There has been a seismic increase in the number of laboratories and genetic tests and studies since 2013, due in part to the Supreme Court ruling that human genes are not patentable. More and more labs are offering testing and multigene panels, new genes and gene mutations are being identified each and every day. While these scientific and clinical developments are leading to increased genetic testing in at risk populations, better risk assessments being performed by providers and widespread population screening, it is a challenge for providers, and cancer registrars, to keep up with the fast paced flood of information. It is evident that the information coming out of genetic testing will require significant upgrades in computerized decision support tools, enhanced data management and collection tools and resources (enter the cancer registrar!) and appropriate linkage and application to personalized and evidence-based medicine.
For Cancer Registrars the challenges also include finding informative and educational materials that are written in a language that lends to understanding and applicability to cancer surveillance. Recently an article was published in the Oncology journal that brings the message home. Click here to access the full article (free).
Is there a connection between lung cancer and outdoor air pollution, or particle pollution? We are aware of the connection between cigarettes, smoking and lung cancer, but did you know air pollution is also a risk factor? There is overwhelming evidence to suggest that the air we breathe, that comes from vehicle exhaust, coal-fired power plants and other industrial sources, can cause lung cancer.
Cancer Registrars have the data and medical information at their fingertips to study this in more detail and in relationship to their population and geographic area(s). If your hospital is currently starting up, or already providing, a lung cancer screening program than you may want to consider using this information as one of your CoC-required studies this year.
Here is a list of just some of the resources you can use for your own analysis:
“The Connection Between Lung Cancer and Outdoor Air Pollution,” CURE Magazine, published July 21, 2016.
“Particle Pollution,” American Lung Association. Website includes resources and a primer on particle pollution with graphic illustrations.
“Lung Cancer,” Centers for Disease Control and Prevention website. Extensive statistical and informational data and resources. Data can be used to benchmarking and comparative analysis.
“State of the Air: 2016,” American Lung Association webpage with statistical and detailed information regarding the air and particle pollution in your geographic area. You can compare the air you breathe in your location with others across the country.
National and State Cancer Registries, databases and resources. Fantastic website that has a compilation of resources on national and state-specific cancer statistics such as incidence, mortality and prevalence of certain risk factors. You will want to bookmark this site for future reference!
Here is a short list of other videos you can watch on the subject of particle pollution:
“Outdoor Air Pollution Causes Lung Cancer,” American Cancer Society on the World Health Organization study
“Air Pollutants,” National Cancer Institute (NCI)
Cancer Registrar’s are capable, well trained healthcare professionals that have the clinical, statistical and demographic data at their fingertips! Registrars can, and should, be using this information to look at risk factors and outcomes associated with lung cancer such as described above! If you are a healthcare professional, physician, nurse or administrator looking to understand what is happening in your community with air pollution and lung cancer, contact your cancer registrar today!
A new combination treatment eliminating many of the side effects of traditional chemotherapy for mantle cell lymphoma has shown favorable response in a two-year trial according to Weill Cornell Medicine research. The pill Lenalidomide, taken in combination with the antibody Rituximab shrunk tumor size by more than more than half in 90% of the patients enrolled in a small efficacy clinical trial. And, more than two-thirds of the group had no evidence of a detectable tumor after treatment completed. Long-term outcomes found that patients were able to resume their daily lifestyle with a higher quality of life while undergoing treatment. You can read more about this exciting research and the findings published in the New England Journal of Medicine by clicking here.
Lots of people look for their dream job in Cancer Registry, but few ever define what that dream job really is. Often a person’s idea of a dream job is based on their desires, or even fantasies, instead of what is realistic.
So, first, let’s look at what a dream job is not a job that:
So, now that we have established what your dream job does not look like, let’s take it a step further. Your dream job is work that you do because you like it. You can tell if you have a dream job when it is a job that:
There are some essential components to a dream job that will help you fill your life with meaning and purpose, such as:
So, how do you create this dream job? No doubt it is going to require some hard work and persistence. While it seems like a simple enough task, most of us can’t do it. But, don’t be discouraged by this. For the most part none of us were taught in school how to create the life of your dreams. Few individuals have had a mentor that helps them discover who they are, what their potential is, or what their dream job is.
If you are looking to the cancer registry profession for your dream job you will need to create the environment you need to step into a position and assume the role of a cancer registrar.
Almost every week I am asked the question by a cancer registry student or potential new hire on how they can get their “foot in the door” of cancer registry. For the past 10 years I have responded the same way to each of these inquiries. And, yet, I am always baffled as to why that individual did not take the advice seriously or determine to create the environment in which they could have landed their dream job. I sincerely hope that as you read this post you will take consider what I am going to offer you today.
Now, for cancer registrars already in a position – perhaps you are discouraged or looking for ways in which to boost or enhance your career. The steps to grow are pretty much the same steps one would take to land the dream job. You, too, must create the environment that will help you grow and to challenge you to expand your knowledge and skill sets.
