CANCER THERAPY

Abstractors Training
 First Course of Therapy
 Treatment Plan
 All cancer-directed treatments specified in
the physician(s) treatment plan and
delivered to the patient after initial
diagnosis are First Course of Therapy
 Describes type(s) of treatment(s) intended
to modify or control the malignancy
 Documentation is frequently found in
several different sources (Ex: medical
record, clinic record, consultation reports,
outpatient records)
 Document treatment plan in your text
 Recording/Abstracting Cancer
Therapy
 All Kentucky registries and registries that are
part of ACoS-accredited cancer programs are
required to record complete first course of
therapy for analytic cases accessioned into
CPDMS.net
 Complete reporting of first course of therapy is
vital to researchers for determining treatment
outcomes and developing more effective
treatment and improving outcomes
 Complete reporting of first course of therapy
impacts cancer patient survival
 Time Period
 All malignancies except leukemia
 First course of therapy includes all cancer-directed
treatment planned by the physician(s) during or after
the first diagnosis of cancer
 Planned therapy may include multiple modes of
therapy, and may encompass intervals of a year or more
 No treatment or active surveillance may be a planned
treatment option, and is considered first course of
therapy
 If a treatment plan is not available, evaluate the therapy
and the time it started – If the therapy is part of an
established protocol or within accepted management
guidelines for the disease, it is first course of therapy
Time Period (continued)
 Consult the attending physician (Ex:
surgeon, medical oncologist, radiation
oncologist) or your registry’s physician
advisor if protocols or management
guidelines are not available
 If there is no treatment plan, established
protocol or management guidelines, and
you cannot consult with a physician, use
the principle, “first course of treatment
must begin within four months of the date
of initial diagnosis”
 Non-Definitive Treatment
 Non-definitive treatment is mainly used for diagnosis of
cancer. This can also be used to prolong the patient’s
life, make the patient comfortable, or prepare the
patient for definitive therapy.
 Not cancer-directed – not meant to reduce the size
of the tumor or delay the spread of disease
 Non-definitive procedures include diagnostic
procedures and supportive care
 Generally not used in statistical analysis of treatment
Non-Definitive Treatment
(continued)
 *NOTE: For many of the reportable hematopoietic diseases, the
principle treatment is either supportive care, observation, or
another type of treatment that does not meet the usual definition
of treatment that “modifies, controls, removes or destroys
proliferating cancer tissue.” Such treatments include phlebotomy,
aspirin, supportive care and observation.
 These treatments are recorded as firstcourse Other Treatment
(code 1) for the hematopoietic diseases ONLY (as directed in
the hematopoietic database and coding manual)
 Record a complete description of the treatment plan in the text
field
Non-Definitive Treatment
(continued)
 Examples of non-definitive treatment:
 Surgical procedures:

 Incisional biopsies

 Exploratory procedures with or without biopsies

 Supportive care/symptom relief:

