge, chair of the CoC, discussing the CoC’s new standard on psychosocial distress screening and Kim Thiboldeaux, CEO of the Cancer Support Community, discussing the need for psychosocial distress screening and current tools available including Cancer Support Source, a new distress screening and referral program development by the Cancer Support Community.  The complete article can be viewed on The Wall Street Journal web site at

JNCI Features CoC Standards

The August 22, 2012 issue of the Journal of the National Cancer Institute (JNCI) includes a news article section titled Official Nudge Toward Patient-Centric Oncology Practices, by Eric T. Rosenthal.  The article reviews the CoC’s new patient-centered standards for accreditation and contains a discussion among several individuals associated with the CoC, including Daniel McKellar, MD, FACS, Chair-elect, and Stephen Edge, MD, FACS, the current CoC Chair.  In addition, views from the field include comments on the new standards from Jimmie Holland, MD, a member of the Institute of Medicine committee that wrote the 2007 consensus report, Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs, and Otis Brawley, MD, chief medical and scientific officer and executive vice president of the American Cancer Society who commented on the Society’s support of the new standards; specifically as they relate to patient navigation and supportive care.  The article is accessible on the JNCI website at

The Recovery Room Show

The Recovery Room Show has come to the American College of Surgeons website.  Eighteen episodes of the show, which originally aired in 2010, are now online and can be downloaded as podcasts.  “Making Sense of Modern Medicine,” The Recovery Room is an audio conversation with experts in surgery, medicine, ethics, and public health about the latest developments in medicine and health care.  Frederick Greene, MD, FACS, former CoC chair and current CoC Surveyor, serves as the show’s host. Dr. Greene is currently the clinical professor of surgery at the University of North Carolina School of Medicine, Chapel Hill, and is former chair of the department of surgery at Carolinas Medical Center, Charlotte, NC. The show’s episodes 6 and 8 cover cancer topics.  For more information visit

CoC Exhibit Schedule

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

Academy of Oncology Nurse Navigators
September 14 - 16
Arizona Grand, South Mountain Ballroom
Phoenix, AZ

American Health Information Management Association
September 29 - October 4
McCormick Place Lakeside Center
Chicago, IL

American College of Surgeons Clinical Congress
September 30 - October 4
McCormick Place Convention Center
Chicago, IL

If you are attending any of these meetings, stop by the exhibit hall and view the CoC’s new materials.  To learn more about the CoC, visit

REMINDER to Complete the Eligibility Requirements

Capturing the Eligibility Requirements (ER) each year allows the accreditation staff to validate that important program components are in place and fully functioning between, and in preparation for, surveys. This process will also reduce the need for review of these components by the surveyor at the time of survey.

Please complete the eligibility requirements (ER) screens and upload required documentation for 2012 cancer program activity by the September 30, 2012 deadline. Failure to complete the ER by the deadline can result in suspension of CoC accreditation and delay survey scheduling.

The Eligibility Requirements Now Available for Completion notification was initially sent out electronically on July 3, 2012 to all cancer programs. The notification is also available on the CoC website at

If you require further assistance or have questions, please contact us at   For problems accessing CoC Datalinks, contact  Please provide your first and last name, facility/network name, facility identification number (FIN), city and state, e-mail address, and phone number with your question.

CAnswer Forum – E7: Radiation Oncology Services

A review of questions submitted to the New 2012 Cancer Program Standard Forum, showed Eligibility Requirement (ER) E7: Radiation Oncology Services receiving the most questions during the months of July and August.

In an effort to address any remaining questions, we are rerunning the article below with added information about the uploaded documentation required to demonstrate compliance with this ER.

CoC-accredited programs provide access to the full scope of radiation oncology treatment services to patients with cancer.  In some instances, patients may be referred to another hospital or freestanding facility to receive radiation oncology treatment. 

The radiation oncology service location should be accredited by an appropriate organization, including the American College of Radiology/American Society for Radiation Oncology or the American College of Radiation Oncology.  Accreditation ensures that treatment is performed safely. CoC-accredited programs are encouraged to refer patients to accredited locations.  If your program and/or referral programs are accredited by a radiation oncology organization, upload the certificate(s) into the ER.  That is all you will need to provide to meet the requirement.

When the radiation oncology service location(s) are not accredited, standard quality assurance (QA) policies and procedures are followed to ensure patient safety. This includes patient- specific policies that confirm patient identity as well as machine-specific quality assurance (QA), which ensures proper dosing.  If your program and/or the referral program(s) are not accredited, upload the policies and procedures that are followed to ensure patient safety. You must provide only this information to meet the requirement. A referral program may submit an attestation letter in lieu of policies and procedures.

The CoC-accredited program obtains documentation of accreditation, confirmation of standard QA policies and procedures from the locations most commonly used for referral. 

Information about the type of radiation oncology service and the location where this is provided (on-site at the facility or by referral) is indicated in the Survey Application Record.

Cancer Program Standards 2012–Best Practices Repository–What’s New in August?

This month we will introduce two of the newest best practices submitted to the CoC Best Practices Repository. The Standards Advisory Group for Excellence (SAGE) have reviewed and approved these documents.

