Recap – National Cancer Registrars Association (NCRA) 44th Annual Conference
New Orleans, Louisiana
Submitted by: Theresa Real, RHIT, CTR, Quality Control Manager and Courtney Jagneaux, RHIA, CTR, Project Manager – NCRA’s 44th Annual Educational Conference was held at the Sheraton Hotel New Orleans, LA from May 20-23, 2018 with 1,381 attendees.
There were many excellent speakers and presentations with the focus primarily on the various 2018 cancer registry changes. Additionally, there were 30 exhibitors set-up in the exhibit hall, including Registry Partners!
The educational conference had an enthusiastic start on Monday with the keynote speaker, Dr. Vince Cataldo, specialist in medical oncology and hematology, setting the tone. He opened the conference enlightening the audience with “A Biography on Cancer”. Dr. Cataldo demonstrated milestones in cancer history sharing the discoveries of Dr. Percivall Pott’s environmental carcinogens, Dr. Rudolf Virchow’s microscopic cancer descriptions, and Dr. William Halsted’s surgical treatment of breast cancer, to name a few.
He spoke about his personal heroes, Nobel Prize-winning Madame Curie, with her discovery of radium as well as the Father of Modern Chemotherapy, Dr. Sidney Farber, and Dr. Emil Freireich who paved the way for Medical Oncology. Dr. Cataldo delved into current cancer incidence and mortality rates along with modern day screening and treatments for breast, prostate, and lung cancer addressing the impact that cancer registrars have with the data they collect.
He also gave a brief overview of the direction that cancer care is going with increasing targeted therapies, including CAR-T Therapy, an up-and-coming autologous T-cell personalized medication. As a native of Louisiana, Dr. Cataldo ended his talk with a humorous “survival guide” to New Orleans, better known as the “Big Easy”.
Monday’s presentations also included Donna Gress, who delivered an excellent presentation with an update and review of AJCC 8th Edition Staging.
She reviewed major changes such as:
- post-therapy classification
- the new grade data items for each stage classification
- required prognostic factors
She reminded the attendees that while physician’s stage for patient care, the registry data is used for data analysis. This means physician stage & registry data mismatches are an opportunity for quality improvement. Donna encouraged all CTRs to let go of “old” registry rules such as down-staging or the uncertainty rule.
Monday’s lineup also included Jennifer Ruhl, MSHCA, RHIT, CCSS, CTR, from the National Cancer Institute (NCI), provided an overview of the Summary Stage 2018 as well as the new Extent of Disease (EOD) data collection system. She reminded attendees that EOD will only be required for SEER states although some states may elect to collect EOD voluntarily.
The entire day on Tuesday was dedicated to AJCC 8th Edition & SEER Summary Staging 2018 as well as Extent Of Disease data collection. Six sites – breast, colon, lung, nasopharynx, prostate and HPV-mediated oropharynx case studies were reviewed in detail by physician presenters. The physician’s demonstrated the changes between the 7th & 8th Edition AJCC staging and presented case studies for each primary site.
Following each site presentation of AJCC staging, staff from NCI-SEER and CDC-NPCR presented the SEER Summary Stage 2018 and EOD presentations for each primary site case study.
Some of the highlights for the site-specific presentations included:
Breast:
- Dr. Jennifer Garreau noted that the size of the breast tumor does not necessarily matter, it’s the biology of the tumor that is most significant.
- One change for breast in the 8th Edition is the fact that lobular carcinoma in-situ is no longer included in the staging system, however, it is still reportable to all standard setters.
Prostate:
- Dr. Priya Rao demonstrated that the subcategories for prostate pathologic T2 (pT2a, pT2b, pT3c) have been eliminated.
- All organ confined disease at resection is now assigned pT2.
- Clinical staging has not changed.
- Dr. Rao also shared that in addition to Gleason score, the Grade Group will be required with diagnosis 2018 and forward.
Oropharynx:
- Dr. Ashish Patel discussed the new AJCC classification for HPV-mediated (p16+) oropharynx cancer in AJCC 8th Edition.
- Tis has been eliminated
- Subcategories T4a and T4b have been eliminated as there was found to be no prognostic significance between the subcategories
- Stage 4 is now reserved for M1
The majority of Wednesday was split into four concurrent sessions which included hospital registries, central registries, cancer registry management and professional development.
Some highlights from Wednesday’s sessions included a presentation titled “Using NCCN Guidelines for Complete and Accurate Treatment Data Collection” presented by Meredith Beck, BA, CTR, senior cancer registrar at Fox Chase Cancer Center in PA. Meredith did a great job demonstrating how to navigate the guidelines for each primary site which is not an easy task.
Wilson Apollo, MS, RTT, CTR, licensed radiation therapist and former Director of the Radiation Therapy School at the Memorial Sloan-Kettering Cancer Center in New York did an excellent job explaining evolving technologies in radiation therapy treatment, and reviewing some of the new radiation treatment codes.
Lisa Pareti, BS, RHIT, CTR, the Education/Training Coordinator for the Louisiana Tumor Registry, did a phenomenal job discussing common coding errors and how to avoid them. She reviewed some problematic data items and reviewed some confusing lymph node data fields. She also provided a presentation on accurate text in the abstract and discussed the importance of proper text documentation and visual editing.
Additionally, Jim Hofferkamp, CTR, Program Manager for Education at NAACCR provided an overview of the NAACCR Edits Metafile and the challenges in developing the v18 Edits Metafile. Some of the challenges include the fact that there the new edits are being developed but there are no cases abstracted in v18 to test the data. Some things to keep in mind:
- the initial metafile will only include edits the NAACCR Edits Work Group feel comfortable releasing with testing on actual v18 data.
- It is anticipated that several updates to the metafile will be necessary as it is used on actual data.
Once again, we heard from Jennifer Ruhl, MSHCA, RHIT, CCSS, CTR, from the National Cancer Institute (NCI), who provided an update to the Hematopoietic and Lymphoid Neoplasm Coding Manual and Database. Some of the updates include:
- grade has been eliminated for all histologies except lymphoma ocular adnexa
- there is no change in the number of M rules but there are clarifications and exceptions added to some
Some highlights during the NCRA luncheon included:
- the installation of the new NCRA executive board for 2018-2019 including president Janet Reynolds
- the April Fritz Outstanding New Professional Award was presented to Ebony Johnson by April’s husband, Robert Fritz
- the Distinguished Member award was presented to Melanie Rogan
- The Volunteer Excellence award was presented to Vonetta Williams
- all new CTRs were recognized during the luncheon with those in attendance being individually recognized.
April Fritz’s presence was felt during the entire educational conference with a Celebration of Life held in her honor on Tuesday evening. Registry Partners hosted a photo booth in the Exhibit Hall with all proceeds to be donated to the April Fritz Memorial Education Fund.
Pictured Left to Right Back Row: Stacey Ballinger, Theresa Real, Courtney Jagneaux, Amy Arnold, Crystal McDaniel and Carla Edwards. Front Row: Olivia Hall, Mandi Kraushaar, Taylor Parker and Linda Reimers.
The conference was a good combination of education and fun. We look forward to the 45th Annual Educational Conference, May 19-22, 2019 at the Sheraton Downtown Denver, Colorado. We look forward to seeing you there!