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SEER Inquiry System - Report
Produced: 08/13/2025 5:11 PM
Question 20000454
Inquiry Details
References:
#1: SEER Program Code Man, 3rd Ed, 119. Rule 4
#2: 2004 SEER Manual, 171
Question:
First Course Treatment: If the patient receives no treatment at the time of diagnosis (either because it is not recommended or because the patient refused treatment at that time) but treatment is later instituted after disease progression, should this treatment be coded as part of the first course of treatment?
Discussion:
Answer:
The SEER rules changed in 1998 regarding what constitutes First Course of Cancer-Directed Therapy.
For cases diagnosed on or after 1/1/98: The First Course of Cancer-Directed Therapy fields will all be coded to 0 [None] for these types of cases. The documented disease progression would stop the timeframe for inclusion of any treatment to be part of first course of therapy.
History:
For cases diagnosed before 1/1/98: The First Course of Cancer-Directed Therapy is the first treatment the patient receives regardless of the time it starts. There must have been some type of treatment given before the rule regarding progression of disease would apply.
EXAMPLE: Patient refuses surgery after being diagnosed with cancer. No other treatment is recommended. One year later, there has been progression of disease, and surgery is done. This surgery is coded as first course of treatment. Two months later there is further progression, and radiation therapy is instituted for the further progression. The radiation would be considered subsequent treatment.