The first best practice supports standard 2.1.  It is a College of American Pathologists (CAP) Audit Summary Report, provided by Allegiance Health, Jackson, MI.  The CAP protocols report the required data elements in 90 percent of the eligible cancer pathology reports each year.  A minimum random sample of 10 percent of the pathology reports eligible for the CAP protocols are reviewed each year to document compliance.  This summary report, documents the month of audit, total number reviewed, total number of CAP-eligible surgical cases, and gives the number or reports in compliance with CAP.  The audit report is set up to add the totals to reduce the error rate.  This system is a good way to document compliance and report the CAP review to the cancer committee.

The second best practice is a Physician Review form to support standard 4.6, provided by Presbyterian Intercommunity Hospital, Whittier, CA.  Each year, a physician member of the cancer committee performs a study to assess whether patients are evaluated and treated according to evidence-based national treatment guidelines. This tool helps review compliance with National Comprehensive Cancer Network guidelines for various cancer types and is a useful form for reporting to the cancer committee. 

We hope our constituents find these examples helpful as they prepare to comply with the new 2012 standards. To view these documents and other newly posted documents, follow the link to the Best Practice Repository, at

Thank you to our constituents, member organizations, and staff, for contributing tools and examples to the repository. We encourage all accredited programs to share with us any best practice contributions from your cancer program. Please visit the link above to download instructions for submitting your best practice.

Update—Implementation of Commission on Cancer Standards 4.4 and 4.5

The Cancer Program Practice Profile Report (CP3R) was updated August 15, 2012, with diagnoses and performance rates for each measure for 2010.

As per the implementation plan for these two standards announced in March, 2012, the CoC will evaluate each program’s performance rates and publish a provisional compliance rating for Standards 4.4 and 4.5 based upon the 2010 diagnosis year.

  • The provisional ratings will be based upon the data in the CP3R by the close of business, Friday, November 30, 2012.
  • The provisional compliance rating will appear in the new Survey Application Record the following week for all accredited programs. A National Cancer Data Base Special Flash announcing the posting of these ratings will be distributed to all programs

Over the next few months the cancer committee, with assistance from the cancer liaison physician, should begin to review the measure-specific performance rates for their program.  The cancer committee should determine if an action plan is needed to address performance levels that fall below the required threshold. The cancer committee should develop and execute the action plan. Cancer committee minutes should record actions to address and resolve performance issues.

During surveys in 2013 the surveyor will review the provisional compliance rating, corresponding performance rates, and cancer committee minutes, documentation, and action plan (if warranted) for each standard. The surveyor may revise the provisional compliance ratings issued by the CoC.

For further information, please refer to the implementation announcement for Standards 4.4 and 4.5 which was released as a CoC Special Flash on March 13, 2012 ( or to the copy posted on the CP3R webpage (

Pardon Our Error

The article highlighting the Chapter 5 standards that was published in the July issue of the CoC Flash (distributed to programs on July 31) provided incorrect information on the follow-up percentages that are required of CoC-accredited programs. The correct information appears below:

The CoC-accredited program obtains current follow-up information on 90 percent of patients diagnosed during the last five years and 80 percent of patients who are included in the data base since the reference date. No Commendation rating is available for these standards.

We apologize for any confusion.

CLP Standard 4.3 Changes and Clarifications

Standard 4.3:  A Cancer Liaison Physician serves in a leadership role within the cancer program and is responsible for evaluating, interpreting, and reporting the program’s performance using the National Cancer Data Base data.  The CLP reports the results of this analysis to the cancer committee at least four times a year.


  • Due to a problem with availability of the NCDB reporting tools earlier in 2012, the CLP reports to the cancer committee are required three times in 2012 and four times in 2013 and beyond.
  • The CLP is required to complete CLP orientation within three months of initial appointment and within six months of their reappointment every three years.  Note:  The CLP orientation webinar can be found on the Commission on Cancer’s Online Education Portal at


  • The CLP may appoint a designee to deliver the report on the facility’s performance and response related to the accountability and quality improvement measures with the cancer committee, however, that designee must be eligible to be a CLP, for example, meet the CLP selection criteria stated in the standards manual. 
  • Whether or not the CLP appoints a designee to deliver the report to the cancer committee, the CLP must still meet standard 1.3 attendance requirements and attend at least 50 percent of the cancer committee meetings held each year. 

Cancer Liaison Physician Breakfast and Podcast

Cancer Liaison Physician Breakfast
October 1, 2012
6:30-8:00 am
Hyatt Regency McCormick Place
Chicago, IL

Who should attend?  CoC-accredited cancer program’s Cancer Liaison Physicians (CLPs) and other physicians interested in knowing more about the role of the CLP.  The CoC State Chairs should also attend.

There will be a podcast of the presentation posted on the CoC website following the 2012 CLP Breakfast.  If you are unable to attend the breakfast, please plan to listen to this podcast for important information and updates.

