Registration Opens for CRAAZ Annual Meeting 2013

Registration opens for the annual meeting today.  As usual, you may register by downloading and completing the form and mailing it with your check to the post office box.  This year we also offer the option to register and pay online.  We have an exciting slate of speakers this year and will be applying to NCRA for 9 CE credits over two days.  Linda Reimers, RHIT, CTR from Registry Partners and Dr. Ted Williamson, MD, CTR the Data Quality Coordinator of the Salem Health Cancer Registry will be reprising their presentations from the 39th Annual NCRA Conference.  Dr. Samuel Aguayo, Associate Chief of Research at the Phoenix VA Medical Center will be discussing new data on lung cancer screening, treatment and survival.  Georgia Yee, BS, CTR Office Chief at the Arizona Department of Health Services will also be bringing us information on Meaningful Use of the Electronic Health Record.  That’s just the first day!  On the second day we are privileged to have Kevin Potter, MD from St Joseph’s who will discuss with us Minimally Invasive GI Surgery as well as Kyle Coppola, RHIT, CTR from the Mayo Clinic who will discuss Adapting Casefinding Strategies and I will be presenting some ideas on Quality Control in Non CoC Approved Hospitals. 

The Early Bird discounted fee is available only until September 3oth, please register soon and help us celebrate our 30th anniversary as an organization.

New Version of CoC Standards Manual

The Commission on Cancer (CoC) New announced that they are wrapping up its project to review, revise and enhance the CoC standard for accreditation. These standards will go into effect January 1, 2020. You can find a copy of the draft minutes click here.  The proposed date of finalization of the standards manual is Fall 2019.

The August 1, 2013 CoC Source announced that the new version of the CoC Program Standards will be delayed until late September.  The CoC did detail some of the upcoming changes which include:

1. As of July 1, Standard 5.2 will be changed from abstracting timeliness to a new standard focused on Rapid Quality Reporting System (RQRS) participation. The RQRS standard will become effective on January 1, 2014, will be valid for commendation only, and will be part of the Outstanding Achievement Award criteria beginning in 2014.

Abstracting timeliness of 2011 cases will continue to be evaluated during the remaining 2013 surveys.  Any deficiencies given for abstracting timeliness will be resolved by on-time submission of the 2012 cases to the National Cancer Data Base (NCDB) in January 2014.

2. Immediately eliminate surveyor review of cases selected for one of the Cancer Program Practice Profile Reports (CP3R) measures during the on-site visit.  The review may be reinstated by the Accreditation Committee when needed to validate new performance measures.  Programs will be notified in advance if the review is reinstated.

3. Retire the 2009 Standards from the survey process beginning January 1, 2014. This change will not affect surveys performed during 2013 which will continue to review 2010 and 2011 activity using the old standards and 2012 using the new standards.  For 2014 surveys, the Outstanding Achievement Award criteria will be adjusted to apply to activities in 2012 and 2013 using only Cancer Program Standards 2012: Ensuring Patient-Centered Care.

Development of the RQRS standard is now complete, and the Accreditation Committee will consider this change at the August 20 conference call meeting.  Version 1.2 will be completed following this meeting and published online in late September.  A special issue of The CoC Source will announce the release of Version 1.2.

Community Events

Hi All!

We are coming up on the racing season and we’ve discussed some event participation.  Just wanted to let you know that Angela Childs has agreed to act as your Cap’n if you’d like to participate in the Komen Event.  The link to the Komen event is:


Please contact Angela as soon as possible if you’d like to participate.  You can reach her at 480 301 6627 or

We’re also discussing other events so stay tuned for more news.

