NCDB Special Study: Post-Active Treatment Surveillance in Prostate Cancer Webinar #4: NCRA 2017-040 5/2/17 Eileen Tonner, MS
Purpose of the Study • For patients who have received curative-intent prostate cancer treatment – Determine whether more frequent PSA testing leads to better survival or more harm for the patient • In order to answer this question, it is important to know every PSA test the patient had – To know exactly how frequently a patient is having PSA tests – To know if the patient has had a recurrence
Thank you for Asking Questions • Many questions relate to “is this patient eligible”? – What if I can only get some records for a patient, but not all the records? – What if the PCP’s office responds but the urologist’s office will not respond? • The key question is : do you feel you are able to record all the PSAs a patient has had after treatment?
Eligibility Criteria 1) Evidence that medical records are available for the patient for 5 years or until distant recurrence or death- whichever is first 2) For patients who received primary radical prostatectomy: the patient’s urologist and primary care physician can be identified • For patients who received primary radiotherapy: the patient’s radiation oncologist and urologist and primary care physician can be identified 3) The patients has at least 1 PSA test result within 2 years after end of primary treatment and registrar is confident in capturing PSA information for 2 years after primary treatment completion
PSA • PSA intervals can range from monthly or to once a year. There is a wide variation. • Registrars should follow the FORDS manual – Example: PSA of 1.2, the registrar can enter 012 or 12. Numerically, these are identical numbers and will not affect the study or data analysis. • When a patient has a result of <0.03 or <0.01 or <0.2 (less than some number), we would prefer that you enter the result "0" for this special study. – In this sole instance we differ from the FORDS manual, and the example was given in the instructions to specifically show this.
Radiation Dose • Reminder: Units for Radiation Dose is Gy not cGy – 100 cGy = 1 Gy (just like 100 cm = 1 m) – If you have already submitted patients in cGy, please send an email to specialstudy@facs.org with your FIN and the Special Study IDs.
Scan • Scans that are clearly not related to prostate cancer or prostate cancer recurrence anywhere in the body do not need to be entered. • This is different from what is stated in the instructions. We have made modifications based on feedback from registrars.
Testosterone • Page 45 typo for units for Total Testosterone values (ng/mL should be ng/dL ) • For some physicians/hospitals, testosterone testing is routine. For others, it's not. There is variation in clinical practice.
Results of Scan • There is no “old finding” option – Example: patient had a bone scan in 2007 which found a spine T7 metastasis, and another bone scan in 2008 which found the same metastasis – Please choose “new finding” (options 3 or 4) as the answer, even though this isn’t exactly correct
Web form • Some registrars were having issues with the display of the Additional Clinical Information Tab – This issue should be resolved now. • We do not have the capabilities to allow for printing or sorting patient lists. We suggest taking screenshots.
Study Communication • Special Study Website: https://www.facs.org/quality- programs/cancer/acs-crp/special-study • CAnswer Forum and Standards Resource Library: http://cancerbulletin.facs.org/forums/ • Please send all study-related questions to specialstudy@facs.org – Study related questions sent to personal FACS accounts will be forwarded to the Special Study address and a ticket will be created. • EITHER send an email through the Contact form of the website OR email the specialstudy@facs.org email address. Please do not send both as all emails go to the same account. • Include FINs in all communication
Email Issues • Emails for the special study are being sent from the specialstudy@facs.org email address through an outside server • If you have not been receiving these emails, send the following information to your IT department and ask them to put us on the whitelist: – IP address: 216.32.180.106, 67.216.228.75
NCRA Webinar Information • NCRA 2017-027 Webinar #1 worth 1.0CE 4/11/17 • NCRA 2017-029 Webinar #2 worth 1.0CE 4/18/17 • NCRA 2017-034 Webinar #3 worth 1.0CE 4/25/17 • NCRA 2017-040 Webinar #4 worth 1.0CE 5/02/17
Questions • Questions from previous webinar and the Canswer Forum will be included on all webinars. • Frequently Asked Questions (FAQ) document will be posted on the website, Canswer Forum, and the web form
Review of FAQs from Previous Webinars
Gleason Score vs. Pattern • Q:When you are asking for the primary biopsy Gleason score and the secondary biopsy Gleason score are you really referring to the primary and secondary pattern? My patient had primary biopsy Gleason score already populated with a 4. Secondary biopsy Gleason score populated with a 3. The score, to me, is the combination of the primary/secondary pattern. • A: Both score and pattern are used and are meant to describe the same thing. – In this case, Primary Biopsy Gleason Score is 4 and Secondary Biopsy Gleason Score is 3.
Recurrence 1. What PSA level should be used to classify a patient as having recurrence? – We are not asking registrars to interpret PSA results – Please record recurrence if clinical notes indicate recurrence, and/or if patient receives treatment for recurrence 2. Does the patient have recurrence if he was never disease free after treatment? – Yes. Please record the date of first PSA test after primary treatment as date of recurrence.
Recurrence • Q: Patient with a regional recurrence with treatment which progressed to distant metastasis? Do you want both recorded and if so which one do you want the treatment for? • A: For recurrence as a whole (biochemical, local, regional, distant), we ask that you capture the first instance of each type of treatment received: hormone therapy, RT, surgery, chemotherapy etc., if the patient received these types of treatments.
What should I do if a physician’s office does not respond to record requests? • If the record request form was faxed, call the office directly to request the records • Make sure to send the letter template for patient information from the CoC so the office is aware this data is required for CoC accreditation
What if the urologist and PCP are retired? • Please see if possible to collect records from their offices. Often, physicians may have retired but records are still available • All NPIs are required for each provider • If the NPI on the Surveillance tab is unknown: – 00000000 if there is no provider – 99999999 if they have the provider, but the NPI is completely unknown – 77777777 if it is unknown whether they have this provider.
NCDB Data • Q: Comparing what information the NCDB tab has for a patient to what the medical record contains, there is more information available in the medical record than was initially abstracted. (i.e. Gleason on Prostatectomy and Date of Last Contact). • A: Please select “No” and fill in the updated information. We are looking for the most current data.
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