Phillip Roland, MD, FACS, Chair of the CoC Committee on Cancer Liaison, will welcome attendees to the breakfast and provide updates.  The agenda will include information to help you as you carry out the critically important CLP role within CoC-accredited cancer programs.  Christopher Pezzi, MD, FACS, Chair of the CoC’s Quality Integration Committee will present Standards 4.4 and 4.5:  Current Quality Standards.  Following Dr. Pezzi, there will be a presentation on how to assess and improve compliance using the Cancer Program Profile Reports (CP3R).  Andrew Stewart from the CoC’s National Cancer Data Base will present ways that the National Cancer Data Base can serve you, and he will highlight some preliminary results from the CLP Research Plan, an ongoing project intended to improve the NCDB web-reporting tools based on input from you and your peers.  The morning will conclude with a live demonstration of the Rapid Quality Reporting System (RQRS).


If your accredited facility does not have a Cancer Liaison Physician appointment in place, you are in jeopardy of being in noncompliance with CoC accreditation standards 1.3 and 4.3.  It is important that an appointment be made as soon as possible and that the individual is designated as the CLP in Datalinks.  If there is not a CLP appointment in Datalinks, the CoC recommends that the cancer committee chair be listed as the interim CLP until the appointment is made. 

CoC staff monitor CLP appointments on a regular basis and will notify you if the appointment remains vacant. 

The Cancer Liaison Committee and the CLP program staff recommend the following selection criteria for appointment of a CLP:  

  • Member of the medical staff
  • Willing to assume the role of liaison between the cancer program and the CoC
  • Willing to serve as a liaison with the American Cancer Society as indicated
  • Exhibits leadership qualities within the facility and within the cancer committee
  • The CLP monitors, interprets, and reports the program’s performance on improvements to the quality of care provision within the facility.  The NCDB is a tool used to monitor performance, and the candidate should be familiar with or willing to learn the tools and the quality improvement processes being used by the facility

If you need assistance with your CLP appointment process, please contact the CLP program staff at


Announcing a New Edit for ICD-9-CM Comorbidities and Complications

The coding instructions for Comorbidities and Complications #1-10 instruct registrars to copy selected International Classification of Diseases (ICD)-9-CM codes from the medical record.  The eligible codes are all disease codes other than primary cancer, other conditions that may affect the patient’s treatment, and complications of treatment.  For proper alignment, registrars are instructed to left-justify the ICD-9-CM code, drop the decimal, and fill any blank spaces at the end of the code with zeroes so that it is exactly 5 characters long. 

Because ICD-9-CM was a living document that changed annually and sometimes more frequently, the standard edit could only check for valid ranges. To prepare for implementing the ICD-10-CM (currently scheduled for fall of 2014), the ICD-9-CM was “frozen” such that no more code changes will be made. Consequently, a revision to the edit for valid ICD-9-CM codes that takes into account the specific values will be implemented in time for use in the January 2013 National Cancer Data Base (NCDB) Call for Data for cases diagnosed in 2011 and subsequently.  Analysis of the ICD-9-CM codes submitted for 2010 diagnosed cases indicates the following types of problems:

1.    Misalignment of ICD-9-CM codes with fewer than 5 characters. 

Example:  The most common ICD-9-CM code submitted was 401.9, continued arterial hypertension (coded 40190 in registries), which was reported for 93,000 cases.  However, 1,200 cases were reported as 04019, a code that does not exist.  If the misaligned value turns out to be a valid ICD-9-CM code or falls within a range selected for analysis, then it can be misrepresented in NCDB and hospital registry usage.

2.    Reporting non-eligible ICD-9-CM codes as a result of misalignment.

Example:  The ICD-9-CM code for prostate cancer is 185 (18500 in registries).  Because it refers to a primary cancer, that value is ineligible for registry submission.  However, nearly 100 patients were reported with the value 00185, a nonexistent ICD-9-CM code.

3.    Inappropriate entry to indicate the case had no eligible Comorbidity and Complication ICD-9-CM code in the record.

Example:  The correct way to indicate that no eligible ICD-9-CM code is recorded in the patient’s record is 00000 for Comorbidity and Complication #1, and blanks for Comorbidity and Complication #2-10.  However, Comorbidities and Complications #1 was coded 88888 for 1600 patients.  88888 is not a valid ICD-9-CM value and is not defined for use in these items.

4.    Failure to report eligible Comorbidities and Complications where they exist. 

Example:  Lung cancer patients typically exhibit numerous health conditions when they are diagnosed.  However, there were no Comorbidities and Complications reported for 27 percent of 2010 lung cancer patients identified as Class of Case 12, diagnosis and all treatment at the reporting facility, where the registry presumably has maximal access to this information.

The revised edit for ICD-9-CM Comorbidities and Complications #1-10 will accept all values that currently are valid ICD-9-CM registry codes or were valid at any time during the tenure of that system.  It will apply to all cases diagnosed in 2011 or later.

What about ICD-10-CM?

CMS has delayed mandatory implementation of ICD-10-CM until October 1, 2014.  This delay means registries are unlikely to see ICD-10-CM codes in their patient records until 2014.  In anticipation of that eventuality, the North American Association of Central Cancer Registries (NAACCR) record layout 13 to be used for 2013 abstracts will provide a new series of data items for the ICD-10-CM codes because those codes may have more than the five characters allowed in the Comorbidities and Complications #1-10 items. The new items will be called Secondary Diagnosis #1-10.  When your program begins collecting ICD-10-CM, please enter any ICD-9-CM codes in the current Comorbidities and Complications #1-10 items, and the ICD-10-CM codes in the new items.  The ICD-10-CM codes must be entered without adding any extra zeroes at the end, but dropping the decimal points as is currently done.  Full instructions will be available in Facility Oncology Registry Data Standards (FORDS): Revised for 2013, which will be posted later this year.



