What Cancer Registrars Should Know About Quality Abstracting and the Use of Manuals

The importance of using manuals to abstract cases and maintain a successful registry continues to be critical. Towards the end of the year, when the standard setters introduce new codes, rules, deletions, or revisions for the upcoming abstracting year, it is even more vital to never rely on what you think you know or what you’ve “always done”.

The world and most importantly cancer patients depend on accurate data from cancer registries. The data that we gather is what is used to determine statistics, treatment, and survival rates. The well-known saying, “Garbage In, Garbage Out” is useful when thinking about changes, modifications, and deletions.

As late as 2021, some CTRs were still coding Collaborative Stage- Derived Stages and Site-Specific Factors! How many times have you heard, “We’ve (or I’ve) always done it this way”? Not only are registrars wasting precious time coding fields that no longer apply, but the risk of garbage going in is greater when manuals are not used in abstracting.

Drop-down menus, although timesavers, do not always contain all the rules applicable to a particular field. Histology, staging, and treatment have very specific rules and manuals should be used to ensure correct coding. For example, incorrect or inaccurate coding registry fields can affect data used by NCDB, SEER, and your state central registries. You must keep in mind that physicians, researchers, epidemiologists, and many more use OUR aggregate data to develop or update standards of care for a cancer patient.

We all tend to be creatures of habit, and when we are accustomed to coding or selecting a certain drop-down choice repeatedly, that field (and its associated rules) become mindless to us. Take, for example, back in 2013, we all remember Herceptin changed from chemotherapy to BRM/Immunotherapy. Habit allowed registrars to continue to code the Herceptin as chemotherapy, we had to understand the changes and learn to code this drug as BRM/Immunotherapy. (A drop-down would not have helped in this case since the codes show the categories but didn’t indicate the change in the drug classification.)

The use of Genedits is important and required, but Genedits is not “smart” enough to know that the upper outer quadrant of the left breast in a female patient should have been lower outer quadrant of the right breast of a male patient; or the patient was diagnosed with endometrial cancer, but you coded the primary site as cervix. Computer algorithms can only decipher if a code is input where it should be and if that code is formatted according to the program.

Tracking Updates & Changes to the Cancer Registry

So where does a registrar find all the updates and changes? As we all know, there are many manuals that we use daily to code a cancer case. Again, our minds are not equipped to hold all the information contained in all the manuals let alone when they change.

Below are some tips on how to keep track of the multitude of changes each year:

• Attend National/Regional/State educational conferences - Jennifer Ruhl, Jim Hofferkamp, Steve Peace, Peggy Adamo, and Donna Gress are experts in cancer registry and usually, all have presentations during conferences that cover upcoming changes. TAKE NOTES!
• View recordings of educational sessions if you cannot attend in person – NAACCR, FCDS, AJCC, CoC and others have past recordings viewable on a variety of topics. WATCH THEM! A couple of very helpful sessions include NAACCR’s annual Boot Camp session and Coding Pitfalls sessions which provide information on common errors registrars are making, updates to new items, and much more.
• View the websites for each standard setter – For example, NAACCR has upcoming, current, and historical standards for fields such as ICD-O, SSDI, and the NAACCR Data Dictionary. Using the website rather than a printed copy of a manual is preferred as the website updates automatically and there is a potential of missed information if we must manually update our manuals.
• Use SEER Inquiry, Ask A SEER Registrar, or CAForum – experts are on these platforms and can answer up to date questions for all data fields. (Keep in mind that the CAForum is an open forum, and while others can provide input and opinions, only rely on the answers by the “professionals” that have the logo included in their signature or profile.)
• Share news with peers/colleagues – If you have attended a conference or watched a recording, take notes, and share with the rest of your team. Make sure that what you are sharing is consistent with what was actually presented. There is no room for adjustments or opinions when a rule changes.

Regardless of how an individual registrar learns and retains knowledge, it is critical for each of us to focus on what is REQUIRED. If you can’t find the ‘proof’ of what “you’ve always done” in a manual, then chances are, you are collecting inaccurate data.

Stay vigilant on keeping up with the changes. Our data is crucial. Take pride in your work. Focus on the end result of our data – excellent quality care and hopefully a cure or at least better treatment for current and future cancer patients.