NCRA 39th Annual Educational Conference

NCRA was an incredible experience.  The national and local coordinators did an excellent job with topics, speakers and site management.  Presenters speaking to some very exciting topics on the linking of quality measures to Medicare reimbursement under the Affordable Healthcare Act (AHCA), the American Taxpayer Relief Act (ATRA), Health Information Technology and Economic and Clinical Health Act (HITECH) and the implementation of ICD 10M.  As new provisions of these laws roll out over 2013 and 2014 you will be interested to know I think how this impacts cancer registries.  Under these acts the model of fee for service is being replaced by fee for performance as Medicare reimbursement will be tied to meeting specified quality measures.  Meaningful use of the electronic health record to improve quality of care was discussed at length.  Reporting cancer cases to the state cancer registry is one of the menu options for compliance by eligible providers.  Participating in the Rapid Quality Reporting System through the Commission on Cancer (CoC) accreditation process has been recognized by the Centers for Medicare/Medicaid Services (CMS) as meeting one of the quality measures for hospitals.  RQRS is only available to CoC approved hospitals. The Hospital Inpatient Quality Reporting (HOQR) mandated by Medicare in 2003 and the Hospital Outpatient Quality Reporting (HOQR) mandated in 2006 reduces reimbursement to hospitals that do not report compliance with quality measures (57 measures).  The Centers for Medicare/Medicaid Services (CMS) is currently testing oncology quality measures with 11 hospitals nationwide.  As part of this project CMS has contracted with the CoC to provide performance measure data (CP3R) for these pilot hospitals.   The CoC has submitted five new quality measures to the National Quality Forum for endorsement.  The quality measures for Standards 4.4 and 4.5 will be expanded as well as existing measures enhanced.  The next measure up for consideration is the number of mediastinal lymph nodes taken in a staging mediastinoscopy for lung cancer cases.  A new version of the CoC program standards manual is due out in July 2013.

How will this come together and how will it affect your registry?  Truthfully, I don’t think the process is completely defined.  There are a variety of options for eligible providers and eligible hospitals to meet quality measures.  These measures must necessarily have some flexibility to their structure since not all hospitals provide the same clinical services or have the same patient mix or clinical needs.  For hospitals who have a significant cancer population though, it is not a stretch to say that administrators are biased to using existing data sources rather than inventing new ones.  The use of clinical registries to document outcomes that affect reimbursement may put new focus on the cancer registry.  In light of CMS already recognizing participation in RQRS as a qualifying performance measure, those hospitals already approved by the CoC may be better positioned to document compliance with quality of care and improve their reimbursement.  In addition, the CMS is aware of the quality measures already in place in approved hospitals and publication of that data is part of the pilot project underway.  The emphasis on measurable quality outcomes may spur a more extensive use of registry data and build relationships with other departments.  The cancer registry as an isolated data enclave may be going the way of the dinosaur.  How is your registry positioned for this transition?  Do you know your data?  Do you trust it?  Quality and completeness have always been important, they are essential now.  What can you do to be ready to promote the administrative and clinical applications of the registry data?  What are your thoughts on the benefits and challenges to a more “meaningful use” of registry data? 

Hospital Inpatient Quality Reporting Requirements:

Hospital Outpatient Quality Reporting Requirements:

NQF Endorsed Measures Related to Cancer Care:

Hospital Compare Website:

Thank You

Past President Nadine Wright very thoughtfully presented an engraved gavel and strike plate to the association in honor of our 30th year as an organization. Thank you Nadine.Gavel

Mentoring the New Registrar – Guest Blog by Melanie Zaleski

Have you ever heard anyone say they want to be a “Cancer Registrar” when they grow up? Well I have not.  The usual response when someone asks what you do for a living is “I have never heard of that field before”.   As most of us in the field did not want to “grow up” to be a Cancer Registrar and stumbled into the position one way or another, it is difficult to promote a field that is not widely known or on any lists of college programs for students to think about.

