Cancer Reporting in Texas Texas Cancer Registry Update

1
Cancer Reporting in TexasTexas Cancer Registry
Update

• Nancy S. Weiss, Ph.D.
• Texas Cancer Registry
• Cancer Epidemiology and Surveillance Branch
• Texas Department of State Health Services
• September 29, 2005

2
Overview

• TCR Administrative Changes
• Impact of 79th Texas Legislative Session
• New Initiatives and Partnerships
• TCR Reporting Changes for 2005 Cases
• Current Reporting Status and Other TCR Activities
• NAACCR Certification Results for 2002 Cases
• Upcoming Data Calls
• Data Availability and Research Using TCR Data
• Miscellaneous Updates

3
Administrative Changes
Cancer Epidemiology And Surveillance Branch (45
Staff 14 Contractors/ In-Kind Staff)
Cancer Epidemiology Group (15 Staff)
Cancer Surveillance Operations Group (38 Staff)
4
Cancer Surveillance Operations Group

• Registry Operations Manager - John Hopkins All
  PHRs
• Registry Operations Supervisors
• Regional Team Leads
• Quality Assurance Team Lead - Susan Perez
• Supervisor - Melanie Williams

- Velma GarzaPHRs 5/6, 7, 8/11 - Elaine Allgood
PHRs 2/3/4, 1/9/10

• - Dora Rodriquez PHRs 2/3/4, 1/9/10
• Judy Spong PHRs 5/6
• Nelda Gonzalez PHRs 7, 8/11

Cancer Epidemiology Group
5
79th Legislative Session

• No Changes to Reporting Law
• Increased funding for the TCR 2.2 million for
  biennium -

Chapter 82, Health Safety Code - Cancer Incidence
Reporting Act (Effective September 1, 2001)
Lawsuit settlement funds Higher Education
Coordinating Board - Fee assessments from
academic centers
6
Rule Reminders

• Chapter 91, Subchapter A TAC Amended April
  24, 2003
• Text documentation to support dx,stage rx codes
  required.
• Monthly submissions required of facilities with
  caseloads gt400.
• - Otherwise on a quarterly basis.
• - Clinical labs must submit at least
  bi-annually.
• Electronic reporting required of facilities with
  caseloads gt50.
• Reporting by facilities and clinical labs
  required within 6 months of dx/admission.
  (extension for 2004 cases - 9 months)
• Requests for personal cancer data for research
  purposes must be approved by the TDH IRB.
• Will be proposing rule amendments later this Fall

7
On-going and New Initiatives

• Pathology Laboratory/Physician Reporting
• Academic Center Partnerships
• Casefinding and Data Collection Continuation
• Web-based Training

8
Pathology Laboratory andPhysician Reporting
Initiative

• Capacity to identify unreported cases from
  clinical labs and follow-back to physicians
  developed
• National Electronic Disease Surveillance System
  (NEDSS)
• SANDCRAB Lite for Path Labs
• Began preliminary data collection in FY05
• 9 Path Labs implemented reporting
• Over 16,000 reports received

9
Partnership with Academic Centers

• Expansion of Regional Registry Presence
• Border area - TxAM School of Rural Public Health
• Tyler Area - to be determined

• Temporary Contract CTRs to Process Record
  Backlogs - MDACC
• Circuit Rider Abstractor - UTMB
• Path lab reporting, Texas - Mexico Data Sharing,
• CTR / Bachelors Degree Program -
  UTHSC-SPH-Houston at Brownsville
• Border Data Quality Improvement in Laredo area -
  UTHSC - SA and San Antonio Cancer Institute

10
Casefinding and Data Collection Pilot

• Pilot-One Time Funding from Preventable Health
  Block Grant
• Casefinding and Data Collection for 2004 cases at
  154 Hospitals with lt100 Cases
• 77 Participation of 199 Hospitals Invited
• 5,267 Cancer Cases Collected
• Improve Timeliness, Completeness and Quality of
  Data

11
Casefinding Data Collection Projectfor 2005 Cases

• Project funded by exceptional item
• 232 hospitals statewide invited and 208 will
  participate (90)
• Approximately 8,900 cases expected
• Work will be performed by contract CTRs
• Work to begin by December 2005 or January 2006

