Collaborative Staging and Data Quality
The Partnership’s second five-year mandate and the next phase of implementing Canada’s national cancer strategy began in April 2012. The priorities and initiatives for 2012-2017 are outlined in our strategic plan, Sustaining Action Toward a Shared Vision and in the Priorities section of our website. The information below reflects work to the end of March 2012.
Evaluating and improving cancer control with information
Cancer stage describes the severity or extent of the disease. There are four possible stages for any type of cancer. For individual patients, doctors use stage information to assess the probable course of the disease and to plan treatment. At the population level, health-care planners and policy-makers can use stage information to gain deeper insight into trends such as incidence, mortality and survival, which can help evaluate and improve the cancer control system.
Collaborative staging, a complex staging system that captures detailed information about the extent of a patient’s disease, is the Canadian standard for staging cancer cases for surveillance purposes. The granularity of collaborative stage data means that it can be used to better understand cancer patterns over time, demonstrating the effectiveness of screening programs that are detecting cancers earlier and enhancing knowledge of treatment needs.
In partnership with provincial and territorial cancer agencies and programs, the goal of the National Staging Initiative is to implement electronic systems that will enable the collection of national population-based stage data for new cases of breast, colorectal, prostate and lung cancer diagnosed on or after January 1, 2010. Currently the initiative aims to capture collaborative stage data for 90 per cent of these four most common cancers in Canada.
Underway since 2008, the National Staging Initiative focuses on three key areas:
- Pathology and implementing synoptic pathology: Promoting the adoption and implementation of pan-Canadian standards for cancer pathology reporting through the use of synoptic reports, or checklists
- Implementing collaborative staging: Helping provinces build the infrastructure required to expand the scope of stage data collection by using electronic systems to capture and access the complex medical data needed for collaborative staging
- Data quality: Improving data quality to ensure that captured data will be reliable and useful across existing structures that relate to cancer staging
Pathology and implementing synoptic pathology
Pathology is the study of disease, including causes, development and effects on the body. Cancer pathology refers to the careful examination of cancer and related tissues using a wide variety of tools including microscopes and genomic analysis to diagnose and classify cancers. Cancer pathology is key to helping determine the stage of an individual’s disease because it provides information on the type of cancer, the size of the tumour and the extent to which the disease has spread to the surrounding area. Clear and complete pathology reports are therefore critical to the success of a pan-Canadian cancer staging program.
Synoptic pathology is a structured reporting format that leverages best practices within the discipline of pathology. The College of American Pathologists’ (CAP) cancer checklists are structured reports that contain required and optional fields to ensure completeness and uniformity.
Results for 2011/12:
- In December 2011, the Partnership partnered with the College of American Pathologists (CAP), the Royal College of Pathologists (U.K.), the Canadian Association of Pathologists and the Royal College of Pathologists of Australasia in the development of internationally agreed upon and standardized reporting protocols for cancer pathology. This initiative was led through the International Collaboration on Cancer Reporting project, which brings together pathology communities from Canada, the U.S., the U.K. and Australasia. It is an important step toward international benchmarking of cancer trends and information sharing.
- Ontario and New Brunswick piloted electronic synoptic pathology reporting projects, enabling access to standardized electronic pathology reports at points of care. These pilot projects provide proof of concept for the transferability of the CAP cancer checklists and a starting point for implementing pan-Canadian synoptic pathology reporting. The efficiencies gained will further improve the quality of data captured through cancer registries.
- The Partnership hosted 10 pathologist-led CAP cancer protocol education workshops. These sessions are accredited by the Royal College of Physicians and Surgeons for continuing education credits. Approximately 40 per cent of Canadian pathologists participated in the meetings.
- Canada’s first multidisciplinary disease-site-specific expert panels were established in the spring of 2011 for breast, colorectal, lung and prostate cancer to provide feedback during the review of current pathology and staging standards. Canadian representatives have been assigned to each of the CAP Cancer Protocol Review Panels to allow for Canadian input into the development and review of CAP’s cancer protocols to ensure they meet Canadian requirements for pathology reporting.
Cancer stage is a way of describing or classifying a cancer based on the extent of disease or the degree to which it has spread within the body. There are four possible stages for any type of cancer. The higher the stage value, the more severe a cancer has become — a higher stage often means higher mortality. Detecting cancer at an earlier stage is important to improving survival rates and enhances the lives of those affected by the disease. Doctors use stage information to assess the probable course of a patient’s disease and to plan treatment.
Collaborative staging is a comprehensive process in which a range of medical data is gathered and entered into a database defined by criteria to determine a cancer stage value between one and four. When stage data is standardized and gathered at the population level, as it is through the National Staging Initiative, health-care planners and policy-makers can use the information to gain deeper insight into trends such as incidence, mortality and survival, which can help to evaluate and improve the cancer control system.
Results for 2011/12:
- The Partnership hosted two training workshops and three webinars to share best practices and lessons learned and to build provincial capacity in collaborative stage data capture and electronic synoptic pathology reporting.
- The Partnership hosted 10 Communities of Practice on pathology and registry software solutions to share lessons learned, resolve outstanding issues and develop an agenda for future progress.
- In March 2012, nine provinces captured collaborative stage data for at least 90 per cent of breast, colorectal, lung and prostate cancer cases diagnosed since January 1, 2010. Seven provinces achieved 100 per cent stage data capture for those cancers and six provinces captured data for all cancers, not just the four most common.
- In collaboration with provincial partners, the Partnership conducted a progress assessment consisting of 10 indicators to measure the impact of the National Staging Initiative and the health of the registry infrastructure.
- The National Staging Initiative undertook an independent evaluation to determine the initiative’s strengths and lessons learned to better inform future similar initiatives.
For more information on this initiative’s results leading up to 2012 and how the work supports the overall cancer control strategy, please read Key Achievements 2007-2012 and see our annual reports and progress reports.
 Adapted from: Canadian Cancer Society. “Pathology and staging of rhabdomyosarcoma,” Canadian Cancer Encyclopedia. Accessed Jan. 6, 2012. http://info.cancer.ca/cce-ecc/