For those of us in the field of course, we talk about it and try to recruit anyone that seems remotely interested.  However, the conversation usually ends there because moving to the next step is where we find the stumbling blocks. While there are educational avenues to obtain a degree in Cancer Registry they are mainly on line, self taught and with little to no mentoring.  A student is required to have 160 hours of onsite training but as registrars know there are not 160 hours in anyone’s schedule to give up to mentor, train or even look at a student. Not only is there the time issue but there is the cooperation of hospital administration to agree to let the student in the door, having space for a student to work and then finding a  schedule that works for the student and the mentor. Once all that is accomplished how do you squeeze everything a new registrar needs to know that is not in any book into 160 hours??

With changes in the standards every year and what seems like a million data fields that are collected, education is key to keeping a student from running toward the door and shaping them into a well rounded new registrar that can benefit a program from day one.  The quote “it takes a village to raise a child” can also apply to the training of a new registrar as it takes a community to raise a well rounded Cancer Registrar.

With cancer programs expanding all over the city and no one to recruit, we in the registrar community need to mentor fledgling registrars, promote the field and find ways to work together to raise the next generation of registrars. If you don’t have 160 hours do you have 25-30? If we work together to create a rotation of training, we could create the village needed…….

Happy National Cancer Registrar’s Week

This week we celebrate the contributions cancer registrars make to the fight against cancer.  Both the CTR credential and the Cancer Registry Association of Arizona turn 30 years old this year and few understand the vital role that registrars play in cancer control.  As you celebrate make it a goal to educate at least one more person about the existence and the value of the registry and the work.  As I once heard Dr. Dana Weeks say, “Someone has this information and it’s usually a woman and she’s usually in the basement”. 

Over the past 30 years survival has increased over a wide range of malignancies due to the efforts of researchers and clinicians and patients participating in clinical trials.  We know of these successes because of cancer registrars.  We work each day to translate the individual experience of cancer patients into data that can be aggregated and analyzed to serve in the search for better treatments and better outcomes.  We sort through manuals, attend webinars, read articles and confer with colleagues, all in an attempt to keep up with the increasingly complex process of diagnosis, treatment and research.  A career in the cancer registry isn’t usually flashy or even well recognized but it is challenging, satisfying and important.  Thank you for all you do.

Welcome to CRAAZ – 2013

I’m excited to welcome you to the revised and updated website for our association.  

We’ve updated our look as well as our functionality.  While you may still apply for membership via the paper application the website now offers the ability to apply and pay on line.  This feature is available during the membership drive period which ends after March 31st, 2013.  It will be available again in the fall to register for the annual conference.  Melanie Zaleski of St. Joseph’s Hospital and Medical Center has graciously secured the use of the Sonntag Pavilion for October 31st and November 1st.  In light of the association celebrating our 30th anniversary the board would like to make this a very special event.  Please stay tuned for more details.  

I’m also pleased to announce that a facebook page has been established for the Cancer Registry Association of Arizona.  Please stop by and say hi as we build both sites.  Phoenix Online Media has done a wonderful job revamping our website and the website will be professionally managed by them.  While we think we’ve addressed our basic needs, obviously the website is a evolving project.  Please let us know if there are any problems with the look or functionality, I’m also looking forward to your suggestions about improving our site and our association. 

Candi Rucker, CTR

President 2013

5 Cancers with the Highest Mortality Rates

Types of Cancer
With cancer becoming the leading cause of death in the United States, research provided by registrars has never been so important.

With fewer than 23,000 deaths separating heart disease and cancer deaths, cancer is poised to become the leading of death in the Unites States, and over 100 forms of cancer have been identified according to the Centers for Disease Control. Although many cancers are fatal, some are associated with higher mortality rates than others.

Lung Cancer

Lung cancer is to blame for more deaths than any other form of cancer. It is estimated that around 160,000 people succumb to lung and bronchial-related cancers every year in the United States. While lung cancer has the highest mortality rate and is the deadliest type of cancer, it is also the most preventable. Most cases of lung cancer are the result of certain lifestyle choices, particularly smoking cigarettes. Quitting smoking is the most effective way to minimize your risk of lung cancer.  New data from the National Lung Cancer Screening Trial indicate that screening for select patients translates into extended survival.

