VI.1 First Course of Treatment - General Instructions

In the treatment section, record all cancer directed therapy administered as part of the first course of treatment. It includes any therapeutic procedure directed at cancer tissue, whether in a primary or metastatic site, whatever the mode of treatment, and regardless of the sequence and degree of completion of any component part.

Effective with cases diagnosed January 1, 1998, a new definition for first course therapy was to be followed. In addition, note the definition for leukemias in see Section VI.1.1.  Use the older definition for cases diagnosed prior to January 1, 1998.

The following rules are to be followed for first course therapy, and they are in the order of precedence:

1. If there is a documented, planned first course of therapy, first course ends at the completion of this treatment plan, regardless of the duration of the treatment plan.
2. If the patient is treated according to a facility's standards of practice, first course ends at the completion of the treatment.
3. First course therapy includes all treatment received before disease progression or treatment failure.
4. When there is no documentation of a treatment plan or progression, recurrence or a treatment failure, first course therapy ends one year after the date of diagnosis.  Any treatment given after one year is second course therapy in the absence of a documented treatment plan or a standard of treatment.
5. If a patient refuses all treatment modalities and does not change his/her mind within a reasonable time frame, or if the physician opts not to treat the patient, record that there was no treatment in the first course.

If treatment is given for symptoms/disease progression after a period of "watchful waiting," this treatment is not considered part of first course. For example, if a physician and patient choose a "wait and watch" approach to prostate cancer or chronic lymphocytic leukemia and the patient becomes symptomatic, consider the symptoms to be an indication that the disease has progressed and that any further treatment is not part of first course.  The data item RX-Treatment Status was added to summarize the status of all treatment modalities.  This data item is a summary of whether treatment was given, including an option that identifies active surveillance or watchful waiting.

The CCR expects every reporting facility that has a tumor registry to obtain information about the entire first course therapy from the medical record and, if necessary, the physicians themselves, regardless of where the treatment was administered. If it cannot be determined whether an intended therapy was actually performed, record that it was recommended but it is not known whether the procedure was administered. (For example, Enter "Radiation therapy, recommended; unknown if given.")  Reporting facilities preparing initial case reports for the sole purpose of meeting state mandatory reporting requirements may elect to record only the treatment documented in their medical records.

Abstractors are provided with two fields to record first course of treatment information. The first treatment field for each modality (except surgery) is known as "Treatment Summary." This field should include any first course treatment administered for that modality, regardless of where it was administered, including treatment administered at the reporting facility. The second treatment field for each modality (except surgery) is known as "Treatment At This Hospital." This field should only include first course treatment administered at the reporting facility, respective to each modality.

Note:  For cases diagnosed January 1, 2010 and forward, referral to an oncologist is considered a recommendation.  Registry personnel should follow-up on these cases to determine whether chemotherapy was administered or not, and code accordingly. Prior to January 1, 2010, referral does not equal a recommendation.

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