Northside Hospital Cancer Registry is Generating Treatment Summaries

According to the American Cancer Society report, Cancer Treatment & Survivorship Facts & Figures: 2016-2017, more than 15 million people in the U.S. are living as cancer survivors and by 2026 this number is expected to grow to more than 20 million. To better meet the needs of these patients, the American College of Surgeons Commission on Cancer (CoC) developed a new edition of its Cancer Program Standards that went into effect in 2016. Specifically, Standard 3.3 instructs accredited facilities to develop a process to distribute treatment summaries and follow-up care plans to those survivors who have completed cancer treatment. 

As a pilot site in the NCI Community Cancer Center Program (NCCCP), Northside Hospital Cancer Institute in Atlanta, Ga., was in an excellent position develop a program to meet that standard. (Among many NCCCP goals, pilot sites were called on to develop and deliver cancer treatment summaries and follow-up care plans to cancer survivors completing therapy.) Northside Hospital recognized early on that registry data were invaluable in creating patient treatment summaries. Hospital CTRs were already responsible for collecting data on every cancer patient’s diagnosis and treatment for the purpose of reporting to the state and National Cancer Database (NCDB), so asking nurse navigators to collect the same information when developing survivorship care plans and treatment summaries would be duplicating efforts and stretching resources thin.

Instead, using NCCCP program funding, Northside Hospital recruited a certified tumor registrar (CTR) to abstract the top five primary sites in real-time, focusing first on breast cancer. Over time, this position evolved into a full-time treatment summary registrar. Today this CTR works alongside their registry software vendor, survivorship coordinator, other registry abstractors, nurse practitioners, and additional members of the care team to continually advance the survivorship program and deliver treatment summaries and survivorship care plans (SCPs) to meet current CoC standards.

In 2013, the treatment summary registrar reached out to Northside’s registry software vendor to create custom templates that would generate patient-friendly treatment summary documents utilizing data already coded in the abstracts. These custom templates were created based on the data elements set forth by the American Society of Clinical Oncology (ASCO) and allowed Northside Hospital to maintain facility branding. The templates have been through several iterations and Northside continues to improve them as they implement additional primary sites based on feedback from steering committee physicians.

While Northside’s treatment summary process engages several staff members, it is streamlined. At the time of case identification in the cancer registry, staff estimate the month that patient is likely to finish treatment based on the patient’s current stage and NCCN treatment guidelines. The treatment summary CTR runs a report using custom data fields in the software that can easily identify which patients are ready to be abstracted and shares that with a team of abstractors. These patients become their top priority for abstraction. Once abstraction is complete and all information is collected (including information from other treatment facilities), the CTR performs quality checks on the treatment summary fields. The quality checks take an average of about 35 to 40 minutes per patient, but quality is a top priority at Northside Hospital. After all treatment summary fields are verified, a treatment summary is created for each patient. Because the templates are built into the database software, it only takes another 5 minutes to generate and save the final treatment summary. From start to finish, once a case is abstracted, QA and treatment summary delivery takes a total of 40-45 minutes per patient.

When treatment summaries are complete, each patient’s summary is uploaded to his or her abstract for document retention. It is also placed into a shared folder on the hospital network drive so that nurses and mid-levels can access it. Once clinical staff sees the new treatment summaries in the shared folder, they reach out to the patients and schedule the survivorship visit.

Prior to the patient’s visit, clinicians prepare the survivorship care plan folder. It includes a survivorship care plan that is specific to the patient’s disease site, fitness and nutrition information, the Cancer Support Community calendar, support group information, survivorship class schedules, and more. These survivorship care plan folders and documents are prewritten and preprinted by a company that prints all of Northside’s marketing materials and forms. Each physician practice that is delivering SCPs has the forms on hand so when the patient comes for their visit, the nurse puts one of each sheet into the folder and hands it to the patient. Because these forms are preprinted, it takes the nurse less than 5 minutes per patient to stuff the folder before the visit. Sometimes the oncology analytics department gets volunteers who are happy to stuff these folders as well, and they get delivered to the doctor offices all ready. The treatment summary that was uploaded to the shared drive is then reviewed with the patient, printed, and added to the survivorship care folder. Once the visit has taken place, the treatment summary CTR updates the registry records with the visit date so information can feed into a dashboard created in Excel to ensure ongoing CoC compliance.

Beginning in 2016, CoC-accredited programs were required to deliver survivorship care plans to 25 percent of eligible cases. Northside Hospital surpassed that goal and is working on delivering survivorship care plans to 50 percent of patients by the end of 2017. In 2018 and beyond, CoC-accredited programs will need to offer survivorship care visits to 75 percent of eligible patients. Currently Northside Hospital focuses on breast, melanoma, endometrium, sarcoma, and cervical cancer, with plans to incorporate ovarian, non-small cell lung cancers, and colorectal by the end of the 2017. Northside Hospital has earned the CoC Outstanding Achievement Award for five consecutive survey cycles (2004, 2007, 2010, 2013, 2016). The hospital strives for this award every survey cycle because this is a quantifiable way to show the quality care of care it provides to patients.

Ebony Johnson, CTR, is the oncology analytics treatment summary specialist at Northside Hospital Cancer Institute, Atlanta, Ga.