Cancer registrars likely know that 2010 will be a big year in their registries, no matter where they work, from the central cancer registry to the hospital and institutional registry. Whether or not all registrars truly understand the scope of those changes remains to be seen, but two things are certain: all registrars will be affected, and industry leaders are working hard to ensure everyone will be ready.

The North American Association of Central Cancer Registries Inc. (NAACCR) and standard setters in the cancer surveillance realm decided to limit major changes to every 3 years to allow time for registries to gear up for the modifications. Next year is one of those big years, and registrars will see three key changes.

The American Joint Committee on Cancer will publish the AJCC Cancer Staging Manual, 7th Edition later this year, and, concurrently, new guidelines for collaborative staging will be released, Collaborative Stage Data Collection System Version 2 (CSv2). The National Cancer Institute/Surveillance Epidemiology and End Results (NCI/SEER) program will unveil the Hematopoietic Multiple Primary and Histology (MP/H) database, and NAACCR will be nearly tripling its record layout beginning in 2010. We'll help you sort through the alphabet soup and see what needs to be done to prepare.

Get Ready for CSv2

Out of all the changes, our sources agreed that hospital and institutional registries will feel the most impact from CSv2. Staging schema were tweaked and new site-specific factors were added to allow for the collection of clinically significant data, according to Suzanna Hoyler, BS, CTR, project leader for CS data collection with the AJCC. Some data items will be new, so registrars will have to learn the new schema and learn about new tests that data will be collected on.

Prognostic indicators were added, as well, and those were put into site-specific factors for each primary site, extending the length of the collaborate stage, according to Lynda Douglas, CTR, National Cancer Registrars Association (NCRA) president and education coordinator with the National Program of Cancer Registries at the Centers for Disease Control and Prevention (CDC). Douglas will join approximately 75 others attending a July "train the trainers" session in Chicago hosted by the AJCC on CSv2. Once those trainers are educated, they'll migrate into the cancer registry community and spread their standardized knowledge of CSv2.

Those trainers will learn about 10 sites and will get an overview of part one of the new CSv2 staging manual, which is where all of the new coding rules are. Trainers will be armed with standard lecture notes, slide presentations and exercises with answer sheets. Representatives from standards setting organizations, as well as other registrars across the nation, will be attending, and AJCC is depending on them to pass the knowledge along. NAACCR will roll out Webinars, and NCRA will offer large-scale training at its 2010 meeting as well as three sessions on CSv2 at its May 31-June 3 conference this year. NAACCR will also host a post-conference workshop after its annual conference this year, June 13-19, on managing change, which is a constant in the cancer surveillance realm, and also about specifically managing the changes in NAACCR Standards for Cancer Registries, Volume II, Version 12.

What Registrars Can Do Now

With all of the education being rolled out, registrars should be examining when they can get educated on the CSv2 changes, Hoyler noted. She believes registrars are aware of the changes in general, but she's not sure they grasp the scope of them yet-that will come with education, and in particular the three presentations slated for this year's NCRA conference.

Registrars can also seek out 2010 implementation guidelines from NAACCR, set for release in July. That guidance will be directed toward hospital and central registries, as well as software vendors. It will address all of the 2010 changes, not just CSv2.

In their own facilities, registrars can begin to look at the type of tests they're seeing from the laboratory on various items to make sure data can be collected in their facilities. NCRA will release a survey in the coming weeks to ensure the data needed is accessible in facilities, Douglas said. Registrars will also be asked to provide test cases to help AJCC with the informatics part of the CSv2 implementation. Hoyler also suggested that registrars bookmark the new CSv2 manual on the desktops of their computers so it can be referenced in a pinch, as it aligns well with AJCC 7th edition manual.

AJCC did change the implementation of the pre- and post-treatment staging categories section of the project until Jan. 1, 2011. Hoyler noted the delay arose because the work couldn't be adequately done along with everything else going on. "We did make that one change," Hoyler noted. "I don't know if we'll be making any others. At this point, the go live would start with Jan. 1, 2010 cases, knowing that many registrars are not going to start collecting that data until later on in the year."

According to Hoyler, who went through the CSv1 roll out on the other end, as a registrar, CSv2 should look somewhat familiar to registrars, unlike the first version, which was completely new. "While we have a lot of new sites that have been added, and we have new coding schemes for them, the structure is still kind of the same," Hoyler explained. "It's still many of the same data items. They'll see some consistency in that. They're still going to have to learn new things, but I don't think it's going to be as overwhelming as when we started doing CSv1."

More Changes Coming

While CSv2 seems to be the change with the most widespread impact, the other changes will affect registrars to a lesser degree. The Hematopoietic MP/H changes will be completely automated, Douglas explained, but registrars will need to read through the automated application to determine if they're using the correct codes. "There will be a lot of information available to registrars to help educate them about hematopoietic diseases using this tool, but still, it's going to require some additional time," Douglas noted.

As for the changes to the NAACCR record layout, a big change is the expansion of the text fields, but registrars won't see much impact from that. The NAACCR record layout has gone from 6,694 character lengths to 22,824, according to Lori Havener, CTR, program manager of standards, NAACCR. "That's an issue for central registries and going through their data processing operations, so those kinds of impacts will affect the central cancer registries that won't impact the hospital cancer registries," Havener said.

With all of the major changes set to hit cancer registry next year, there have been concerns about whether or not registrars can shoulder the additional burdens and garner all the education they need to face the changes. The decision to go with major changes every 3 years is still being looked at and could be revised, Havener explained. "We still need to analyze that process to see if this was a good plan or whether we need to relook at things and come up with a new plan for the implementation of major changes," Havener said.

Lynn Jusinski is an associate editor with ADVANCE.