MCR MINI-UPDATE OCTOBER 2012
Fellow Registrars,
It was great to see many of you at the recent MoSTRA meeting in Cape Girardeau. The planning teams did a great job of both educating and entertaining us.Back in Columbia, Fall seems to be coming on quickly this year. Here’s our news for October:
MCR NEWS
Case Submission
2011 cases were officially due to MCR by July 15, but there are a number of cases that we need which have not yet been submitted. If your facility has cases that are ready to send to us, please do get them uploaded now so that we can process and consolidate them to meet our national deadlines for complete data. As you finish additional cases in coming weeks regular uploads to us would be of great benefit!
Death Clearance
Death Clearance is underway and emails informing hospitals of their cases were sent out in early September. Not all facilities had cases identified from the death certificates so if you did not receive a letter that would be the indication. The deadline to release the response in Web Plus is October 1st, so if you have not submitted them please do so at this time. It is important that you return them so we can move forward in the process. If any cases are determined to be missed for your hospital,be sure to mark the case resolution forms accordingly and release them. You should also submit abstracts for them with your next routine transmission. If you have any questions regarding the Death Clearance process please contact Debra Douglas at or 877 735-0755. If you have technical questions or issues regarding submission through WebPlus please contact Shari El Shoubasi at or 866-240-8809.
Education
Basic Cancer Registry Training – October 25-26, St. Peters, MO – More information is available on the Education/Training page of our website. Please pass this information along to others.
Fundamentals of Abstracting Workshop – November 12 -13, at the Missouri Cancer Registry and Research Center more information is available on the Education/Training page of our website. Please pass this information along to others.
NAACCR Webinar - Collecting Cancer Data: Stomach and Esophagus will be taking place on October 4 from 8am to 11 am at the Missouri Cancer Registry and Research Center, Room 426.
Live Meeting – Using MCR-ARC Data will be the next presentation on October 10 at 10 am.
To register for any of our educational opportunities please contact Shari El Shoubasi at or 866-240-8809.
Need CEs? – We’ve got you covered!We are one step closer to getting recorded NAACCR Webinars up on our website. Keep checking your email for updates.
Abstracting Tips
Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma
During Louanne’s presentation at MoSTRA, this point generated lots of interest, so I wanted to pass it on to everyone. The Hematopoietic Manual rules have been clarified in Lymphoma/Leukemia Module 3, PH8. If the diagnosis is CLL/SLL or CLL or SLL, then code primary site to Bone Marrow (C42.1) WHENEVER bone marrow is involved; code to Site of Other Involvement (LN regions, organ, tissues) WHEN bone marrow is not involved. The histology in both cases is 9823/3. Code 9670 (SLL) is now obsolete as it was virtually impossible to distinguish SLL from CLL/SLL. Infiltrate in the spleen does not indicate primary site involvement, but rather a filtering of the blood resulting in leukemia deposits in the spleen.
Incorrect coding of Date of First Contact can adversely affect your facility’s ability to meet CoC and MCR-ARC standards for timely abstracting.
Date of First Contact is the date the primary qualified to be coded as either analytic or nonanalytic for your facility. For analytic cases, this means that the date of first contact cannot occur before the date the primary was diagnosed. Think about it this way: If a person was seen at your facility for cancer symptoms but has no cancer diagnosis at that point, there is nothing reportable to abstract for the day of that encounter. No reportable diagnosis = no abstract. No abstract = no class of case. Date of First Contact for nonanalytic cases is the date the patient’s status met criteria for the assigned class of case.
FORDS 2012, Section Two: Coding Instructions/Cancer Identification; pp. 4, 91.
Grade
Remember that Missouri still requires coding of the field “Grade” (NAACCR #440). Instructions for coding are in the MCR Abstract Code Manual
Coding Skin Primaries
Several surgery codes for skin cases depend on the width of the marginas confirmed on microscopic exam. Please be sure to note the width of the free margin in your text to support your code choice. If the margin is not stated in the path report, note that in your text.
STANDARD SETTER NEWS
Standard Setters Don’t Always Agree
Many registrars have discovered the SEER Inquiry System and Ask a SEER Registrar as resources at While these can be very helpful, it is important to remember that specific standard setters have some unique codes/instructions and may not agree on all coding issues. So it is possible that advice you get from SEER sources may not apply to MCR or CoC reporting. Major unresolved issues are outlined in Chapter V of the NAACCR Data Dictionary . MCR requirements are explained in the MCR Abstract Code Manual; required fields are listed under Required Data Elements
Briefly, fields where differences occur include:
- County – MCR allows 998 for unknown counties outside of Missouri when a partial address is known.
- Spanish/Hispanic Origin – MCR runs a surname algorithm here, so reporting registrars should not use code 7(Spanish surname only)
- Occupation/Industry – MCR requires only text entries, not numeric codes
- Grade/Differentiation – follow the MCR Manual
- Definition and Timing of First Course of Treatment – MCR requires the CoC field , Date of 1st CRSRX CoC (NAACCR item #1270) which has different rules than the SEER field Date of Initial RX SEER (NAACCR item #1260). The field First Course Calc Method (1500) records which organization your abstract follows and is coded 1 for the CoC item.
- Staging and Treatment Fields – Each agency requires a different mix of staging and treatment fields, so be sure the answer you get from SEER is for a field you use in Missouri.
- Vital Status – MCR uses use the CoC code 0 when a patient has died, not SEER 4.
Hematopoietic Database and Manual
The web-based version of the Hematopoietic Database & Manual will be the most current version each time you access it. If you prefer to download the software version to your desktop, you’ll also want to register for email updates to keep you current. Check to be sure you have the most recent version dated 5/23/12. A history of revisions is available at:
CS Video Access Options
In an effort to bring the Collaborative Staging educational videos to users who are blocked from logging onto YouTube at work, the CS team has also made them viewable directly within the CS website. Go to and click on a choice from the listed topics.
National Cancer Institute Cancer Trends Progress Report 2011/2012 Update
This document with data drawn from SEER registries is rich with information presented in a variety of ways. Tables and charts might be useful in presentations and annual reports or might complement a quality study at your facility.
NCCN Guidelines Updated
The National Comprehensive Cancer Network has recently published updates for treatment of HER2 positive breast cancer with the chemotherapy drug pertuzumab.
RESOURCES
As Mobile Devices Catch On, Data Breach Risks Grow
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Current Ploys Used in Phishing Emails
Do You Need a Tumor Board Assessment? (article that informs patients)
Cancer in the Oldest Old in the US (possible idea for a facility study)
Early Lung Cancer Patients Living Longer After Radiotherapy (possible idea for a facility outcomes study)
Ten Practice Changes I Will Make after Attending ASCO 2012 (your oncologist may too)
Breast Cancer Chemoprevention: Hit It Harder (possible MD seminar topic?)
DNA Alone Inadequate to Identify HPV-Related Head & Neck Cancers
Genes Reveal Four Breast Cancer Subtypes (Washington University research)
Improved Diagnostic Test Benefits Children with AML
New Imaging Agent Approved for Prostate Cancer
Impact of HER2 Gene Amplification in Esophageal Cancer
Enjoy the beautiful weekend!
Nancy H. Rold, CTR
QA Unit Supervisor
Missouri Cancer Registry and Research Center