title: Availability of TNM Staging Data Elements in the Medical Record and Training Needs Assessment: Results from the 2014 SEER Training Needs Assessment for TNM Study.
abstract: BACKGROUND
  In 2016, the cancer registry community will directly assign T, N and M components of stage. The Surveillance, Epidemiology, and End Results program implemented a field study to determine how often T, N and M were not available in the medical record, requiring the registrar to directly assign clinical or pathologic TNM stage components. The field study also identified specific training needs.
  
  
  METHODS
  T, N and M status were collected from multiple sources within medical records for a total of 280 cases, 56 each from breast, prostate, colon, lung, and ovarian cancer. TNM data elements were also directly assigned by a series of reviewers and by study participants using the medical records with TNM information redacted. Availability of physician-assigned TNM was estimated from the medical record. Also, participant responses were compared to preferred answers.
  
  
  RESULTS
  Pathologic T, N and M were available more often in the medical records than were clinical values and varied by site. Pathologic T and N were available for about two-thirds of the cases, but the clinical elements were available for only about 20% of cases. The agreement between participant responses and review panel assignments varied by data element and cancer site. Agreement was modest for most data elements and cancer sites, ranging from 54% for clinical T to 92% for clinical M for all cancer sites combined.
  
  
  CONCLUSIONS
  The data elements for TNM staging and stage group were often missing from the medical records, so registrars in the field will need to assign TNM frequently. Furthermore, the results of this study strongly suggest that more training is required, even among those who currently assign TNM.
authors.forename: Anne-Michelle
authors.initials: AM
authors.lastname: Noone
authors.forename: Nicola
authors.initials: N
authors.lastname: Schussler
authors.forename: Serban
authors.initials: S
authors.lastname: Negoita
authors.forename: Margaret
authors.initials: M
authors.lastname: Adamo
authors.forename: Kathleen
authors.initials: K
authors.lastname: Cronin
authors.forename: Jean
authors.initials: J
authors.lastname: Cyr
authors.forename: Donna
authors.initials: D
authors.lastname: Gress
authors.forename: Carmela
authors.initials: C
authors.lastname: Grove
authors.forename: Carol
authors.initials: C
authors.lastname: Kosary
authors.forename: Benmei
authors.initials: B
authors.lastname: Liu
authors.forename: Leon
authors.initials: L
authors.lastname: Sun
authors.forename: Kevin
authors.initials: K
authors.lastname: Ward
authors.forename: Lynne
authors.initials: L
authors.lastname: Penberthy
mesh_terms: D006801:Humans; D007318:Inservice Training / Q000592:standards*; D008499:Medical Records / Q000592:standards; D020380:Needs Assessment; D009367:Neoplasm Staging / Q000592:standards*; D018426:SEER Program / Q000458:organization & administration* / Q000592:standards