October 2017
    Vol 6 Issue 3
From the Editor  
Normally this is my favorite time of year: the colors of the leaves start changing and the temperatures start to dip making a walk in the morning or evening beyond delightful. However, we've suffered some sorrowful events recently that make us pause and take notice. Last month we lost a pillar in the cancer registry community when April Fritz died September 12th from pancreatic cancer. Many of you have had the distinct pleasure of having learned from April in one of her week-long training sessions or in a presentation at a local, state or national conference. She will be sorely missed. Then the tragedy struck at Las Vegas with the senseless deaths of fifty-eight people and injuries to over five hundred. And right now so much of our state is up in flames. My thoughts and prayers go out to each of you that may be touched by these deadly and destructive fires. When you can, please take a moment or two to appreciate what we lost, but also to feel gratitude for the opportunities we had (such as attending one of April's workshops), as well as what we continue to have.

We start this issue with an article by our newest Research Associate, Amy Klapheke, on some interesting findings in treatment and disparity with women in cervical cancer. Amy 
joined the Cancer Registry of Greater California last October as a Research Associate III. She is especially interested in identifying disparities in cancer treatment and survival and studying how social determinants of health are associated with patient outcomes. She is also pursuing a PhD in Epidemiology at U.C. Davis with an emphasis in epidemiological methods and cancer research. Her current work focuses on health-related quality of life in older women with gynecological cancer. She earned her BA/BS in Zoology from Miami University in Ohio, and holds a MPH from the Colorado School of Public Health.

Taina Valone, RHIA, CTR provides an update on an audit that was recently conducted at CRGC on male breast cancer cases to see if gender was correctly coded. You might recall that earlier years were audited in the same manner, and the purpose of this audit was to see if there was any change in results from previous years that were audited, as well as to make sure gender was correctly coded. In addition, Taina shares abstracting tips as well as some visual editing tips to help ensure data quality with regards to gender.

We also share with you an open peer commentary from Dr. Robert McLaughlin and his colleagues, Dr. Rosemary Cress and Dr. Marta Induni on a recently published article by Dr. Lisa M. Lee, the Executive Director of the Presidential Commission on BioEthics Issues. You may at first wonder, "What does this have to do with me?", but if you think about it, we are all doing our part to contribute quality data to our cancer registry and this opportunity explores cancer registries as another valuable resource. 

And lastly we are providing a specific link to the CRGC website where you can find information regarding the changes coming in 2018. Currently posted are two webinars hosted by NAACCR on 2018 Implementation. We will continue to post relevant webinars and resource information to keep you informed.

We hope you find these articles interesting and informative. As always, thanks for all you do to provide accurate, timely and complete data.

Underutilization of Brachytherapy and Disparities in Survival for Women with Cervical Cancer in California
Amy Klapheke, MPH
Research Associate, CRGC
Though largely preventable, cervical cancer represents a significant public health problem in the US. Last year, nearly 13,000 women were diagnosed with cervical cancer and more than 4,100 died from the disease. The standard of care for patients with this cancer consists of concurrent external beam radiotherapy (EBRT) and chemotherapy followed by brachytherapy. Brachytherapy, a type of internal radiation therapy, has been found to play an important role in the management of cervical cancer and promotion of disease-free survival. However, despite the known benefit of brachytherapy, utilization of this treatment appears to be decreasing nationally. Further, there may be disparities in its use.
The objectives of this study were to investigate the sociodemographic and tumor-related factors associated with receiving a brachytherapy boost after initial EBRT treatment and to evaluate the impact of brachytherapy on both cervical cancer-specific and all-cause mortality. This project was led by Dr. Jyoti Mayadev, formerly of the Department of Radiation Oncology at UC Davis and now the Director of Gynecologic Brachytherapy at UC San Diego, in collaboration with Amy Klapheke and Dr. Rosemary Cress from CRGC.
Using data from the California Cancer Registry, we identified 4,783 women diagnosed with FIGO stage IB2-IVA cervical cancer between 2004 and 2014 in California who were initially treated with EBRT. Only 45% of the study population was treated with brachytherapy boost, while 18% received other radiation boost, and 37% were not treated with any boost. As patients aged, the use of brachytherapy decreased, from 46% among patients under age 50 to 33% for patients over age 80. There was little variation in brachytherapy utilization by race or socioeconomic status. Compared to those receiving BT, not receiving a radiation boost was significantly associated with both death from cervical cancer (HR = 1.16, 95% CI 1.01-1.34, p = 0.0330) and death from all causes (HR = 1.14, 95% CI 1.01-1.28, p = 0.0333). However, there was no significant survival advantage of brachytherapy over other EBRT boost. Black patients, those with low SES, and patients with more advanced disease were more likely to die, adjusting for other factors.
Overall, the results of this study indicate that there is underutilization of brachytherapy in California, with less than half of patients receiving this boost for the treatment of cervical cancer. Further, not receiving radiation boost was associated with increased risk of death from both cervical cancer and all causes. Future research should investigate the reasons for this underutilization so that we can design tailored interventions to increase access to and receipt of brachytherapy and improve outcomes for women with cervical cancer.

2015 Male Breast Cases
Taina Valone, RHIA, CTR
Quality Control Specialist, CRGC

Prior to our SEER data submission, we performed a review of the CRGC male breast cancer cases with a 2015 diagnosis year.  The main mission was to make sure our patient gender data was correctly coded so that we had an accurate count of male breast cancer cases.  Second, we wanted to follow up on our review of male breast cancer cases done in 2015 on 2013 and 2014 diagnosis year cases to see if there was any change in the percentage of female breast cancer cases miscoded to male.

Cancer Registries as a Resource for Linking Bioethics and Environmental Ethics

Robert McLaughlin, JD, PhD
Special Programs Advisor, CRGC

The Executive Director of the Presidential Commission on BioEthics Issues, Dr. Lisa M. Lee, has recently authored a call for a bridge between the fields of bioethics and environmental ethics that connects the ambitions of the past century to the practical needs and scientific potential of the present and future. We were invited to submit an open peer commentary on her published article which appears in the September edition of the American Journal of Bioethics.  

Our commentary, authored by Drs. Robert McLaughlin, Marta Induni, and Rosemary Cress, functions to describe cancer registries as a common good that relate both to bioethics and to environmental ethics, and the science that cancer registries support as a field of possibility to realize Lee's vision.  We cite, for example, cancer research investigating environmental exposures and note how the power of molecular science to validate gene and protein targets relates simultaneously to individual cancer patients and to population-based health interests in service of whole communities.  

In preparing our commentary, we opted to speak to practical considerations-the ethics of access to tissue samples, the balance between individual privacy rights and collective rights to the benefits of scientific and medical advancements, and core principles of human dignity and productive agency. These principles not only underline our work, but also provide critical connections between the intellectual trajectories of bioethics and environmental ethics for which Lee imagines a bridge and urges its construction.

The citation for our commentary is:
The American Journal of Bioethics, 17(9): 1-3, 2017 
Copyright © Taylor & Francis Group, LLC 
ISSN: 1526-5161 print / 1536-0075 online
DOI: 10.1080/15265161.2017.1353167 
2018 Data Implementation Posted on CRGC Website

CRGC has created a special location on our website regarding 2018 Implementation and Data Changes to help keep our registrar community informed. Currently posted are two webinars, hosted by NAACCR, that we found especially helpful. Check them out when you can!

We will continue to post resources and other webinars on 2018 Data Changes to this site as they become available. We hope that having one spot to look for information regarding the changes coming in 2018 will prove helpful to each of you. It is under CRGC Website/Registrar Resources/Registrar Education.

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