The Commission on Cancer (CoC) is pleased to provide this complimentary copy of FORDS: Revised for 2016 for your individual use. Please understand, however, that this information is the copyrighted property of the Commission on Cancer of the American College of Surgeons. Any use of this material outside of its original format or context requires permission from the CoC. You may print a copy for your own use.
FORDS: Revised for 2016
This version of FORDS replaces all previous versions. Registries are encouraged to read the Preface and review Appendix C for an overview of 2016 changes. Revisions to CoC reporting requirements for 2016 are minimal and are primarily due to the discontinued use of Collaborative Stage (CS) to stage cancer cases. Other than the below-specified revisions, CoC data reporting requirements remain the same as for 2015. The CoC’s transition away from use of CS includes the requirement of AJCC clinical and pathologic stage (requirement of both now enforced via edits), SEER Summary Stage 2000, and new Tumor Size Summary and Mets at Diagnosis data items. The CoC will continue to use the Collaborative Stage Data Collection System Version 02.05 for cases diagnosed 2004–2015, and only for the collection of Site-specific Factors (SSF) for cases diagnosed January 1, 2016 and forward. The majority of CS input data items are no longer required.
New Data Items
Eight new data items are introduced in FORDS: Revised for 2016 and required for cases diagnosed January 1, 2016 and later.
- Tumor Size Summary 
- Mets at Diagnosis - Distant Lymph Nodes 
- Mets at Diagnosis – Bone 
- Mets at Diagnosis – Brain 
- Mets at Diagnosis – Liver 
- Mets at Diagnosis – Lung 
- Mets at Diagnosis – Other 
- SEER Summary Stage 2000 
Discontinued Data Items (No Longer Required)
Beginning with cases diagnosed in 2016, the following CS input data items are no longer required. They must continue to be abstracted for cases diagnosed from 2004 through 2015.
- CS Tumor Size 
- CS Extension 
- CS Tumor Size/Ext Eval 
- CS Lymph Nodes 
- CS Lymph Nodes Eval 
- CS Mets at DX Data Items [2850-2854]
- CS Mets Eval 
- CS Version Derived 
- Derived AJCC-6 Data Items [2940-3000]
- Derived SS and Flag Data Items [3010-3050]
- Derived AJCC-7 Data Items [3400-3430]
Specific-Stage Data Items with Continuing Requirement
The following data items were considered as CS input data items for the purposes of CS, but are now are continued to be required for AJCC staffing and research purposes. They are required for all cases diagnosed in 2004 and later:
- Regional Nodes Positive 
- Regional Nodes Examined 
- Lymph-vascular Invasion 
- CS Site-specific Factors [2861-2880, 2890-2930]
- CS Version Input Original 
- CS Version Input Current 
Please note: The CoC’s requirements for the site-specific Factors have not changed from 2015; the data items of CS Version Input Original and Current continue to be required to accommodate continued collection of the SSFs.
Implementation of New AJCC T, N, and M Categories
Beginning in 2016, new T, N, and M categories were implemented by the AJCC T, N, and M data items [940, 950, 960, 880, 890, and 900]. These new categories have been generated by adding the prefixes of ‘c’ and ‘p’ to existing valid clinical and pathologic T, N, and M categories respectively, and modifying, adding and deleting specific categories. The new categories enable registrars to comply with AJCC clinical and pathologic staging/classification timeframe rules while abstracting. The new categories will be used for cases of all diagnosis years abstracted using NAACCR version 16-compliant (and later) software. Please note that not all possible categories were added in 2016, only those addressing prominent issues. Additional T, N, and M categories will be added and use of existing categories will be expanded with the implementation of the AJCC 8th Edition Manual. This implementation will allow registrars to comply with AJCC rules while abstracting, thus reducing stage assignment confusion and increasing registrar confidence in assigning AJCC stage, increasing data integrity, and reducing the time and resources that registrars and standard setters currently spend addressing these issues.
The CoC will require CoC-accredited cancer programs to use the new T, N, and M categories and convert historical data upon upgrading to NAACCR version 16-compliant software (Please see the NAACCR 2016 Implementation Guidelines for complete details). Conversion of historical data for the diagnosis years of 2015 and earlier is being carried out for the purposes of formatting the data to accommodate consistent viewing, abstraction, and editing of the data across all diagnosis years. Please note that the prefixes included in the new categories are only intended to reflect clinical significance for cases diagnosed January 1, 2016 and later, and should not be analyzed in any fashion for cases diagnosed Existing T, N, and M values will not be converted for any cases diagnosed in 2016 that are initially abstracted using NAACCR Version 15-compliant software. As a result, the T, N, and M categories will need to be reviewed for these cases upon upgrade to NAACCR Version 16-compliant software. The registrar will have to accurately re-assign the new T, N, and M categories (that include c and p designations).
Clinical and Pathologic AJCC Stage Required
Beginning with cases diagnosed January 1, 2016 and later, both clinical and pathologic AJCC stage will be required for data submission to the NCDB. The requirement will be enforced via edits. CS is no longer required (required historically for cases diagnosed from 2004 – 2015).
No Submission of Derived Stage to the NCDB for Cases Diagnosed 2016 and Later
For cases diagnosed 2016 and later, no software-derived values should be submitted in the directly-assigned AJCC Stage data items [910, 970]. Registrars are encouraged to fully understand how their vendor software functions, and should never manually copy over any derived values into the directly-assigned data items. Algorithms are under development to identify derived values submitted in the directly-assigned data items. Programs will receive a deficiency on CoC Program Standard 5.6 if submission of derived values in the directly-assigned AJCC Stage data items is detected.
Documenting Clinical and Pathologic AJCC Stage
The hospital registrar will be responsible for recording the physician-assigned stage in the registry database.
- If the stage assigned by the physician is inconsistent with the documentation in the medical record, the registrar should assign the stage and record the registrar-assigned stage in the registry database. The registrar should verify the case information with the physician, as he or she may have additional information that would aid in the assignment of a stage. However, it is outside the realm of the responsibility of the registrar to educate the physician. The registrar should inform the registry physician advisor and refer identified coding issues to the Cancer Committee for quality improvement activities.
- If no physician-assigned stage can be found in the medical record, the registrar should assign the stage and record it in the registry database. The registrar should inform the registry physician advisor and refer identified documentation issues to the Cancer Committee for quality improvement activities.
- CoC Program Standard 1.10, Clinical Educational Activity states that the required cancer-related educational activity offered to physicians, nurses, and other allied health professionals is to be focused on the use of AJCC (or other appropriate) staging. The cancer committee is encouraged to use AJCC-developed materials for this purpose.
Revision of TNM Staged By Data Items
The length of the TNM Path Staged By  and TNM Clin Staged By  data items has been expanded to 2 digits to accommodate new codes. The historic 1 character codes will be concerted to the new codes upon upgrade to NAACCR Version 16-compliant software.
All items in FORDS are required for CoC-accredited cancer programs. Supplementary references are necessary for coding American Joint Committee on Cancer, Collaborative Stage, multiple primaries and histologies, hematopoietic tumors, and systemic agents.
FORDS: Revised for 2016
Earlier versions of CoC registry coding manuals are available online.
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