Tackling the Chronic Non-communicable Disease _CNCD_ Epidemic The by hedongchenchen

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									     Methods of data collection:
Case finding & sources of information

                 Angela M C Rose, BNR Director
  Chronic Disease Research Centre, University of the West Indies


             PAHO/IARC, Port-of-Spain, Trinidad, April 2010
Overview

•   Case finding
•   Methods and tracking systems
•   Sources of cases
•   Steps in case finding
    - in hospitals and other data sources


          PAHO/IARC, Port-of-Spain, Trinidad, April 2010
Population-based
cancer registries
• Notification form
• Active reporting – collection at data source
• Passive – notification forms submitted
• Both (active and passive)
• Automatic – web site / email


          PAHO/IARC, Port-of-Spain, Trinidad, April 2010
Population-based
cancer registries

 Instructions for reporting
 • All cases of newly diagnosed tumour(s)
 • All cases of multiple primary tumours
   (One notification for each tumour: IARC rules)
Case finding: which cases?

• Registry will locate and report every new
  case of cancer diagnosed in the area
• See Morphology section of ICD-O for all
  malignant tumours
• All morphological types




         PAHO/IARC, Port-of-Spain, Trinidad, April 2010
Case finding: which cases?

• All diagnoses of cancer by a physician or
  dentist
  – whether clinically diagnosed or
    histopathologically proven
  – positive pathology report takes precedence over
    other reports or statements in patient’s notes



          PAHO/IARC, Port-of-Spain, Trinidad, April 2010
Case finding: organisation

 Case finding and abstracting not always
   done at the same time
 •   Most registries find cases first
 •   A record is kept of these files (suspense file)
     until data are complete




           PAHO/IARC, Port-of-Spain, Trinidad, April 2010
Case finding: what is it?

• A system for locating every patient
  – in-patient or out-patient, public or private
  – diagnosed and/or treated with a reportable diagnosis

• Need tracking system
  – status of case finding can be known at any time

• Keep list of cases already in registry
  – potential new cases checked against list



            PAHO/IARC, Port-of-Spain, Trinidad, April 2010
Case finding

 • To abstract data from medical records
   – combine information from different data sources
   – hospital, labs, radiotherapy, etc.


 • Supervisor/Director must check if potential
   sources of cases have been covered and when
   – e.g. annually, compare # cases on registry with source
   – internal validity/data quality checking


           PAHO/IARC, Port-of-Spain, Trinidad, April 2010
Case finding: hospital

 Careful monitoring of the records kept in
 • Hospital medical records’ departments
    – admission and discharge books
    – medical record disease index

 • In- and out-patients’ clinics
 • General and specialist clinics
    – oncology, gynaecological, haematology, urology etc.


            PAHO/IARC, Port-of-Spain, Trinidad, April 2010
Case finding: hospital

 Careful monitoring of the records kept in
 • Pathology and haematology laboratories
 • Radiotherapy units
    – ultrasonography, other imaging logs

 • Death certificates, etc.
 • Wherever malignant tumours are mentioned


            PAHO/IARC, Port-of-Spain, Trinidad, April 2010
Medical records’ dept

Two methods
•    Review the medical records’ diagnoses kept by
     the coders regularly, to facilitate lists and
     abstraction
•    Screen medical records of discharged
     patients daily
    – irritating to medical records’ dept personnel
    – very time-consuming in large hospitals



              PAHO/IARC, Port-of-Spain, Trinidad, April 2010
Out-patients’ clinics
 Know where your cancer patients are seen
   in an out-patient setting
 •   Oncology clinics
 •   Out-patient surgery centers
 •   Specialist clinics e.g. eye, skin, gynae


 Find out how records are kept in these
    settings – it may be difficult to identify
    new cancer cases!
           PAHO/IARC, Port-of-Spain, Trinidad, April 2010
Pathology reports

Two methods of case finding
•       Review copies of histology, haematology, and
        bone marrow examination reports and log books
•       Review computer listing of coded final
        histological diagnoses
    –     or log books containing only malignancies




               PAHO/IARC, Port-of-Spain, Trinidad, April 2010
Cytology reports

 • Cytology information often stored
   separately from pathology
 • May be coded
   – positives can be retrieved from computer
     print-out or log books
 • Cytologists often keep own logs in which
   they note positive specimens

          PAHO/IARC, Port-of-Spain, Trinidad, April 2010
Autopsy reports

• Screen these once or twice a year
• Read all diagnoses recorded, not only the
  ones that resulted in death
  – occult malignancies may be found at death

• Read reports based on anatomical
  findings and diagnoses made on
  microscopic examination
         PAHO/IARC, Port-of-Spain, Trinidad, April 2010
Death certificates

• Review at local level or preferably at the
  central Statistical Office
• Review all cases where cancer is
  mentioned anywhere on the death
  certificate either as immediate,
  antecedent, underlying or contributory
  cause of death

         PAHO/IARC, Port-of-Spain, Trinidad, April 2010
Radiation therapy dept

Several ways to find cases here
•    New patients’ list
•    Billing register?
•    Treatment record for new patients
•    Radiation therapy summary sheet
•    If dept sends summary sheets to registry
    – make sure cases checked by registry personnel




             PAHO/IARC, Port-of-Spain, Trinidad, April 2010
Nuclear Medicine dept

• This department treats cancer with
  radioactive isotopes (usually for thyroid
  cancer)
• A case-finding procedure should be set up
  to identify these patients

• Note: usually for metastatic cancers

          PAHO/IARC, Port-of-Spain, Trinidad, April 2010
SCHEMA OF SECTION HEADINGS IN THE CORE CANCER DATASET, Ireland 2010

         DEMOGRAPHY                                          DEATH




             1997 CANCER EPISODE 1
          2001 CANCER EPISODE 2
       2009 CANCER EPISODE 3

                                                        PALLIATIVE
             REFERRAL                                     CARE




                                                        FOLLOW-UP
              IMAGING




              BIOPSY         STAGING



                                                 RADIATION            MEDICAL
                                                 ONCOLOGY            ONCOLOGY

            PATHOLOGY/
                             SURGERY
           HAEMATOLOGY




                             MULTIDISCIPLINARY
                                                        DIAGNOSIS
                                   TEAM
Summary

• Many sources of data
  – even in hospital, ++depts
• Ensure you know all
  sources in your area
• Keep track and compare
  # cases annually
  – systematic monitoring

                                                           21
          PAHO/IARC, Port-of-Spain, Trinidad, April 2010
Acknowledgements

•   Veronica Roach
•   Maria Paula Curado




         PAHO/IARC, Port-of-Spain, Trinidad, April 2010

								
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