Christina Panicker, MBA, CTR

We are pleased to introduce Dr. Monawar Hosain as OCCR’s new Cancer Surveillance Coordinator. This position is responsible for coordinating the activities of the statewide OCCR surveillance system ensuring the data meets national data quality standards, as well as conducting advanced epidemiologic analysis related to cancer and associated chronic disease.

For over 6 years, Dr. Hosain has worked with the New Hampshire State Health Department, initially as a State Cancer Epidemiologist for the New Hampshire State Cancer Registry, and then as a Uniform Hospital Discharge Data Coordinator.

He obtained his medical degree from Dhaka Medical College, Bangladesh, and worked as a

medical officer for several years. Next he pursued his Diploma in Primary Health Care and his Masters of Science in Community Health at the University of Western Australia.

After returning to Bangladesh, he was hired by the World Health Organization for their 'development of an epidemiological surveillance system for prevention and control of cancer' project with a particular aim to establish the first ever 'hospital based’ and ‘population based’ cancer registry in Bangladesh. He then worked as a junior faculty at Gono University Medical School, Bangledesh.

He moved to Houston in 2001 to pursue a Ph.D. in Epidemiology at the University of Texas School of Public Health. His post-

OKLAHOMA STATE DEPARTMENT OF HEALTH

June 2019Oklahoma Central Cancer Registry

OCCR QUARTERLY

Inside this issue:

New OCCR Consultant 2

OCRA Fall Education Conference 2

Importance of Text Documentation 3

RMCDS Version 18 4

Web Plus 2018 Update 4

Death Clearance has Begun 5

Science News 6-7

Upcoming NAACCR Webinars 7

OCCR Staff 8

OCCR WELCOMES NEW CANCER SURVEILLANCE COORDINATOR

doctoral training was completed at the University of Texas Medical Branch in Galveston, TX, and the Baylor College of Medicine in Houston, TX.

Dr. Monawar recently moved from New Hampshire to Oklahoma with his wife, Sultana Nasrin. They are excited about living in Oklahoma. He is a member of the American Public Health Association and the American Urological Association. In his spare time, he likes to travel, garden, watch sports and read. He has published many research papers and is also a reviewer of a variety of scientific journals.

We welcome Dr. Hosain to Oklahoma and look forward to working with him for many years to come!

Monawar Hosain, MD, MS, PhD

2019 OCRA FALL EDUCATION CONFERENCE

Leslie Dill

The OCCR enthusiastically welcomes a new addition to our registry consultant staff, Julie Bennett. A native Oklahoman, Julie grew up in El Reno. She attended the University of Oklahoma where she earned a degree in marketing. As fate would have it, Julie’s life steered away from the marketing world, and she became a stay at home mother of three for the next 18 years. In 2010, eager to focus on her career again, Julie decided not to return to marketing. An innate interest in healthcare and cancer led Julie to pursue coding. She graduated from Rose State College in 2013 with a Health Information degree, and immediately began working as an inpatient / outpatient coder for a large hospital. Fast forward to six years later, Julie has joined our team as a Registry Consultant, assisting with accuracy and flow of data into and out of the cancer database, and providing technical advice and software training to all Oklahoma treatment centers and urologists. On a more personal note, Julie is a very proud mom. Her oldest son recently graduated from college, while her younger son and daughter are currently in their junior year of college. She enjoys gardening, shopping and spending time with family and friends. OCCR welcomes Julie aboard and invites the treatment centers and urologists to reach out to her at JulieB@health.ok.gov or (405)271-9444, ext. 55720.

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NEW OCCR CONSULTANT

Happy Fall

Leslie Dill

Fall will be here before you know it. Make plans now to attend the Oklahoma Cancer Registrars Association 2019 Fall Educational Conference in Tulsa. This two-day event will feature renowned guest speaker, Denise Harrison, BS, CTR, and will be hosted by the Oklahoma Surgical Hospital.

For more details on conference registration, topics to be covered, and hotel accommodations, visit the OCRA website, http://ocra-ok.org.

Julie Bennett, BS, RHIT

Susan Nagelhout, CTR

The Centers for Disease Control and Prevention, National Program of Cancer Registries (CDC-NPCR) performs a Data Quality Evaluation at each state central cancer registry every five years. In April of this year, the Oklahoma Central Cancer Registry’s data from 2010-2016 was evaluated for data quality. The main focus of this year’s evaluation was the consolidation process and correct use of the 2007 Multiple Primary and Histology Rules (MPH).

