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 A primary step toward increasing the clinical relevance of the cancer abstract is the implementation of Version 2 of Collaborative Stage (CSv2), starting Jan. 1, 2010; roughly 2 months away. CSv2, a data collection system, is designed to correspond with release of the 7th Revision of the AJCC Cancer Staging Manual, published by the American Joint Cancer Committee (AJCC), January 1, 2010. This anatomic staging and prognostic indicator system is a primary determinant of the patient's course of treatment. Proper treatment is based on comprehensive staging.
The Collaborative Stage Data Collection System (CS), which was first implemented in 2004, was intended to harmonize the AJCC TNM Staging, Summary Staging and Extent of Disease coding systems. CS permitted data collection for different agendas using a single set of coding and timing rules.
A consortium of seven organizations has collaborated to accomplish this standardization, including: the American Joint Committee on Cancer (AJCC); the Surveillance, Epidemiology and End Results Program (SEER) of the National Cancer Institute; the National Program of Cancer Registries (NPCR) of the Centers for Disease Control and Prevention; the National Cancer Registrars Association (NCRA); the North American Association of Central Cancer Registries (NAACCR); the Commission on Cancer (COC) of the American College of Surgeons (AcoS); and Statistics Canada.
As a result of the expanded information in the AJCC Cancer Staging Manual, 7th Edition, CS Version 2 contains 143 individual schemas (vs. 94 in version 1) cancer types, which include the nine core data items plus up to 25 site-specific factors. Each schema will list the applicable primary site and subsite codes and the range of applicable histology codes. Additional fields for pre- and post-treatment data items are deferred until 2011. That release is being referred to as Phase 2.
These sponsoring organizations have announced a wide-ranging set of training resources and opportunities, which are summarized below:
AJCC and CSv2:
In late July, the CSv2 Education and Training team held a Train the Trainers workshop for a cadre of 75 trainers from all states and Canada. This workshop, and the ongoing Webinars for the trainers, provide the trainers with the resources to deliver presentations and case exercises at state registrars association meetings and other trainings. Training materials include scripted presentations and cases exercises to reinforce the information presented, and that address the following sites: Breast, Colorectal, Head and Neck, Prostate and GU, Lung, Skin/Merkel cell/ melanoma, Liver/bile ducts, Lymphoma/hematopoietic, GIST/neuroendocrin, and GYN. Lists of the trained trainers and scheduled workshops are posted at www.cancerstaging.org/cstage/education.html. The Speakers Bureau members are not employed by the AJCC.
Each site-specific presentation will include: An overview of the CSv2 manual, with emphasis on new changes, Explanations for ambiguous terminology, Histology exclusion groups, Advanced abstracting of site-specific factors. The learning objectives are to: understand the rationale behind changes and updates to CS, understand the use of codes and the reporting of CS, determine the proper use of codes for accurate reporting in CS, and to understand how to locate specific documentation relative to site-specific factors (SSFs) within CS.
Quarterly updates will continue to be developed and disseminated through the COC, NCRA, and NAACCR listservs. The next one is scheduled for January 2010 to coincide with the official release of CSv2.
NCRA
NCRA is providing a new series, which has a total of 12 Webinars, to support training and education on CSv2. Each Webinar will include 100 minutes of lecture, a review of three exercises and 20 minutes of questions and answers. A hard copy of the lecture and exercises will be forwarded to the registrants prior to each Webinar. The Webinars will be recorded and archived by the NCRA and will be made available for later purchase from the NCRA Web site. Registrants for this training will earn two CE credits per Webinar. The Webinar schedule, registration fees, and details on how to register are given on the NCRA web site.
The CSv2 Workgroup features articles in the NCRA's newsletter, The Connection. Upcoming articles include an overview of the new site-specific factors with a focus on colon, and addresses strategies for how the cancer registry community can prepare for implementation of CSv2, and the educational resources available for training on CSv2.
Additional articles are being planned for the Journal of Registry Management to include an informational article about the CSv2 project, and a second article related to the experiences of people who have used CSv2. In addition, the January 2010 issue will include preliminary results of the CSv2 field study related to the availability of data to collect the new site-specific factors.