12
TCR Reporting Reminders for 2004 Cases

• Collaborative Stage
• Revisions to coding guidelines 01.02.00
• Must be used with 2005 cases (up to facilities if
  they choose to recode 2004 cases)
• Revisions to algorithm which affect derived
  stages
• Thyroid primary revisions affect summary stage
• ACoS and non-ACOS facilities
• Both must submit detailed text to support coded
  data items or enable staff to code

13
TCR Reporting Changes for 2006 Cases

• 12 New Reportable Data Items
• Casefinding Source - NAACCR Data Item 501
• Primary Payer at Dx - 630
• Reason for No Surgery - 1340
• Rx Summ - Surg/Rad Seq - 1380
• Rx Summ - System Sur Seq - 1639
• Address at Dx Supplemental - 2235
• Text for Chemo, Hormone, BRM Other 2640,
  2650, 2660, 2670
• Managing Physician 2460
• Follow-up Physician - 2470

• 6 Months Reporting Requirement

14
Compliance Requirements

• 2003 cases - Were due by December 31, 2004
• (12 months reporting)
• 2004 cases - Extended to September 30, 2005
• (9 months reporting)
• 2005 Cases - Due June 30, 2006
• (6 months reporting)

15
Cancer Reporting to the TCR

• Between September 2004 and September 2005
• - 230,254 reports were received and processed
  (15 increase over last year).
• - 101,006 Texas resident cancer cases for the
  years
• 2001-2004 were added to the database (9
  increase over last year).

16
Electronic Reporting to the TCR(2003 Cases)

• 97.5 of facilities reported electronically
  (increase from 80)
• 98 of records were reported electronically
• 62 of facilities reported using SCL (increase
  from 47)
• 25 of records were reported using SCL
• 55 of reports were from ACoS facilities

17
Electronic Reporting via the Web(September 2004
- September 2005)

• CRESS (Cancer Registry Electronic Submission
  System) and SCL FTP Users
• No. of Facilities Reporting 409 (300 increase)
• No. of Submissions 2,407 (325 increase)
• No. of Records 143,695 (580 increase)

18
Estimated Statewide CaseCompleteness
Expected Cases
Year
Percent
2000 2001 2002 2003 2004
95 98 97 88 49
81,960 83,959 86,086 88,268 90,356
(As of September 22, 2005)
19
Status of Cancer Case Completenessby Public
Health Region
Percent
Texas
Public Health Region
20
Reporting TimelinessTexas ACoS vs non-ACoS
Facilities2002 vs. 2003 Admissions
439
450
348
344
306
Median Days
2002
2003
2002
2003
ACoS (69 Facilities) non-ACoS (410 Facilities)
As of August 15, 2004
21
Data Quality Audits

• Audits by TCR staff (or contractors) of
  completeness and quality of data reported by
  facility
• - Casefinding 21 facilities audited for 2003
  cases
• - 2 Contract auditors selected through state
  bid
• process (3 CTRs performed work)
• - Results pending

22
Regional TrainingsCollaborative Staging
Workshops Covering Collaborative Staging System
Guidelines / Revisions(by Emory University
Rollins School of Public Health)

• To provide training to state cancer reporters and
  TCR staff
• To offer continuing education credits for Texas
  CTRs at no cost

• 5.5 CE Hours
• 6 Trainings - 132 Attendees
• Dallas 30
• Houston 23
• Austin 14
• TCR Staff 21

• San Antonio 28
• El Paso 16

23
Texas Results of the NAACCR Registry
Certification(2002 Diagnosis Year)
Gold Standards Achieved

• Completeness of information recorded
• Duplicate Primary Cases
• Passing EDITS
• Timeliness

24
Texas Results of the NAACCR Registry
Certification(2002 Diagnosis Year) (cont)
Silver Standard Achieved

• Death Certificate Only Cases

4.1 - Texas lt3 - Gold Standard
-
25
NAACCR Registry Certification (cont)(2002
Diagnosis Year)

