Raise your hand if you have ever heard the cry go out from MCR, “Send us text!” Lots of hands going up. Many of you have no doubt wondered, “Why does MCR require all that text??” After all, you’ve coded all of the data items. Isn’t it a little redundant to code the item AND enter it in text? If you are one who has wondered, “What does MCR do with all that text?” - wonder no more! (continued below)

NAACCR Text Field / Minimum text should cover / Additional text we’d LOVE to see / Thegood,the bad and the ugly
DX Proc-PE / Size and location of any palpable masses, DRE results for prostate, size and location of skin primaries / Race, age, sex (Especially helpful when the patient name is unusual for the gender and when unusual or mixed race codes are used.) / 38 y/o WF with 3.5 cm mass UOQ rt breast
Breast mass
Pt c/o breast pain and cough
DX Proc—X-ray/scan / Results of imaging studies that describe size and location of primary tumor, other findings that contribute to Collaborative Staging / Date test performed / 3/3/07 CT: 4 cm RUL mass; pleural fluid, liver mets
lung mass and mets seen on CT
CT done at outside hospital
DX Proc—Scopes / Any findings that describe size and location of primary site, findings that contribute to Collaborative Staging / Date test performed
Biopsy? / 4/7/07 Obstructing cecal mass; bx done
Colonoscopy showed mass
Scope pos
DX Proc—Lab Tests / Any values that are reported in Collaborative Stage fields, any values that contribute to the diagnostic process e.g., AFP for hepatocellular carcinoma, urinary IgG electophoresis for multiple myeloma / Date test performed / 5/8/07 AFP > 10,000
PSA pos
WBC 9,000; MCV normal; HCT 38 (brain primary)
DX Proc—Op / Any findings that describe size and location of primary tumor, findings that contribute to Collaborate Staging and/or explain extent of surgery performed / Date of procedure / 6/9/07 tumor debulked – gross residual dz
Lung tumor removed
Porta-Cath placed for post-op chemo
DX Proc—Path / Findings from pathology review of resection specimens and biopsies that confirm the histologic diagnosis, contribute to Collaborate Staging, status of nodes and surgical margins / 2.5 cm invasive ductal ca, no DCIS seen; 0/8 nodes pos; margins free
node dissection positive
adenoca
Primary Site Title / Specific site and laterality / Right breast UOQ
Skin of arm
Lung
Histology Title / Histology and tumor
grade / Cutaneous T-cell lymphoma
Bronchogenic carcinoma (was coded 8046/3)
Mixed ca (was coded 8346/3)
Staging / Findings for the basis of Collaborative Stage (or SEER Summary Stage pre-2004) codes. / Direct extension to rib; no LN; no mets
Liver mets
In chart
Remarks / Information that explains unusual circumstances, use of estimated dates, cancer history and the like. / It’s all good when it adds clarity to the case.
Surgery Primary Site / Enter the name of the procedure for the primary site surgery code used as shown in FORDS. / Regional lymph node and other site surgery coded. / Lobectomy RML w/mediastinal node dissection
Colon resection
Surgery followed by RT
Radiation (Beam & Other) / Modality, volume treated / XRT to brain mets
prostate RT
RT by Dr. Zappa
Chemo / List the chemo drugs or regimen / 5-FU and VP-16
multiple agents (Rx was thio-tepa & BCG, a BRM)
chemo in Dr’s office
Hormone, BRM, Other / Enter the name of the agent or treatment

Abstracts must contain corroborating text in order for us to assure that what is entered into the MCR database is the most accurate information for each case reported. The operative concept here is “corroborating.” That is, text should provide the rationale for selecting the codes assigned to primary site, histology, extent of disease and treatment fields. It’s not necessary to strive for great literary expression.... Brief, meaningful comments is all it takes to tell us what we need to know.

At MCR, we get a LOT of abstracts to review. In fact, we get way more abstracts than we do cancer cases which, of course, means some cases will be reported by two or more facilities. One of the key functions of MCR is to ensure that each cancer reported to us is represented by only one “best abstract” in our database. How do we decide which codes to accept when there is a discrepancy between what GeneralHospital and Chicago Hope report? Factors such as class of case and treating facility play a part, but most decisions are made based on the best text documentation. We at MCR have seen abstracts containing text that rivals War and Peace in length to those containing no text at all. Quality of text has encompassed the good, the bad and (dare I say) the ugly. So, just what are we looking for in text documentation on case abstracts? The previous table lists some guidelines for what to enter in the text fields that are transmitted to MCR, along with some examples of good and of not-so-great text.