NAACCR
NAACCR offers a Webinar series package for purchase, which includes access to 12, nine, or six live Webinars. The NAACCR series will present a different Webinar every month beginning in October 2009 through September 2010. Each Webinar is 3-hours long and will be presented on the first Thursday of each month. Each site-specific Webinar includes anatomical information needed to abstract and code the cases, to determine the number of primary tumors, to code topography and histology, to code the CSv2 data items, and to code the treatments. In addition, each Webinar includes a live question and answer session, quizzes, exercises, slides, various abstracting tools, technical support, and recordings that can be viewed at one's convenience. The entire series has been approved for 36 NCRA CE hours, that is 3 hours per Webinar. Visit the NAACCR Web site for the Webinar schedule, registration fees, and details on how to register
NAACCR will host a Town Hall meeting (webinar) for cancer registry software vendors sometime in November. This will coincide with release of the beta version CSv2 algorithm and API.
SEER Program of the National Cancer Institute
The SEER training Web site includes a CS Web module (http://www.training.seer.cancer.gov/collaborative/). This module is based on CS Version 1. A CSv2 training module will be developed in the near future.
Questions may be submitted to the SEER Inquiry & Response System
NPCR of the Centers for Disease Control and Prevention
The 2009 Annual Education & Training Conference in Atlanta was dedicated to training for CSv2. The Education and Training Coordinators from the 48 CDC/NPCR funded central cancer registries have been added to the list of trainers that were trained in Chicago, in July, 2009. These trainers will be providing training at no charge to cancer data reporters in their state or area.
COC of the ACoS Inquiry and Response System
Questions about the CS Data Collection System can be submitted to the COC Inquiry and Response (I & R) System. Users can also search the I & R database for existing questions and answers on CS, http://web.facs.org/coc/default.htm
The National Cancer Institute of Canada (NCIC) of the Canadian Cancer Society:
The Public Health Agency of Canada working with the Canadian Council of Cancer Registries, and other Canadian organizations is developing a Canadian CSv2 training plan.
State Cancer Registrar Associations:
It is anticipated that many Fall 2009, and Spring 2010, State association workshops will include sessions on CSv2
Data System Vendors and Registry Software:
Cancer registry data system vendors will necessarily play an important part in education and training. The software includes the mapping and schema selection algorithms, will provide Stage Grouping, 1977 and 2000, and will display many important notes and guidelines.
Coding Manual and Instructions: Collaborative Stage Data Collection System: Part I: A good place to start familiarization with CSv2 is the Manual, commonly referred to as "Part I." Part I is an electronic manual, intended to used on the registrar's computer desktop. It will be in the public domain, available for free, posted on the AJCC website, http://www.cancerstaging.org/ later this year. The National Cancer Registrar's Association plans to sell a printed copy of the manual.
Part I is divided into two sections. The first section includes the general instructions and coding rules for the CS data elements and discussion of changes and revisions in abstracting rules between CS version 1 and CS version 2. The second section provides site-specific notes issues related to the individual primary cancers, such as the Site-Specific Factors (SSF): needed for TNM Mapping, tumor markers and lab values, and other non-anatomic information such as prognostic indicators, future research items, and relevant patient history for some cancers.
The number of SSF per site/histology differ: for example there are 24 for breast, and 9 for colon. In general, if information regarding a SSF is not present in the pathology report or medical record, the registrar is not required to go looking for it.
There are many important players helping to plan and coordinate this CSv2 training effort, too numerous to mention. The Management team includes: Suzy Hoyler, BS, CTR, Project Leader, AJCC and CSv2 staff: Karen Pollitt, Donna Gress, RHIT, CTR, and Martin Madera. The educational effort is chaired by Cynthia Boudreaux, LPN, CTR.
Herman Menck has been a project manager, and past deputy director, for the Cancer Surveillance Program of Los Angeles County since 1971. He is active in NCRA and NAACCR Informatics and Education Committees, and has served as an Editor of NCRA Textbooks and Journal. He would like to thank the CSv2 Education and Training Team for its help with this column.
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