New NCDB Edit Metafile Posted for NAACCR Layout Version 12.2

A revised edit metafile will be available on September 1 for use by registrars who submit data during the remainder of 2012 for a scheduled submission for National Cancer Data Base (NCDB) deficiency resolution, to qualify for a first CoC survey, and for Rapid Quality Reporting System (RQRS) submission.  This metafile should only be used by programs that already implemented the 2012 upgrades to NAACCR version 12.2 (which includes Collaborative Stage [CS] version 02.04) in their registry software.  Go to for details and to download the updated metafile.  File names for the new NCDB metafile and configuration files end in 08202012.

The updated NCDB edits were drawn from the most recent NAACCR edit metafile (12.2c at This metafile was made available to software providers, central registries, and NCDB on August 15.  The only NCDB changes adopted for the current update affect edits already in use for NCDB or RQRS submissions during 2012.

The following modifications were made in the 08/20/2012 NCDB update:

•    The rules for coding Scope of Regional Lymph Node Surgery were modified beginning with 2012 diagnoses. For 2012 diagnoses and later, a sentinel lymph node procedure is recorded even if the procedure fails to “map” (see FORDS: Revised for 2012 at  The following edits were modified for 2012 and future cases to allow for the possibility that Scope code 2 may not result in any nodes being removed:  Surgery, Rad, Surg/Rad Seq (COC); Surgery, RX Date—Surgery, ICDO3(COC); and Systemic RX, Surgery, Systemic/Sur Seq(COC).  Because the changes are limited to 2012 and future diagnoses, only RQRS submissions are affected at this time.

•    Some CS edits were reworked as a result of the change in coding rules for Scope of Regional Lymph Node Surgery.  These changes do not use the Date of Diagnosis, but rather the direction of the logic was altered.

  • CS SSF 16, MerkelCell Schemas (CS) now checks:  if Scope of Regional LN Surg = 0, then CS SSF 16 must = 998 or 999 and regional nodes positive must = 98.
  • CS SSF 17, MerkelCell Schemas (CS) now checks:  if Scope of Regional LN Surg = 0, then CS SSF 17 must = 000, 020, 030, 050, 060, 080, 090, 999.
  • CS SSF 9, Head and Neck Schemas (CS) now checks:  if Scope of Regional LN Surg = 0, then CS SSF 9 must = 998 or 999.

•    Syntax errors were corrected in the following edit (it now works in accordance with its description): CS Lymph Nodes, SSF3, Nodes Eval, MelanomaSkin(CS).

•    The edit CS Extension, CS Tumor Size, Site, Hist ICDO3 (CS) now includes Prostate SSF 3 (= 950) as well as CS Extension (= 950) when requiring CS Tumor Size to equal 000.

•    Code 987 was added to the list of Head and Neck SSF 2 codes allowed (along with 988 and 999) when CS Lymph Nodes = 999.

•    The error message was corrected for the edit CS TS/Ext Eval, Surgery, Prostate Schema (CS).

•    The description of codes was corrected for the edit Grade Path System (COC).

These and all edits are described in detail in very user-friendly pdf files available on the NCDB Edits website ( with the applicable metafiles.

Release of Registry Plus Online Help Version 12.2 for 2012

A new version of Registry Plus Online Help (RPOH) has been released by the Centers for Disease Control and Prevention (CDC) Division of Cancer Prevention and Control, Cancer Surveillance Branch.  This new version is available at  RPOH provides online versions of FORDS, the SEER coding manual, Collaborative Stage manual, and other resources in a free, easy-to-use package.

RPOH is an integrated, user-friendly help system for cancer registrars and others who work with cancer data. Developed in support of CDC's National Program of Cancer Registries (NPCR), RPOH facilitates the abstraction of cancer cases by centralizing standard abstracting and coding manuals into one accessible, easy-to-use resource. The manuals within RPOH are cross-referenced, indexed, and context-linked, making the information readily available to the user, so RPOH can eliminate the need for printed manuals.

The following manuals are included in this release:

  • NAACCR Data Standards and Data Dictionary for record layout version 12.2
  • Online help for the NAACCR Edits Metafile V12.2B
  • FORDS (Facility Oncology Registry Data Standards) 2012
  • Collaborative Stage Data Collection System [CS]: User Documentation and Coding Instructions, Version 02.04 (including both Parts I and II)
  • SEER Program Coding and Staging Manual 2011
  • ICD-O-3, Introductory Material and Morphology Numerical Lists
  • Multiple Primary and Histology Coding Rules (updated through 9/27/11)

Registry Plus Online Help is part of the Registry Plus software suite for cancer registries.

Are You Caught Up On The Latest New Standards Education?

Stay up-to-date on the latest CoC standards education and view one of the 13 recently launched webinars on the CoC Online Education Portal. These webinars were created to support all cancer program staff in understanding and implementing the 2012 patient centered standards.