The vast majority of cases that were interpreted as incorrect by the contract reviewer had insufficient documentation of a date in the applicable text field. The date of diagnosis and dates of treatment are valuable information and should be recorded in a text field. The following is a list of text fields that require documentation of a date, along with the applicable text information:

Text – Path: Date(s) of FNA, biopsy and/or surgery

Text – PE: Date of diagnosis, if clinically diagnosed or if date of diagnosis is estimated

Text – X-ray/Scan: Date(s) of each individual imaging test

Text – Scopes: Date(s) of endoscopy

Text – Lab Tests: Date(s) of all pertinent laboratory exams

Text – Op Procedure: Date(s) of diagnostic or surgical procedures

Text – Surgery: Date(s) of surgical procedures

Text – Radiation (Beam): Start date and end date of radiation therapy

Text – Radiation Other: Start date and end date of radiation

Text – Chemotherapy: Date(s) chemotherapy administered

Text – Hormone: Date(s) of hormone therapy administered

Text – BRM: Date(s) immunotherapy (BRM) administered

Text – Other: Date(s) other treatment administered

The purpose of the text fields is to document and validate the codes in the data item fields. Since dates are included as data item fields, it is appropriate to add dates to the text.

In addition to lack of dates in text fields, another inconsistency with text documentation was identified. When coding a transurethral resection of a bladder tumor (TURBT) as surgery code 22, it must be documented in the Text – Surgery field that electrocautery was used during the procedure. At the central cancer registry, the validity of surgery code 22 (for bladder) cannot be determined without proper documentation.

Prior to completing each abstract, review your text fields. This review will ensure that appropriate information is included in each applicable text field. With your assistance, the OCCR will attain the highest quality data.

IMPORTANCE OF TEXT DOCUMENTATION IN THE CANCER ABSTRACT

Page 3 OKLAHOMA CENTRAL CANCER REGISTRY

Christy Dabbs, AA, CTR

RMCDS hospital version is now in version 18. If you have completed your 2017 cases and have submitted them to OCCR you should have already run the conversion on your software. You should be abstracting 2018+ cases.

If you have completed and submitted your 2017 cases but have not yet converted your software please contact me as soon as possible. If you

have converted your software to version 18 but have not notified me, please do so as soon as possible so that I can notify RMCDS.

Some things to keep in mind for version 18

If you are a state report only facility you should be using screen set 18 to abstract cases diagnosed in 2018+.

If you need to abstract cases in previous years you may use screen set 96 or 90 depending on diagnosis date on the case. Cases diagnosed prior to 1997 are not-reportable to OCCR.

RMCDS continues to make updates to the software when issues are identified. They are not publishing a list of changes so it is recommended that you run the software update weekly to be sure you have the most recent updates.

You should be running the Central: Incoming Abs State 18.gei error check on your cases. It is recommended that you re-run the error check on your state backup file prior to uploading it to Web Plus. You can set RMCDS to automatically run the error check program when you create a state backup. The setting is located in parameters system tab. You must have administrator rights in RMCDS to access this tab.

OCCR is requesting that when submitting a file to the state that you begin using the state backup file located in the transfer folder. This has been available for over a year now. Please discontinue using the naaccr.p file in the Pfiles folder. The reason for this is that there is nothing unique about the file name. OCCR has many facilities that use RMCDS and would like to stop receiving multiple files with the same name.

If you have questions regarding RMCDS please contact the data manager at christyd@health.ok.gov or 405-271-9444 x57121.

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RMCDS VERSION 18

WEB PLUS for 2018 UPDATE Christy Dabbs, AA, CTR

File Uploaders Web Plus has been updated to accept 2018+ cases and has the most current edit metafile 18C. As a remind-er, when you upload cases the edit check automatically runs the Central: Vs18 State Example – Incoming Abstracts metafile. Please limit your uploaded files to 300 cases or less to prevent any issues with the file upload. If you have large files of cases (up to 300) please wait for the edit report confirmation before closing Web Plus.

Facility Abstractors The Low Volume Facility display is up and running. This display contains new data fields for 2018. If you have questions about case abstraction, the new data fields or updating cases that were completed prior to the update for 2018, please contact your facility consultant or myself. Please review your cancer abstract carefully to make sure what is being entered is correct. If you have a code in the Diagnostic Procedure data item you should also have a date in the date field for that item. The same goes for Surgery Primary Site data item. If you have a code in this item, you should have a date in the date

Continued on page 5

field. Just because your abstract passes the edit check does not mean that your abstract is 100 percent correct.

