Texas Cancer Registry Update

1
Texas Cancer RegistryUpdate

• Nancy S. Weiss, Ph.D.
• Director, Texas Cancer Registry
• October 2002

2
Legislation and Rules Status

• Legislation Chapter 82, Health Safety Code -
• Cancer Incidence Reporting Act
• Amended by SB285 (Effective
  September 1, 2001)
• Rules Chapter 91, Texas Administrative Code -
• Being Considered for Adoption at October
  Board of Health
• Meeting

3
Implementation of Amended Legislation

• Board of Health Rules revised
• Focus on known physician specialties with
  unreported cases
• Identify unreported cases from clinical labs and
  follow-back to physicians
• Work with physicians to pilot test reporting
  methods
• Continue to look for additional funds and other
  resources to fully implement
• Begin with 2003 cases?

4
Impact of Rules Changes

• Health care practitioner required to furnish data
  or provide access to records if the same data or
  records are not reported by a health care
  facility or clinical laboratory.
• Text documentation to support dx,stage rx codes
  required of all cancer reporters.
• 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.
• Reporting by health care practitioners required
  within 4 months of follow-back request for
  information.
• - Otherwise reporting should be
  quarterly.
• Requests for personal cancer data for research
  purposes must be approved by the TDH IRB.

5
Impact of HIPAA (Health Insurance Portability and
AccountabilityAct of 1996) and State Medical
Records Privacy Act (TexasHealth and Safety
Code, Chapter 181)

• Reporting to TCR allowed without consent
• Only data items required by TCR should be
  reported
• Disclosure of health data by the TCR must meet
  certain standards (currently under development)
• Audit trail of data released must be kept
• Sharing of death information by the TCR to
  providers still allowed
• End of provision of death fiche alternative
  method
• HIPAA compliance required by April 14, 2003
• Medical Privacy Act compliance required by
  September 1, 2003

6
Proposed TCR Reporting Changes for 2003(Soon To
Be Finalized)

• Current TCR Fields No Longer Required To Be
  Reported
• Rx Dates Chemo, Hormone, BRM, Other (1220,
  1230, 1240, 1250)
• Rx Text Chemo, Hormone, BRM, Other (2640,
  2650, 2660, 2670)
• Reason for No Surgery XRT, Chemo, Hormone
  (1340, 1430, 1440, 1450)
• Marital Status at Dx (150)
• Text Usual Occupation (310)
• Text Usual Industry (320)
• Cause of Death (1910)
• ICD Revision Number (1920)
• Name Suffix (2270)
• Alias (2280)
• Will Obtain from Death Certificate

7
Proposed TCR Reporting Changes for 2003
(cont)(Soon To Be Finalized)

• Current Required TCR Fields That Will Continue
  But Are Not Required By FORDS
• NAACCR Record Version (50)
• Tumor Record No. (60)
• Type of Reporting Source (500)
• Maiden Name (2390)
• Text Primary Site, Histology, Staging (2580,
  2590, 2600)
• Rx Text Surgery, Radiation (2610, 2620)
• Newly Required TCR Field
• Physician Follow-Up (2470)

8
Compliance Requirements

• 2000 cases - Were due by December 31, 2001
• 2001 cases - Due December 31, 2002
• 2002 cases - Due within 6 months

9
Cancer Reporting to the TCR

• Between September 2001 and September 2002
• - 178,425 reports were received and processed.
• (24 increase over previous year)
• - 95,346 cancer cases for the years 1998-2001
  were added to the database.
• (30 increase over previous year)

10
Electronic Reporting to the TCR(2000 Cases)

• 79 of facilities reported electronically
• 98 of records were reported electronically
• 50 of facilities reported using SCL
• 24 of records were reported using SCL
• 62 of reports were from ACoS facilities

11
Estimated Statewide CaseCompleteness
Expected Cases
Year
Percent
1997 1998 1999 2000 2001
99 100 99 86 49
74,482 74,531 75,271 78,235 79,810
(As of September 30, 2002)
12
Status of Cancer Case Completenessby Public
Health Region
Percent
Texas
Public Health Region
13
Quality of Cancer Data Reported

• Of Coded Records Submitted Since March 2001
• 47,924 records (32) of 148,717 records
  contained one or more errors.
• Fields with Errors
• Address
• Social Security Number
• Summary Stage
• Date of Admission/First Contact
• Rx Dates
• Rx Summary
• Summary Stage
• Tumor Record Number
• Type of Reporting Source

14
Data Quality Audits

• Audits by TCR staff (or contractors) of quality
  of data reported by facility
• - Casefinding 41 facilities audited for 1999
  cases
• - 4 Contract auditors selected through state
  bid
• process

15
Casefinding Audit Results - 2002(1999 Cases)

• Overall 17.0 of cases unreported
• Range 2.0 to 62.9

Facility Caseload
Mean Percent Unreported (Range)
gt601 cases (11 facilities) 301 to 600 cases (11
facilities) 151 to 300 cases (10 facilities) lt150
cases (9 facilities)
12.2 (2.8 - 43.0) 22.8 (2.0 - 62.9) 24.6
(6.4 - 55.2) 18.8 (3.1 - 55.4)
-
16
Texas Results of the NAACCR Registry
Certification(1999 Diagnosis Year)
Gold Standards Achieved

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

17
NAACCR Registry Certification (cont)

• Standards Not Achieved

• Completeness of Case Ascertainment
• 79.8 - Texas
• Death Certificate Only Cases
• 5.5 - Texas

18
Recent Research UsingTexas Cancer Registry Data

• Texas AM School of Rural Public Health -
• Agricultural Pesticides and Childhood Cancers
  Study
• UCLA Study Occupational cohort study of
  employees with radiation exposure
• Cooper Institute, Dallas Study of physical
  activity and subsequent cancer incidence
• Indian Health Service Linkage of IHS and TCR
  data to determine extent of misclassification of
  American Indian/
• Alaska Natives

19
Recent Upcoming Cancer Data Reports

• Cancer in Texas, 1998
• Texas Cancer Facts Figures, 2002-2003-ACS
• Prostate Cancer in Texas
• 2000 Texas Cancer Mortality Statistics
• Cancer in Texas, 1999
• Childhood Cancer in Texas, 1990-1998
• Cancer Along the Texas-Mexico Border, 1995-1998

20
Availability of Cancer Data

• Incidence1992, 1995 1998
• Mortality 1990 2000
• Published reports or fact sheets/journal articles
• Special data runs upon request 1-800-252-8059
• TCR Web Site
  http//www.tdh.state.tx.us/tcr

21
Miscellaneous Mentions

• Death Clearance for 2000 cases
• File Transfer Protocol (FTP)
• SANDCRAB Lite - v 5.1 (NAACCR v 10)
• SANDCRAB Windows - Central Registry Software
• TCR Edits Software for Facilities
• Data Rejection
• Matching Documentation from Reporters
• No TCR Conference in 2003