Some of the most popular webinars include:

  • Cancer Program Standards 2012 Continuum of Care Services: Focus on Survivorship Care Plans
  • Studies of Quality and Quality Improvements
  • Cancer Program Standards 2012 Continuum of Care Services: Focus on Psychosocial Distress Screening, Tools and Resources
  • Quality of Patient Care: New CoC Standard

For more information and to register visit the CoC Online Education Portal.




AJCC Cancer Staging Atlas, 2nd Edition – Now Available!  

Significantly expanded, expertly and beautifully illustrated, The AJCC Cancer Staging Atlas, 2nd Edition, offers more than 600 illustrations created exclusively for this new edition and is fully updated to reflect the concepts discussed in the 7th Edition of both the AJCC Cancer Staging Manual and its companion Handbook.  This Atlas illustrates the TNM classifications of all cancer sites and types included in the 7th Edition of the Manual and visually conceptualizes the TNM classifications and stage groupings.  

Specifically designed for simplicity and precision, the drawings have been verified through multi-disciplinary review to ensure accuracy and relevancy for clinical use.  Every illustration provides detailed anatomic depictions to clarify critical structures and to allow the reader to instantly visualize the progressive extent of malignant disease.  In addition, nodal maps are included for each site, appropriate labeling has been incorporated to identify significant anatomic structures, and each illustration is accompanied by an explanatory legend. 

  • Combines the AJCC Staging Atlas with a CD containing all images 
  • Users can also import figures into presentations for cancer conferences, grand rounds, presentations, and journal articles/book chapters
  • Based on the 7th Edition staging system

The AJCC Cancer Staging Atlas, 2nd Edition, is an official publication of the American Joint Committee on Cancer, the recognized international leader in state-of-the-art information on cancer staging.  This Atlas has been created as a companion to the updated 7th Edition of the AJCC Cancer Staging Manual, which continues to disseminate the importance of anatomical and pathological staging in the management of cancer.  This state-of-the-art, invaluable 2nd Edition includes a CD containing PowerPoint slides of all illustrations, additional color, and a user-friendly, easy-to-read layout.  The AJCC Cancer Staging Atlas, 2nd Edition will serve as an indispensable reference for clinicians, registrars, students, trainees, and patients!

Order your copy today at or directly at:

CAnswer Forum: How to Determine an "Official" Response

Have you noticed the Collaborative Stage (CS) logo or the American Joint Committee on Cancer (AJCC) logo when you view answers to posts in the CS Forum?  The AJCC logo indicates an official answer.

Registrars have volunteered to be members of the Collaborative Stage Technical Advisory Panel (CTAP) teams.  We have eight teams covering all of the sites in the CS  Forum.  These team members receive notification of the posts (questions) submitted for their sites.  The CTAP team members then review the documentation available in the CS Coding Instructions, both Part I (the rules) and Part II (schema tables and notes).  If the CTAP team member needs assistance answering the question, they reach out to the AJCC Expert Panel members, many of whom wrote the chapters for the AJCC Cancer Staging Manual.  When the CTAP team members post their answers, they use a signature line and logo that indicates they are on the CTAP team.  This distinguishes their posts as the official answer and allows other registrars to express their thoughts and comments on the forum and thoroughly discuss  the issue.  These posts from other registrars can offer a unique perspective and valuable insights into the issue.

You will also see the AJCC logo in the CS Forum.  There are times that AJCC staff can provide insight into an issue since CS is based on the AJCC Cancer Staging Manual, 7th edition, and the AJCC rules for staging.  Information from an AJCC Expert Panel Member appears in bold, along with the AJCC logo.

Understanding the meaning behind these signatures and logos can make finding the answer to a question easier and more efficient. While all the comments on the forum are important, it can sometimes be difficult to navigate through all the posts to quickly find the information you are looking for if you are unaware of the significance of the CTAP signatures and the CS and AJCC logos.  Please keep this in mind next time you use the CAnswer Forum and you might find an answer to your questions more quickly! 

CS Education Resources: Know What’s Available and Where to Find Them

Take advantage of the many Collaborative Stage (CS) educational resources available  A brief overview of the various resources available and the direct links to take you to the information follows:

You Tube
Available for some time, the AJCC YouTube Channel offers short presentations that focus on specific topics such as 998 vs. 999, Neoadjuvant, Testis, and Grade Path Value/Grade Path System.  These videos are now viewable directly from within the CS website. The YouTube videos are found under the education section on the Cancer Staging on YouTube tab. By clicking on this tab, website visitors will be taken to the CS YouTube Page, where they can watch all the CS videos from the bulleted list at the bottom of the page. 

The CS education team hopes this additional viewing option will be welcomed by those who had trouble accessing YouTube from their facility and were previously unable to view these free educational presentations.  More videos will be forthcoming as the CS education team continues to develop short presentations that focus on issues that trouble CS registrars. Suggestions for topics to be addressed in YouTube videos can be submitted to the CAnswer Forum.