 Pain medication

 Oxygen

 Antibiotics administered for an associated infection

 Transfusions*

 Intravenous therapy to maintain fluid or nutritional balance

 Laser therapy directed at relieving symptoms

Definitive Treatment
 Definitive treatment modifies, controls,
removes, or destroys proliferating cancer
tissue
 May be directed toward either the primary
site or to metastatic sites
 Administered to minimize the size of the
tumor or to delay the spread of disease
 NOTE: Only definitive therapy should be
included in statistical analyses of treatment
– Surgery codes 00-07, and ‘Other’
treatment code 0 are not considered
definitive therapy and must be excluded
from analyses
 Palliative Treatment
 Palliative treatment improves the patient’s quality of life by
preventing or relieving suffering
 May include definitive treatment procedures as well as non-
definitive patient care procedures (Ex: Patient diagnosed with
stage IV colon cancer with extensive liver metastasis – Patient is
unresectable due to advanced stage of disease and advanced
age - Begins chemotherapy intended to shrink the metastatic
tumor and relieve symptoms – The chemotherapy is palliative
because shrank the tumors and relieved symptoms AND the
chemotherapy is also definitive therapy because it destroyed
proliferating cancer tissue)
 Record any palliative therapy that modifies or destroys
cancer tissue if planned as part of first course definitive
therapy
Adjuvant vs Neo-adjuvant
Therapy
 Definitive therapy (chemotherapy, radiation
therapy, hormone therapy, immunotherapy,
etc) given as part of planned first course of
therapy after surgical resection is called
‘adjuvant’ therapy.
 Definitive therapy (chemotherapy, radiation
therapy, hormone therapy, immunotherapy,
etc) given as part of planned first course of
therapy before surgical resection is called
‘neo-adjuvant’ therapy.
Treatment-Related Coding Fields
Treatment Status
 Summarizes whether patient received any treatment or was
under active surveillance (watchful waiting)
 This field may be left blank for cases diagnosed prior to 1/1/10
 Treatment administered after a period of active surveillance is
considered subsequent therapy and is not coded in this item
 Definition:
 Code 0 = No treatment given
 Code 1 = Treatment given
 Code 2 = Active surveillance (watchful waiting)
 Code 3 = Unknown if treatment was given
Treatment Status (continued)
 Coding sample:
1. Patient diagnosed with prostate
cancer and chooses to “watch and
wait”. Treatment status code?
2. Patient diagnosed with colon cancer
and undergoes a colectomy.
Treatment status code?
Systemic Surgery Sequence
 Records sequencing of systemic therapy and surgical procedures given
as part of first course of treatment
 Use this data field for cases diagnosed on or after 1/1/06
 Codes:
 0 = No systemic therapy and/or surgical procedures
 2 = Systemic therapy before surgery
 3 = Systemic therapy after surgery
 4 = Systemic therapy both before and after surgery
 5 = Intraoperative systemic therapy
 6 = Intraoperative systemic therapy with other systemic therapy
administered before or after surgery
 9 = Sequence unknown
Radiation/Surgery Sequence

 Records the sequencing of radiation and surgical

procedures given as part of first course of treatment
 Codes:
 0 = No radiation therapy and/or surgical procedure
 2 = Radiation therapy before surgery
 3 = Radiation therapy after surgery
 4 = Radiation therapy both before and after surgery
 5 = Intraoperative radiation therapy
 6 = Intraoperative radiation therapy with other
therapy administered before or after surgery
 9 = Sequence unknown
Reason No Non-Definitive
Surgery
 Code reason no non-definitive surgical
procedure performed as part of initial
diagnostic work-up
 If non-definitive surgical specimen is diagnostic
of malignancy, must create a non-definitive
surgical therapy record for the earliest positive
non-definitive surgical procedure
 For this field, record only biopsies that obtain
tissue; fine needle aspirations that obtain only
cells (not tissue) for cytology are not coded in
this field
 Reason No Non-Definitive
Surgery (continued)
 Definitions of codes:
0 Non-definitive surgery not performed; not applicable; not recommended for
this case; autopsy only
1 Non-defininve surgery performed and results diagnostic of malignancy
2 Non-definitive surgery performed and results negative for malignancy
3 Non-definitive surgery performed and results turned out to be definitive
therapy (excisional biopsy)
8 No non-definitive surgery at this hospital; unknown if
non-definitive surgery done elsewhere
9 Unknown if non-definitive surgery performed
Reason No Therapy

 Code reason why treatment not

administered as part of first course of
therapy
 Includes reason no surgery, no
chemotherapy, no radiation therapy, no
hormone therapy, no immunotherapy,
no other therapy
 Reason No Therapy (continued)
 Definition of codes 0 and 1 for surgery:
 Code 0 for surgery = Surgery was performed as part
of planned first course of therapy
 Code 1 for surgery = Surgery was NOT performed as
part of planned first course of therapy
 Reason No Therapy (continued)
 Definition of codes 0 and 1 for chemotherapy, radiation therapy,
hormone therapy, immunotherapy and other therapy:
 Code 0 for chemotherapy, radiation therapy, hormone
therapy, immunotherapy and other therapy = not
administered because it was not part of planned first course
therapy – Use code 0 when:
 There is no information in the patient’s medical record
about these therapies AND
 it is known that these therapies are not usually
performed for this type and/or stage of cancer OR
 there is no reason to suspect that the patient would
have undergone one of these therapies
Reason No Therapy (continued)
 If the treatment plan offered multiple treatment
options and the patient selected treatment that did not
include any of these therapies
 Patient elects to pursue no treatment following
discussion of these treatments (a discussion does not
equal a recommendation)
 Only information available is that the patient was
referred to an oncologist (a referral does not equal a
recommendation)
 Watchful waiting is the planned course of treatment
 Patient diagnosed at autopsy
 Code 1 for chemotherapy, radiation therapy, hormone
therapy, immunotherapy and other therapy = Therapy
administered as part of first course of therapy
 Reason No Therapy (continued)
 Definitions of codes 2 – 9 for ALL therapies:
 Code 2 = Therapy not recommended/administered
because it was contraindicated due to other patient
risk factors (co-morbid conditions, advanced age, etc)
 Code 5 = Therapy not administered because patient
died prior to planned or recommended therapy
 Code 6 = Therapy not administered; was
recommended by patient’s physician, but was not
administered as part of first course of treatment – no
reason why noted in the medical record
Reason No Therapy (continued)
 Code 7 = Therapy not administered; was recommended by the patient’s
physician, but treatment was refused by patient, patient’s family
member, or patient’s guardian – refusal noted in the medical record
 Code 8 = Therapy recommended, but unknown whether it was
administered
 Code 9 = Unknown if therapy recommended or administered, or death
certificate case only*