• Standards Not Achieved

- Completeness of Case Ascertainment 88.8 -
Texas 90 - Silver Standard 95 - Gold
Standard
26
NAACCR Call for Data2003 Cases

• Due December 1, 2005
• Target for Silver Certification
• CDC - U.S. Cancer Statistics - 2003 - January 2006

Other Calls for Data
27
Availability of Texas Cancer Data

• Incidence 1995 2002
• Mortality 1990 2003
• Expected Numbers of Cancer Cases and Deaths, 2005
• Published Reports, Statistical Tables, Fact
  Sheets on the Web
• Special Data Runs Upon Request 1-800-252-8059
• TCR Web Site http//www.dshs.state.tx.us/tcr

28
Recent Upcoming Cancer Reportsthat Include
Texas Data
National

• Special Colorectal Cancer Monograph in Cancer
• U.S. Cancer Statistics - 2002 (soon to be
  released)
• Annual Report to the Nation on the Status of
  Cancer, 1975-2003, with a Special Feature on
  Cancer in U.S. Hispanics/Latinos 1999-2003
• Central Brain Tumor Registry of the United
  States, Primary Brain Tumors in the U.S.,
  Statistical Report, 1998-2002

State

• Texas Cancer Facts and Figures, 2004
• Regional Facts Sheets, 2005
• County Facts Sheets, 2005
• Cancer Incidence and Mortality in Texas,
  1990-2002
• Tobacco in Texas, 1998-2002
• Prostate Cancer Incidence, 1998-2002
• Breast and Cervical Cancer Incidence, 1998-2002

29
Research Studies UsingTexas Cancer Registry Data

• UTSPH-Houston Air Toxics and Cancer in Houston
• University of Pittsburgh Graduate School of
  Public Health Cohort Mortality and Cancer
  Incidence Studies on Rahway, New Jersey Facility
  (linkage completed)
• UTSPH-Houston Analysis of Endometrial and Ovarian
  Cancer Incidence, Stage at Diagnosis, Mortality,
  and Survival by Race/Ethnicity, Socio-economic
  Status, and Rural/Urban Residence in Texas,
  1995-2002
• UCLA Ovarian Cancer Care and Outcomes Study
• Harvard Cohort Cancer Registry Follow-up Study
• UTSPH Houston Gynecologic Cancers Among
  Veterans in Texas
• MD Anderson/American Cancer Society Prostate
  Cancer Screening Cohort Study
• University of Alabama at Birmingham Study of Good
  Year Tire Employees, Tyler, TX
• Cooper Institute and Vanderbilt University Impact
  of Physical Fitness and Exercise on Health Study

30
The Power of Texas Data

• Prior studies indicated conflicting results
  regarding if cervical cancer survival is affected
  by race/ethnicity, rural status, education level,
  and/or poverty.
• Studies were limited by
• The number of cervical cancer cases/deaths
• The type of population

• Texas was an optimal state to further study the
  impact of these factors on cervical cancer
  survival
• Large ethnically diverse population with large
  urban and rural areas
• All of these various factors could be analyzed
  simultaneously

31
The Power of Texas Data (continued)

• UTSPH-Houston conducted study, Socio-economic
  Status as a Predictor of Cervical Cancer
  Survival.
• African Americans, low income, and those living
  in rural areas may be at higher risk of dying
  from a preventable cancer
• Additional research needed on these high risk
  women in order to identify missed opportunities
  for preventing these kinds of deaths

• Lead to National Institute of Health funded
  study, Understanding Disparities in Cervical
  Cancer Survival Study to be conducted by the
  UTSPH-Houston
• Also lead to additional study of these factors
  and their potential impact on endometrial and
  ovarian cancers by team of gynecologic
  oncologists from UTSPH-Houston and UT MD Anderson

32
Miscellaneous Mentions

• Unknown Diagnosis Year Follow - back
• Death Clearance for 2003 cases
• SANDCRAB Lite - v 9.0 (NAACCR v 10.1)
• TCR Edits for Facilities with Vendor Software
• Electronic Death Information Update
• - National Death Index
• - Texas Vital Statistics
• Matching Documentation from Reporters for CDC
  Grant