CS webinars
There are seven Collaborative Stage webinars available at the AJCC Education Portal for complimentary viewing to the entire registry community.  Several leaders in the field developed and now present these seven webinars.  The webinars are available for viewing 24 hours a day, 7 days a week and include the following topics:
•    CS 101
•    Eval Codes Explanations and Examples
•    Part  1 Section 1 Coding Instructions: Overview and Update
•    Part 1 Section II Coding Instructions: Site Specific Factors and Molecular Markers
•    Site Specific Schemas: Bladder, Kidney, and Testis
•    Coding Factoids and FAQs
•    Site Specific Factors: Stomach and Esophagus and Myeloma

The CS webinars are free, but creation of an account to view the webinars is necessary for new users.  If you have previously viewed an AJCC or CoC webinar through the CommPartners Education Portal, you can begin viewing the presentations immediately by adding the CS webinars to your cart.  For technical issues, such as login or account creation, contact Comm Partners directly at

The original presentations and supporting materials for all of these presentations are available on the CS website under the Presentations Tab of the Education section.  These presentations are a tremendous resource on their own and readily available from the CS website for those who have already viewed the webinars and just want to quickly reference the information in the presentation. 

CS website
The CS website has all the critical information you need for CS coding -- from the General Rules of the Coding Instruction (essential reading for any CS coder!) to the CoC and SEER  Combined Required Site Specific Factors, there are many helpful documents on the CS website for registrars.  Check out the recently added Education Presentations page, which includes the CS presentations from the 2011 and 2012 National Cancer Registrars Association (NCRA) meeting for anyone to download. The page also contains the PowerPoint slides, the handouts, the quiz and the answer sheet for the seven CS webinars available on the AJCC Education Portal. All these materials have been made available so that all registrars have access to these important educational resources. 

CAnswer Forum
Finally, if you have a question that isn’t addressed by any of the educational resources, the CAnswer Forum is the best place to visit.  It is likely that someone else has the same question, so be sure to search the CAnswer Forum for your question before posting a new one.  

The CS Education and Training Team encourages registrars to get familiar with these resources as more content will continue to be added. The CS education team has strived to provide education in a variety of formats to cater to the various learning styles of the registry community.

We hope that you will find these resources useful and, as always, we welcome your feedback at

2012 SEER Manual Posted on SEER Website

The 2012 edition of the Surveillance, Epidemiology and End Results (SEER) Manual is available on the SEER website.
A detailed list of changes made to the 2012 Manual is posted.

Appendix C has been updated to include links to CS v. 02.04.

A detailed list of changes made to Appendix C is posted on the Appendix C webpage

No changes were made to Appendices A, B, or D for 2012.

The Multiple Primary and Histology Coding Rules (MP/H) manual data items section has also been updated to include the revisions in the 2012 SEER Manual.



Lead Your Breast Program to Excellence Conference
Learn from those who developed the standards!

The National Accreditation Program for Breast Centers (NAPBC), in conjunction with the National Consortium of Breast Centers, will host a dynamic two-day conference where nationally recognized leaders will discuss critical success factors for comprehensive breast centers.

When: Friday and Saturday, November 16–17, 2012

Where: Renaissance Chicago O’Hare Suites, Chicago, IL

What: Learn how others built their multidisciplinary breast center from the ground up using nationally recognized programs. This two-day conference will include authorities discussing:

  • National Quality Programs: The What, Why, and How of NAPBC, the National Quality Measures for Breast Centers, and the Breast Imaging Center of Excellence
  • Developing a High-Quality Breast Program
  • Critical Success Factors for Developing Certification/Accreditation-worthy Breast Programs
  • Benefits and Cost-Effectiveness of Breast Center Programs
  • Defining Benchmarks for Breast Centers of Excellence
  • Breast Diagnostic, Treatment, and Management Quality Metrics
  • Aggressive Screening Programs, Patient Navigation, Genetic Risk Assessment and Counseling, Survivorship, and Advocacy

Who: The ideal audience for this conference will be:

  • Hospital Chief Executive Officers and Chief Operating Officers
  • Service Line Administrators
  • Breast Program Leaders and other physicians involved with breast centers
  • Radiologists and Technologists Involved with Breast Centers
  • Nurse Navigators, Quality Managers
  • Breast Imaging Supervisors
  • Genetic Counselors
  • Social Workers

The American College of Surgeons is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The American College of Surgeons designates this live activity for a maximum of 16 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Education hours pending approval from NCRA.

Seating for this conference will be limited, and because of the comprehensive nature of the agenda, will sell out quickly.

To learn more about the Lead Your Breast Program to Excellence conference and REGISTER TODAY, go to


NCRA 2013: The Call for Presentation Abstracts Is Now Open

Share your expertise with your colleagues at NCRA’s 39th Annual Educational Conference, May 30-June 2, 2013, in San Francisco, CA. Abstracts may be submitted from August 30 through October 10 and will be reviewed by the NCRA 2013 Program Committee. All submissions will be acknowledged, and those selected will be notified by November 15, 2012. Submit a presentation abstract using NCRA’s online system at

Date Change for Fall Webinar by Carol Hahn Johnson, BS, CTR

The date for NCRA’s webinar, Guidelines to Using the 2012 Hematopoietic Coding Manual, has been moved from Wednesday, October 10 to Wednesday, October 17, 2012. Hahn Johnson will explain how and when to use the hematopoietic and lymphoid neoplasm multiple primary, primary site and histology, grade rules, and help registrars learn how to use the manual efficiently. The one-hour webinar is $50 for NCRA members and $75 for non-members. Earn one CE. For more information and to register, go to

Order the Premier Cancer Registry Desk Reference Guide Today!