*The Kentucky Cancer Registry and the Commission on Cancer (for ACoS-accredited
registries) recommend that you utilize all resources to obtain complete first
course of therapy information. This may entail obtaining information from
outside resources such as physician offices and other facilities. NCCN guidelines
are a great resource for identifying usual treatment recommendations by primary
site and stage of disease. NCCN guidelines can be found at www.nccn.org. The
Hematopoietic Database is an excellent resource for identifying usual treatment
recommendations for hematopoietic diseases. Consult the attending physician
(Ex: surgeon, medical oncologist, radiation oncologist) or your registry’s physician
advisor if protocols or management guidelines are not available.
Reason No Therapy (continued)
 Coding sample:
1. Patient undergoes an LAR (lower anterior resection)
for a rectosigmoid colon cancer. Reason no surgery
code?
2. Patient is recommended by physician to undergo
chemotherapy for colon cancer, but patient refuses.
Reason no chemotherapy code?
3. Patient is diagnosed with rectal cancer at your
facility and is discharged. No additional work-up
performed at your facility (stage of disease
unknown), no treatment at your facility, and no
treatment plan documented, and unknown if
treatment administered elsewhere. Reason no
therapy code(s)?
Reason No Therapy (continued)

4. Patient diagnosed with lymph node

positive colon cancer and undergoes
hemicolectomy at your facility. There
is no information re: adjuvant
therapy in the medical record. Per
NCCN treatment guidelines,
chemotherapy is recommended.
Reason no therapy chemotherapy
code?
 Palliative Care

 Record the type of palliative care provided during the first

course of planned therapy
 Given to relieve symptoms and may include surgery, radiation,
systemic therapy or other pain management therapy
 Palliative procedures do not diagnose or stage the primary
tumor
 Palliative surgical procedures, radiation therapy, and systemic
therapy that are part of first course of therapy and that also
remove or modify primary or secondary malignant tissue are
coded in the palliative care fields AND in the respective
therapy fields
Palliative Care (Continued)

 Codes:
 Code 0 = No palliative care provided; diagnosed at autopsy
only
 Code 1 = Surgery (which may involve a bypass procedure) to
alleviate symptoms, but no attempt to diagnose, stage, or
treat the primary tumor is made
 Code 2 = Radiation therapy to alleviate symptoms, but no
attempt to diagnose, stage or treat the primary tumor is
made
 Code 3 = Chemotherapy, hormone therapy, or other systemic
drugs to alleviate symptoms, but no attempt to diagnose,
stage, or treat the primary tumor is made
 Code 4 = Patient received or referred for pain management
therapy with no other palliative care
Palliative Care (Continued)
 Codes (continued):
 Code 5 = Any combination of codes 1, 2, and/or 3
WITHOUT code 4
 Code 6 = Any combination of codes 1, 2, and/or 3 WITH
code 4
 Code 7 = Palliative care was performed or referred, but
no information on the type of procedure available in the
patient record; palliative care was provided that does
not fit the descriptions in codes 1-6 (Ex: stent
placement in bile duct for patient with pancreatic
cancer)
 Code 9 = Unknown if palliative care performed or
referred; not stated in patient record
Palliative Care (continued)

 Coding sample:
1. Patient diagnosed with advanced colon
cancer undergoes colon bypass surgery
with colostomy due to obstruction.
Palliative care code?
2. Patient diagnosed with unresectable,
obstructive colon cancer with extensive
liver metastases and undergoes
chemotherapy to hopefully reduce the
tumor burden and relieve symptoms.
Palliative care code?
End of Cancer Therapy Presentation
Any questions?
Lets complete the reason no therapy exercises.
SS