A Guide to Successful Cancer Registry Virtual Management

Cancer registries are central to a successful organization’s cancer program. From quality metrics tracking to regulatory agencies at the highest level, cancer registries perform essential reporting functions and provide crucial data to drive program decisions.

As working remotely becomes more of the norm across the nation, organizations must be flexible to the needs of cancer registry professionals to work in a virtual environment.

At their core, cancer registries are information repositories, existing to house data on people that have cancer. The cancer registry (or tumor registry) can be an immensely useful tool in cancer surveillance, as well as a source for driving prevention and quality control activities.

Cancer registries are typically hospital-based, geographically centralized, population-based, or cancer-specific in nature. Regulatory agencies at the state and federal level require reporting on neoplasms (or cancers) from cancer registries, especially those that are hospital-based.

These data are then used in statistical analysis to inform research studies, national annual reports, and to measure progress in preventing and treating cancers.

According to the Surveillance, Epidemiology, and End Results Program (SEER), a program of the National Cancer Institute (NCI), there are several categories of data that cancer registries capture:

• Patient demographics: Patient demographic information identifies the cancer patient. It includes the patient’s name, age, gender, race, ethnicity, and birthplace.
• Tumor (cancer) characteristics: Tumor characteristics describe tumor cell type(s), biological and clinical aspects of the malignancy (such as the body organ where the cancer started), and now genomic information on the tumor (such as specific biomarkers that might predict outcomes or response to specific therapies).
• Stage of disease: The cancer stage describes the extent of the disease, such as how far the cancer has spread. This information informs whether a cancer has been diagnosed early or late and what treatment plans should be considered.
• Treatment: Treatment information captures the various options selected to treat the cancer patient, such as surgery, radiation therapy, chemotherapy, hormone therapy, and immunotherapy.
• Outcomes: Outcomes information consists of the patient’s vital status, cause of death, and survival time.

In a hospital-based scenario, oncology departments often rely on cancer registries to support the performance tracking of their clinical quality programs and accreditation efforts. For example, at cancer centers accredited by the American College of Surgeons Commission on Cancer, data from the cancer registry is required to be uploaded to the National Cancer Database on a monthly basis, then utilized twice per year as a status report on quality programs within the cancer program.

If the program was set to focus for the calendar year on improving rates of radiation therapy being administered, the cancer registry professional on the cancer committee would provide a report from the NCDB, populated originally by their data submission. This report could be limited by variables such as female patients under age 70 within one year of diagnosis, who have received breast-conserving surgery for breast cancer.

Luckily, many of these cancer committees are now meeting virtually, allowing for the cancer registry professional to attend remotely, but maintaining compliance with all required reporting.

Cancer registries that are aligned with regions or hospital-based cancer programs are composed of certified and non-certified staff trained to handle the required cancer data reporting. The certified staff are Certified Tumor Registrars (CTR), clinical data specialists who have obtained specific education on reporting neoplasms.

Educational paths and requirements for CTRs include:
Path 1:

• Earn an associate degree in cancer registry management
• Complete a clinical practicum at a cancer registry
• Pass the Certified Tumor Registrar (CTR) exam
• Maintain the CTR credential with continuing education courses

Path 2:

• Complete 60 hours of college-level courses
• Earn a certificate in cancer registry management
• Complete a clinical practicum at a cancer registry
• Pass the Certified Tumor Registrar (CTR) exam
• Maintain the CTR credential with continuing education courses

Path 3:

• Earn an associate degree or complete 60 hours of college-level courses, including six college credit hours in human anatomy and human physiology
• Complete one year (1,950 hours) of cancer registry experience
• Pass the Certified Tumor Registrar (CTR) exam
• Maintain the CTR credential with continuing education courses

It’s recommended to have all cancer case abstracting performed by a CTR. Unfortunately, there are limited options for prospective CTRs to seek their educational pathway from an accredited institution. Therefore, it is difficult for hiring managers to source qualified candidates for these critical roles on the cancer program team.

However, a hiring manager can make their open position more attractive to candidates by classifying the role as remote. This allows for these clinical data specialists to participate in meetings and adhere to all job requirements from a lower cost of living area than the geographies where many comprehensive cancer centers are located.

The non-credentialed professionals should be sourced from a medical coding background, but are not required to have a CTR certification. These staff members will complete cancer case identification, or casefinding, and long-term follow up of cancer cases. The American College of Surgeons Commission on Cancer requires that these staff complete three hours of qualifying continuing education per year, to maintain competency in cancer data services.

Currently in healthcare administration there is a trend of outsourcing cancer registry operations to companies that contract solely for that purpose. Within expensive metropolitan areas, building space and non-clinical, non-revenue generating work areas are at a premium, and hospital systems are faced with making the decision of what to keep onsite or move to a remote setting.

While there is an argument that it is financially effective to have required reporting completed by contracted CTRs, hiring CTRs as employees establishes commitment to the organization, healthcare benefits aligned with their employer, and sustainable employee engagement, among other advantages.

Employing a CTR directly into a full-time position will often yield higher case production and quality work. Work at this level can be attributed to the use of this data in cancer committees, quality initiatives, and research studies. This can all be achieved with a remote employee, operating in a virtual environment.

Cancer registry professionals can thrive while in a virtual environment.

CTRs and non-certified cancer registry professionals are brought together by the niche skills in cancer data reporting. They aspire to provide the best, top-quality data to their cancer programs.

In recent years, there has been a shift in allowing for flexible work environments, including telework. The development of these remote team approaches to work should be applied to cancer registry professionals due to the ease of implementing performance metrics designed for quality and accuracy in abstracting.

The National Cancer Registrar Association (NCRA) for resources on developing daily and weekly performance metrics for your cancer registry professionals.

For example, a standard requirement for a CTR annual production is 500 cases, which includes both analytic and non-analytic cases. This standard does not take into consideration for cancer committee appointments nor support for tumor board conferences or administrative duties. Refer to the North American Association for Central Cancer Registries (NACCR) for resources on developing appropriate performance metrics for CTRs.

Virtual operational management is achievable through the monrioting of the cancer registry-specific software, which has many routine reports available for managers to explore. Most cancer registries have purchased software designed for database management. For example, when using the database, a remote log of user time is a potential download for managers to monitor production.

Areas capable of monitoring CTR production include (but are not limited to):

• Case production
• Quality control
• Class of case accuracy

Finally, managers can monitor accuracy and timeliness—two main performance metrics for cancer registry professionals—through the reporting available through the state and federal agencies. For example, the California Cancer Registry, as performed through the Cancer Registry of Greater California, performs monthly audits of abstracts for quality and accuracy. Management receives these reports directly and can follow up with staff accordingly.

In terms of team connection, it’s strongly advised to designate time for the team to interact virtually. This can be achieved with team huddles on performance, organizational and departmental news, and educational topics. Keeping the focus on team goals and progress to date will allow for comradery to build over time.

Leaders should build in time for connective and creative breaks, to ensure sustainable engagement and collaboration. Only meeting about work-related topics can lead to burn out and a feeling of disconnection. Teams that spend time sharing about personal hobbies and their families can build real connections, allowing for flexibility when times get tough.

Many industries have shown that virtual teams are here to stay, and the cancer registry is one department well suited for permanent remote work. CTRs are capable of producing top-quality work from a remote location, by combining forces with like-skilled professionals to elevate quality through a peer atmosphere.

Prudent cancer programs will consider hiring remote cancer registry teams, with full-time employee status to achieve their cancer data goals.