Recently I came across the work of James Altucher, thought leader and entrepreneur, who has published a considerable amount of work in this area. James has created a graphic entitled “How to Create Your Scene” that is appropriate for use as you seek your dream job or desire to enhance your career.
To download a PDF of James’ infographic, right click on the title here to save to your desktop, Create Your Scene-James Altucher.
I wish you well as you seek to expand your career. Post your comments, successes and your challenges below so that we can dialogue with you and offer you suggestions and words of encouragement.
As Cancer Registrars we all hear physicians and cancer conference participants talk about the risk of a DCIS recurrence. In this short video Dr. Rick Baehner, Senior Director of Pathology at Genomic Health, talks about what DCIS breast cancer patients can expect in terms of percentages.
I found this video on TedMed and no matter how many times I watch it I am still amazed. While some will find parts of the video or the concepts presented to be controversial it is hard to not acknowledge this as a suitable alternative to human organ donors. But, don’t take my word for it, take a few minutes to watch it today.
Recently, while performing case-finding, I came upon a path report with a diagnosis of a gastrointestinal stromal tumor, or GIST. After discovering that there was no statement of malignancy I contacted my pathologist and asked for a clarification. What seemed like a simple step ultimately led me to learn more about these tumors and how the pathologic and clinical understanding of GIST tumors is changing.
GISTs occur anywhere along the length of the gastrointestinal (GI) tract and in extravisceral sites (or outside of the internal organs that are enclosed within a body cavity, such as the abdomen, thorax, pelvis or endocrine organs) such as the omentum, mesentery, pelvis and retroperitoneum. GISTs tend to arise from the wall of the GI tract and extend inward toward the mucosa, outward toward the serosa, or in both directions. As the lesions invade the wall of the GI tract they may cause ulceration of the overlying mucosa. Infrequently there will be invasion through the muscularis with involvement of the mucosa. Anatomic location is a prognostic indicator and tumors arising in the stomach have a more favorable prognosis. An accurate anatomic location, ulceration, level of mucosal invasion, and extent of disease is important to the patient’s prognosis and the Cancer Registrar should carefully document this information.
For a GIST tumor to be reportable, the standards tell us that there must be a pathologic or clinical documentation of malignancy. When the cancer registrar encounters a case that does not specifically state whether the tumor is malignant or not they should seek clarification from the pathologist and/or clinician. SEER SINQ 20100014 has listed a number of scenarios to use when it is not certain whether a GIST is reportable or not.
Understanding the etiology of GIST tumors will help the registrar not only in case-finding, but also in coding, abstracting and follow-up surveillance of GIST tumors. Cancer Registrars can enhance their knowledge of this type of malignancy and its behavior through a number of online resources, such as:
Even with all these great resources, however, you may find yourself in a situation where your pathologist states that all GISTs are to be considered malignant unless otherwise documented. So, what should a registrar do in this situation?
If your pathologists feel that the scientific evidence supports the reportability of ALL GIST tumors in your facility, unless specifically identified as a benign tumor, you CAN collect and report these cases. However, to support your actions you should ask for their statement in writing, including their clinical and pathologic rationale for doing so. This document can be presented to your Cancer Committee for review and then included in your Registry’s Policy and Procedure Manual. Note: we are NOT advocating that Registrar’s ignore or habitually not follow the standards, rules and guidelines. However, we are encouraging the Registrar to become knowledgeable and to seek the input and advice of the scientific and clinical experts in their facilities and nationwide.
GIST tumors spread by the shedding of the tumor cells into the bloodstream. While there are new studies and tests under development and the use of tumor markers are increasing (as evidenced in the resources listed above) the healthcare and research communities are now studying GIST tumors in greater detail that may impact how registries report these in the future. Once released into the bloodstream the cells may migrate and not manifest signs or symptoms of active, recurrent or metastatic disease for years and pathologists are now taking a more conservative approach to reporting a benign versus malignant diagnosis to GIST tumors.
Cancer Registrars are faced with situations quite often and the best approach is to: 1) undertake a personal course of study in the tumor type, its etiology, disease progression and clinical manifestation process; and 2) consult with the pathologists and clinicians to better understand the diagnosis and treatment of the patient with this type of tumor.
Did you know that people who live in a state of gratitude are actually more successful in life and business than those who do not? I want to challenge you today. Take a few minutes to sit in a quiet spot with pen and paper. Think of the person who has influenced you the most, someone who has challenged you to be your best. Write down how this person inspires and helps you. Go ahead … do this now and then come back to this post.
THEN, when you are done writing, pick up the phone and call them. Tell them you are taking part in this experiment in happiness and then read what you wrote to them. I promise you, it’s not painful and you will LOVE the results!
If you are still not sure about this, watch the video below. But it comes with a warning, it just may make you smile and could change you forever!