Casefinding is a systematic process for locating every patient-inpatient or outpatient diagnosed and/or treated with a reportable diagnosis. The casefinding process must be extensive enough to “capture” all of the reportable cancer cases. The effectiveness and completeness of casefinding must be monitored for quality control purposes.
Most government agencies only require malignant (International Classification of Diseases for Oncology (ICD-O) behavior codes 2 [in situ] and 3 [malignant, primary site]) cases to be included in the registry. However, hospital cancer committees or even some central registries may require the registry to include benign or borderline/uncertain cases. Examples include benign brain tumors or carcinoid tumors of the appendix.
The criteria for eligible cases in a cancer registry depend upon the governing agencies of the registry. Along with state-specific reportable cases, registries participating in the Approvals Program of the Commission on Cancer (COC) of the American College of Surgeons (ACoS) must use the reportable list defined by the combination of requirements set forth by the state registry, American College of Surgeons Commission on Cancer and the facility cancer committee.
The three casefinding sources primarily utilized by the UPMC Network Cancer Registry include the following.
- Hospital Billing Systems: Medipac and EPIC are utilized to ascertain any and all episodes of care assigned an International Classification of Diseases (ICD)-10 code. Cancer registry professionals must evaluate the patient record to determine ultimate reportability.
- Pathology: The CoPath laboratory information system is utilized to ascertain any and all neoplastic specimens assigned a Systematized Nomenclature Of MEDicine (SNOMED) code falling into the range of 80002-9989. These specimens ultimately may be related to a new primary diagnosis, progression or recurrence of an existing disease.
- Radiation Oncology: The ARIA oncology electronic medical record application is reviewed for patients treated with radiation as part of their first or subsequent treatment courses are evaluated to ensure they are accessioned into the cancer registry and reported.
Additional sources may be used for disease-specific needs and/or at the discretion of individual facilities within the network.
If a case meets the following general criteria and the diagnosis is on the list of reportable conditions, they will be included in the UPMC Network Cancer Registry database:
- Diagnosed and/or receiving all or part of cancer directed therapy at our facility
- Neoplasms with tumor behavior of in situ or higher per International Classification of Disease for Oncology, 3rd Edition
- Basal and squamous cell carcinomas except when primary to the skin. Carcinomas originating in mucoepidermoid sites are reportable.
- Cases with a clinical diagnosis including those not histologically confirmed
- Diagnosis and treatment in a staff physician office
- Specific hematologic disorders newly diagnosed as of 2003
- Benign Brain and Central Nervous System tumors newly diagnosed as of 2004
- Cases diagnosed at autopsy
If a case falls into one or more of the following scenarios, they will generally not be included in the UPMC Network Cancer Registry Database:
- Consultation only to confirm diagnosis and/or treatment plan
- Patient receiving transient care only
- All basal and squamous cell carcinomas of skin regardless of stage at initial diagnosis for cases diagnosed since 2003
- Patients with active disease seen at the facility for unrelated condition
- Precancerous and benign disorders*
- Exception 1: Specific hematologic disorders newly diagnosed as of 2003
- Exception 2: Benign Brain Tumors reportable as of new dx in 2004
- Intraepithelial Neoplasias (cervix, vagina, vulva, prostate)
- History of cancer with no active disease/treatment and never treated for cancer at the facility