*REMINDER* If you release cases there is no option to go back and update them. This has been a specific issue with cases that were abstracted prior to the 2018 update and were released without being reviewed and updated by the facility abstractor. Cases diagnosed in 2018+ MUST have the new data items entered and pass all 2018 edit checks for cases to be counted for your reporting facility. Please see prior emails that have been sent with specific instructions on updating 2018 cases. Web Plus Online Training OCCR has developed an online training video for Web Plus Facility Abstractors. If you would like to view this

video please contact your facility consultant.

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WEB PLUS FOR 2018 UPDATE, CONTINUED FROM PAGE 4

Kaela Howell, RHIA

Each year the OCCR links incidence data with OK state death certificates for the purpose of identifying potential missed incidence cases - a process called “death clearance”. Any death with a reportable cancer mentioned as a cause of death that is not found in the registry database must be investigated via follow-back procedures. To identify possible follow-back sources, the OCCR utilizes the facility name recorded as place of death on the death certificate as well as linkages with Oklahoma hospital discharge data. In the coming weeks a death clearance list will be sent to your facility for reconciliation. The list will include any case where your facility was identified via hospital discharge data or documented on the death certificate as the place of death. If the case is determined to be non-reportable, you will need to provide information from your medical record to assist the OCCR with reconciling the case. This includes an estimated date of diagnosis as well as any information on another facility or physician that may have diagnosed or treated the patient. If the case is determined to be reportable, you will need to submit an abstract as quickly as possible to the OCCR. Please understand that as we receive information from other facilities, additional requests may be sent to you. The death clearance process is required by the North American Association of Central Cancer Registries (NAACCR) and CDC-NPCR as a measure of completeness and accuracy. The OCCR appreciates your assistance in completion of this very important process! Please direct any questions regarding this process to Kaela Howell at KaelaB@health.ok.gov or call (405) 271-9444 ext. 57138

DEATH CLEARANCE HAS BEGUN

Bone Cells Suppress Cancer Metastasis Article submitted by Judy Hanna, HT(ASCP), CTR Source: Thomas Jefferson University, May 13, 2019

In breast cancer, there are cases of women and men whose cancer returns in their bones 20-30 years after they were treated for their primary disease and thought they were cancer-free. This phenomenon always puzzled Jefferson researcher Karen Bussard, PhD. How is it possible that breast cancer cells from a primary tumor are able to reach the bones when a patient is deemed "cancer-free" after treatment? What was happening in bones that allowed the cancer cells to remain there for up to 30 years, alive but in a sleeping state, only to re-awaken decades later? In a step towards answering these questions, Dr. Bussard recently discovered a type of bone cell that can subdue cancer cells, slowing their growth, even in one of the most aggressive types of breast cancer: triple negative.

The results, published in Breast Cancer Research, raise intriguing questions about how these bone cells exert their sleep-inducing influence, and whether it's possible to replicate and permanently turn cancers dormant.

"Cancer has this uncanny ability to turn other cell types it comes in contact with to the cancer cell's advantage," says Dr. Bussard, Assistant Professor of Cancer Biology at Thomas Jefferson University and a researcher at the Sidney Kimmel Cancer Center -- Jefferson Health. "For example, cancer cells can turn the immune cells that should kill it, into its own guards. However, we have now found a population of bone cells that not only resists, but subdues the cancer. It's fascinating."

Together with co-first authors and graduate students, Alexus D. Kolb and Alison B. Shupp and others, Dr. Bussard probed how bone cells change once they interact with breast cancer cells in the bone. Specifically, they looked at osteoblasts -- a kind of bone cell that lays down new bone, like cement, during growth and repair.

The research team showed that the osteoblast cells from mice as well as humans drastically changed their function after interacting with bone-metastatic breast cancer cells. Earlier studies had shown that in advanced stage bone-metastatic breast cancer patients, osteoblasts stopped working; failing to produce a matrix that stabilizes and strengthens bone. The changes lead to loss of bone density that is common in these patients. In her new work, Dr. Bussard and colleagues showed that in earlier stages of the disease, when cancer cells first enter the bone, rather than producing new bone, osteoblasts may divert their energy toward producing factors to halt cancer cell growth.