NCRA's Cancer Registry Management: Principles and Practices for Hospitals and Central Registries is the only one-stop desk reference for cancer registry professionals. NCRA members may order by phone at 800-228-0810 to receive the member discount.

New Version of CDC's Registry Plus Online Help (RPOH) Released

The U.S. Center for Disease Control and Prevention’s (CDC) Division of Cancer Prevention and Control, Cancer Surveillance branch has released a new version of Registry Plus Online Help. It provides online versions of Facility Oncology Registry Data Standards (FORDS), the SEER coding manual, Collaborative Stage manual, and other resources in a free, easy-to-use package. Visit the site.


Monthly Spotlight: American Academy of Pediatrics

The Commission on Cancer regularly collaborates with over 50 member organizations in its mission to provide quality cancer care. This month we introduce the American Academy of Pediatrics (AAP).

The AAP is an organization of 60,000 pediatricians committed to the optimal physical, mental, and social health and well-being of infants, children, adolescents and young adults. The AAP issues policy statements, clinical reports, technical reports, and practice guidelines on a broad range of topics that form the basis of pediatric preventive health care. The AAP offers continuing medical education to its members, including hundreds of sessions at its National Conference and Exhibition, taking place this year in New Orleans, Oct. 20-23.

The AAP advocates to protect children’s access to health care and promotes the best possible outcomes for children and the pediatricians who care for them. The AAP believes that each child should have a “medical home”—a model of health care where care is accessible, family-centered, ongoing, comprehensive, coordinated, compassionate, and culturally effective.  

The AAP has the largest pediatric publishing program in the world, with more than 300 titles for consumers and more than 500 titles for physicians and other health care professionals. In 2009, the AAP launched a parent-oriented website,, which offers up-to-date health advice for parents and caregivers.

For more information about the AAP, please visit

Monthly Spotlight: American College of Obstetricians and Gynecologists

The Commission on Cancer regularly collaborates with more than 50 member organizations in its mission to provide quality cancer care. This month we introduce the American College of Obstetricians and Gynecologists (ACOG).

ACOG and its 57,000 obstetricians, gynecologists, and other partners in women’s health care are dedicated, through continuing medical education, practice, and research, to the prevention and treatment of cervical cancer and other conditions affecting women’s health.

Event Information:
Registration is open now for these 2012 postgraduate courses offering up to 16 continuing medical education credits:

“Practical Obstetrics and Gynecology,” December 13 – 15, features sessions on abnormal Pap test results and oncofertility. Program director: Patrick Duff, MD. More information and registration information is available at:

“Update on Cervical Diseases,” November 29 – December 1, at the Bellagio Hotel, Las Vegas, NV, is designed to update clinicians with the dramatic changes that have occurred over the past five to ten years in the understanding of causes, screening methods, prevention, identification, and management of cervical precancer. The carcinogenic human papillomavirus (HPV) on the cervix will be discussed, along with the new evidence-based consensus guidelines that were developed to guide clinicians in the management of patients with cervical precancer.

Program director: Mark Spitzer, MD. More information and registration information is available at:

ACOG has issued the following guidelines on cancer:

  • Practice Bulletin #126, “Management of Gynecologic Issues in Women With Breast Cancer”
  • Practice Bulletin #122, “Breast Cancer Screening”
  • Practice Bulletin #117, “Gynecologic Care for Women with Human Immunodeficiency Virus”

ACOG has issued the following patient pamphlets on cancer (available in English and Spanish):

  • Cancer of the Ovary (AP096)
  • Cancer of the Cervix (AP163)
  • Human Papillomavirus Infection (AP073)

Please visit our website to view a complete listing of our available publications.

For more information on this organization, please contact:
Resource Center, American College of Obstetricians and Gynecologists, PO Box 96920, Washington, DC 20090-6920
Phone: 202-638-5577
Website:  | E-mail:

Monthly Spotlight: American Pediatric Surgery Association

The Commission on Cancer regularly collaborates with over 50 member organizations in its mission to provide quality cancer care. This month we introduce the American Pediatric Surgery Association (APSA).     

September is Pediatric Cancer Awareness Month.  Our organization, APSA, is dedicated to ensuring optimal pediatric surgical care of patients and their families, and to promote excellence in the field of pediatric surgery, especially in the area of pediatric surgical oncology.  This organization advocates for high standards in all aspects of surgical care of infants and children, and strives to make these surgical services available to as many children as possible.  APSA creates a community and identity among pediatric surgeons, and provides high quality continuing education for its members. APSA has a rich history in supporting discovery, innovation, and improvement of care for children with surgical diseases.  

APSA’s headquarters are located in Deerfield, IL.  Keith T. Oldham, MD, is the current president of the organization, and Ms. Lee Ann Clark is the executive director.  The website address is

Event Information:
The APSA annual meeting will take place May 2-5, 2013, at Marco Island Marriott Beach Resort, Marco Island, FL.  This meeting will include abstracts from basic and clinical aspects of pediatric surgical oncology.  The cancer committee will providean update on developments in pediatric surgical oncology.