Colorectal Cancer

52,857 Americans died from colorectal cancer in 2008. Most colorectal cancer cases begin with groupings of small, benign cells called polyps, and over time these polyps become cancerous. Screening is the only effective way to check for cancer of the colon and rectum, but many people tend to feel slightly embarrassed and ashamed about having these screening tests conducted, and choose to avoid having them done. As a result, many people who develop colorectal cancer learn that their cancer could have been diagnosed earlier, had they not avoided being screened.

Breast Cancer

Breast cancer is the second most common cancer found in women, but contrary to what many believe, it is not exclusive to women and it can affect both sexes. It is the single most deadly cancer among women, with roughly 35% of the cases in the United States resulting in fatality. Breast cancer is another form of cancer where early detection can mean the difference between life and death. Women of all ages should conduct monthly examinations of their own breasts to check for any lumps or abnormalities, and women over 40 should visit their doctor annually for a mammogram examination.

Pancreatic Cancer

The pancreas is an essential part of the digestive system, and it aids in digestion and regulating metabolism. Cancer of the pancreas is often deadly, because it is extremely difficult to detect in its early stages. Pancreatic cancer does not always produce symptoms and it is a rapidly progressive cancer. Roughly 40,000 people die from pancreatic cancer every year.

Prostate Cancer

Only the males can develop prostate cancer, and it is the second leading cause of cancer deaths among men. This type of cancer forms in the prostate, the gland that produces seminal fluid. In 2013 it is estimated that 238,590 men will be diagnosed with prostate cancer, and 29,720 will die from the disease. The American Cancer Society estimates that 1 out of 6 men will be diagnosed with prostate cancer in his lifetime.

Arizona Cancer Profile

CRAAZ Member
Recent studies on cancer cases throughout the state of Arizona suggests that residents experience lower rates of cancer than the national average.

A 2009 study conducted on cancer rates in the state of Arizona analyzed the incidence of diagnosis, prevalence of type and mortality rates for residents suffering from cancer. Overall, the study concluded that Mojave County is the only county with a cancer rate higher than the national average, though the cancer rate in Mojave is falling. Graham, Greenlee, and Gila counties all presented rates similar to the U.S. average, while Apache, La Paz, Arizona, Cochise, Coconino, Maricopa, Navajo, Pima, Pinal, Santa Cruz, Yavapai, and Yuma counties all presented statistics lower than the country’s average. Many of these counties also showed declining cancer rates.

Melanoma rates among men in Arizona were higher than the U.S. average. Liver cancer among females and thyroid cancers in males were similar to the average, though both show signs of rising. Conversely, liver cancer in males in Arizona was lower than the national average.

A number of cancers in Arizona were similar to the national average and were found to be a stable trend. These included brain cancer in both males and females, esophagus cancer in males and females, kidney and renal pelvis cancer in males and females, and ovarian cancer in females.

Childhood cancer in Arizona was also similar to the national average; however, the study found the incidences of childhood cancer was declining in 2009. Leukemia in females was also in decline, as was female melanoma and Non-Hodgkin lymphoma in females.

Other cancers that were lower than the national average and showed signs of continued decline, include bladder cancer in both males and females, breast cancer in females, cervical cancer in females, colorectal cancer in males and females, leukemia in males, lung cancer in males and females, oral cancer in males and females, pancreatic cancer in males, prostate cancer in males, and stomach cancer in males and females.

In comparison to the rest of the country, Arizona met the healthy people objective of 160.6 and had a falling mortality rate for cancer. The United States as a whole did not meet the objective but did observe a falling mortality rate. Only four counties in Arizona failed to meet the objective – Greenlee, Mojave, Gila, and Graham. Greenlee and Graham counties saw a stable trend in their mortality rates while Mojave and Gila have begun to see a decline in their cancer mortality rates, according to the 2009 study.