When osteoblasts from humans or mice were exposed to triple negative or estrogen receptor positive breast cancer cells that had migrated to the bone, the osteoblasts released factors that changed cancer cell behavior. These factors were able to swing the balance away from limitless cancer cell growth, and toward restoring production of the cell-cycle checkpoint protein p21, which stops metastatic breast cancer cells from replicating endlessly. Dr. Bussard's team showed that cancer growth slowed in the presence of osteoblasts that had come in contact with metastatic breast cancer cells. The osteoblasts that did not interact with metastatic breast cancer cells, on the other hand, were unable to slow cancer cell growth.

"The bone-building osteoblast cells have a complex relationship with cancer," says Dr. Bussard. "In advanced

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SCIENCE NEWS

“We have now found a population of bone cells that

not only resists, but subdues the cancer.

It’s fascinating.”

Continued on page 7

Bone Cells Suppress Cancer Metastasis, cont’d. stages of the disease, we know that metastatic breast cancer cells can co-opt the normal cells of the bone to help cancer metastases thrive. However, our new work suggests that during early stages of the disease, such as when metastatic breast cancer cells first migrate to the bone, these cancer-exposed osteoblasts resist and fight cancer growth."

"Understanding how breast cancer cells prosper through metastasis to bone has been a long held goal of the breast cancer research community. Dr. Bussard's breakthrough discoveries pave the way toward developing new strategies to prevent or treat metastatic disease," says Karen E. Knudsen, PhD, EVP of Oncology Services and Enterprise Director of the Sidney Kimmel Cancer Center -- Jefferson Health.

The next step, says Dr. Bussard, is to fully characterize the molecules that osteoblasts use to reign in cancer growth, and see whether it's possible to turn that understanding toward treatments that can put cancer cells to sleep forever.

Alexus D. Kolb, Alison B. Shupp, Dimpi Mukhopadhyay, Frank C. Marini, Karen M. Bussard. Osteoblasts are “educated” by crosstalk with metastatic breast cancer cells in the bone tumor microenvironment. Breast Cancer Research, 2019; 21 (1) DOI: 10.1186/s13058-019-1117-0

Thomas Jefferson University. "Bone cells suppress cancer metastases." ScienceDaily. ScienceDaily, 13 May 2019.

SCIENCE NEWS

Page 7 OKLAHOMA CENTRAL CANCER REGISTRY

UPCOMING NAACCR WEBINAR PRESENTATIONS

Trying to pick up some CEUs? OCCR can help! Take advantage of the 3-hour NAACCR webinars being offered free by OCCR to all Oklahoma reporters. Each one is carefully designed by NAACCR to meet registrar training needs. You may attend the live webinars offered in Oklahoma City and Tulsa, or register to receive a link to listen to the recorded webinar at a later date from your desk! The live webinars in Oklahoma City will be hosted by INTEGRIS Cancer Institute. Cancer Treatment Centers of America will host in Tulsa. All webinars are from 8:00 a.m. - 11:00 a.m.

NEXT IN THE NAACCR WEBINAR SERIES:

07/11/2019 Hospital Cancer Registry Operations-- A Registrar’s Defense to ACoS Accreditations

08/01/2013 Solid Tumor Rules

09/05/2019 Coding Pitfalls

Please register ahead of time for the live or recorded webinars to ensure that the handouts will be emailed to you. You may register by emailing LeslieD@health.ok.gov.

Amber Sheikh, MPH, ext. 57411

Christy Dabbs, AA, CTR, ext. 57121

Christina Panicker, MBA, CTR, ext. 57108

Judy Hanna, HT (ASCP), CTR, ext. 57148

Julie Bennett, RHIT, ext. 55720

Kaela Howell, RHIA, ext. 57138

Leslie Dill, ext. 57120

Monawar Hosain, MD, MS, PhD, ext. 57131

Susan Nagelhout, CTR, ext. 57006

Oklahoma Central Cancer Registry

1000 NE 10th St., Room 807 Center for Health Statistics Oklahoma City, OK 73117-1299

Phone: (405) 271-6225 Fax: (405) 271-9061

Funding was made possible by the Centers for Disease Control and Prevention (CDC) and

the National Program of Cancer Registries, grant #1 NU58DP006285-03-00.

This publication was issued by the Oklahoma State Department of Health (OSDH), an equal

opportunity employer and provider. A Digital file has been deposited with the Publications

Clearinghouse of the Oklahoma Department of Libraries in compliance with section 3-114

of Title 65 of the Oklahoma Statutes and is available for download at documents.ok.gov. |

June 2019

We’re on the web!

https://www.ok.gov/health/Health_Promotion/

Oklahoma_Central_Cancer_Registry_(OCCR)/index.html

Contact the OCCR Staff (405) 271-9444

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