Recent Publications and/or Products:
1.     Loworn HN, Ayers, D, Zhao Z, et al.  Defining hepatoblastoma responsiveness to induction therapy as measured by tumor volume and serum α-fetoprotein kinetics.  J Pediatr Surg 2010; 45:121-9.
2.      Oltmann SC, Garcia N, Barber R, et al. Can we preoperatively risk stratify ovarian masses for malignancy? J Pediatr Surg 2010; 45:130-4.
3.     Oltmann SC, Fischer A,  Barber R, et al.  Pediatric ovarian malignancy presenting as ovarian torsion incidence and relevance.  J Pediatr Surg 2010; 45:135-9.
4.     Rich BS, McEvoy MP, LaQuaglia MP, Wolden SL.  Local control, survival, and operative morbidity and mortality after re-resection, and intraoperative radiation therapy for recurrent or persistent primary high-risk neuroblastoma.  J Pediatr Surg 2011; 46:97-102.

For more information on this organization, please contact:
Lee Ann Clark, Executive Director, APSA Headquarters,111 Deer Lake Road, Suite 100, Deerfield, IL 60015
Phone: 847-480-9576 | Fax: 847-480-9282
Web Address: | E-mail:

American College of Surgeons Cancer Programs Featured in International Innovation

The American College of Surgeons (ACS) Cancer Programs are featured in International Innovation, a leading global publication for the scientific, technology and research communities. In an interview, David Winchester, MD, FACS, Medical Director of ACS Cancer Programs, offers readers fascinating insight into his role, the extensive expansion that the ACS has experienced over the last 25 years, and the multidisciplinary cancer programs currently instigated and supported by ACS. “All of the ACS cancer programs have national organizational partners to minimize, and in some cases, eliminate cancer as a major public health problem,” Dr. Winchester explains  

Dr. Winchester also highlights several major achievements of the ACS Cancer Programs, citing the Commission on Cancer and its National Cancer Data Base, among others. He concludes: “I would say that the cancer programs are embodied with the fundamental belief that the ACS inspires quality through the highest standards, resulting in better outcomes.”

International Innovation reports on the latest science, research and technological innovations on a global level. For more information and to sign up for a complimentary subscription offer to the publication, go to:

SGO Creates Cancer Survivorship Toolkit

As cancer survival rates improve, there are increasing numbers of cancer survivors. Cancer and cancer treatment affect patients in all aspects of their lives, including physical, psychological, financial, and social. The Commission on Cancer with the American College of Surgeons accreditation process requires implementation of Standard 3.3 by 2015. This requires accredited cancer centers to have a process in place to disseminate a comprehensive care summary and follow-up plan for patients completing cancer treatment. The process will be monitored, evaluated, and presented to the cancer committee annually.

The Foundation for Gynecologic Oncology during Gynecologic Cancer Awareness Month in September 2012 is releasing a set of cancer survivorship documents to address the needs of cancer survivors with gynecologic malignancies. Created by the Society of Gynecologic Oncology, the SGO Survivorship Toolkit will make it easy for members to implement a care summary and follow-up plan into their cancer centers and practices. “These documents will clarify for the patient and her providers who is coordinating her cancer surveillance and what that should entail,” said Lynn P. Parker, MD, a member of the SGO Clinical Practice Committee and chair of the working group that created the toolkit. Dr. Parker is division director of gynecologic oncology at the University of Louisville, (KY).

The toolkit includes templates for individualized care plans for survivors of endometrial, cervical, ovarian, and vulvar cancers. A genera  post-treatment self-care plan for all cancers survivors completes the packet. Each three-page document allows the physician to list names and contact information for members of the patient’s cancer treatment and post-treatment team; cancer history; diagnosis and treatment summary; disease status at completion of primary therapy; adverse treatment-associated effects after therapy; and follow up recommendations. The SGO Survivorship Toolkit is available at

The National Cancer Legal Services Network Helps National Cancer Community Locate Free Legal Assistance

In March 2012 the National Cancer Legal Services Network (NCLSN) launched a new website,, featuring a national directory of organizations that provide free legal assistance for people and families affected by a cancer diagnosis. The website, which also includes training materials and resources to assist those starting new cancer legal advocacy programs, aims to increase the accessibility and availability of legal resources for cancer survivors.

The website and establishment of the NCLSN was led by LegalHealth, a division of the New York Legal Assistance Group, with initial funding from the LiveSTRONG Foundation. LegalHealth, the National Coalition for Cancer Survivorship, and Atlanta Legal Aid conducted a national survey of private law firms, not-for-profit legal aid organizations, medical-legal partnerships, bar associations, cancer support organizations, individual attorneys, social workers, and patient navigator programs to create the directory.

“ is a new resource for people from many different perspectives--patients, health care professionals, legal aid programs, and the entire cancer community—from which they can learn more about these services,” said Randye Retkin, Director of LegalHealth. “In spite of the devastating nonmedical consequences of an overwhelmingly prevalent disease, cancer legal services programs are far too few. Through, we not only hope to make it easier to locate those programs that exist, but also to encourage their increased availability nationwide.”

In addition to the map, directory, studies, and training materials, the NCLSN uses the platform to demonstrate the nonmedical and legal issues that cancer survivors and providers experience so visitors can better understand the significance and need for cancer legal advocacy programs.  The NCLSN provides patient navigators and other members of cancer care teams with resources to help survivors address cancer-related legal issues.