American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

No Use of SEER*RSA in CoC-Accredited Hospitals

In September 2013, the American Joint Committee on Cancer (AJCC), Centers for Disease Control and Prevention (CDC), the Commission on Cancer (CoC), and the National Cancer Institute (NCI) agreed not to continue using Collaborative Stage beyond 2015 and to transition to directly-assigned AJCC staging for cases diagnosed in 2016. The formal announcement of this commitment can be found online.

The current standard for TNM Staging in the United States is American Joint Committee on Cancer (AJCC, 7th Edition). AJCC TNM Staging has been the de facto standard for staging in the United States for over 3 decades. The CoC NCDB has been collecting AJCC TNM in some fashion for over 20 years. Registrars at CoC-accredited hospitals are required to stage cancer cases using directly-assigned AJCC TNM stage.  Beginning with cases diagnosed January 1, 2016 and later, the Commission on Cancer (CoC) National Cancer Database (NCDB) is requiring the submission of both clinical and pathologic AJCC stage, enforcing this requirement via data quality edits applied to incoming data.

In early February 2016, NCI SEER announced the release of the Registrar Staging Assistant (SEER*RSA) website, a tool to help registrars with assigning stage and coding of predictive and prognostic factors. It should be noted that the staging system used within the SEER*RSA is the Union for International Cancer Control (UICC) TNM 7th edition. This Staging system is not to be confused with, nor meant to replace, the  AJCC TNM Staging System, as there are known differences between UICC 7th edition and AJCC 7th edition, some of which are significant.

The COC is honoring the commitment made in 2013 and will not allow Collaborative Stage (or notes from the CS system) to be used for cases diagnoses in 2016. Additionally, the CoC will only accept directly-assigned AJCC TNM, not UICC or derived TNM, in the AJCC data items.

Therefore, registrars at CoC-accredited hospitals are not to make use of the SEER*RSA website when assigning the individual T, N, M categories and stage group for cases in their registries. The AJCC 7th edition manual remains the foremost resource for staging instructions and information for registrars at CoC-accredited hospitals. UICC-based staging resources offered from the SEER website and rules found in Section V: Stage at Diagnosis of the 2016 SEER Manual (based primarily on rules used for Collaborative Stage and SEER Summary Stage) are not to be used as staging references by CoC-accredited programs. Software vendors servicing CoC-accredited Cancer Programs are not to incorporate SEER*RSA content (directly or via available API or software libraries) into any software used by CoC-accredited hospitals.

Submission of complete, high quality AJCC TNM stage data is crucial to the NCDB. Hospital registrar effort to assure accurately assigned AJCC stage enables the NCDB to provide useful data for research, develop and implement quality of care measures, develop and implement process measures, and provide assessment of patient outcomes. Comingling of 2 different TNM stage systems with the addition of SEER coding rules within the AJCC data items will result in compromised stage data and have a detrimental effect on the NCDB and future editions of the AJCC Staging manual which are largely informed by NCDB data.

Stage data submitted to the NCDB will be analyzed for use of UICC coding rules, SEER registrar notes found in the staging tables within SEER*RSA and 2016 SEER Manual Section V: Stage at Diagnosis rules. Any CoC-accredited Program identified as using above-specified stage rules will receive an automatic deficiency on CoC Program Standard 5.6, which will not be eligible for appeal.