First Course Treatment/Immunotherapy--Colon: Can "Sandostatin" be coded for treatment of carcinoid tumors of the colon because it flushes tumor cells from the colon in addition to controlling diarrhea?
Do not code Sandostatin (Ocreotide Acetate) as treatment. This is an ancillary drug used to treat symptoms of diarrhea. SEER Book 8 is undergoing revision and will include this change.
First Course Treatment/Radiation Therapy/Immunotherapy--Thyroid: For this primary, do we code I-131 as a Radio-isotope as well as a Biological Response Modifier? See Description.
(SEER Book 8 lists I-131 as a Biological Response Modifier.) Immunoglobulin is listed as immunotherapy agent in the CCR manual also coded as immunotherapy. Are there two different types of I-131, immunoglobulin and sodium iodide?
Sodium Iodide is listed as an ancillary drug in SEER Book 8, page 45. The listing on page 63 refers to Antiferritin antibody, or AntiCEA. Both of these were under clinical investigation when Book 8 was written. They are no longer active and this change will be made when Book 8 is revised.
First Course Treatment/Surgery of Primary Site--Lung: How is radiofrequency ablation for lung primaries coded?
Assign code 15 [Local tumor destruction, NOS] in the Surgery of Primary Site field. RFA is a technique where a probe placed in or near a tumor sends radio waves into the tumor, causing it to heat up and kill the cancer cells. RFA doesn't fit neatly into code 12 or 13, so we are left with the NOS code.
First Course Treatment: If a patient makes a blanket refusal of all recommended therapy or refuses all treatment before any therapy was recommended, are only immunotherapy and hematologic/endocrine therapies to be coded as refused (code 87)? Or should all treatment modalities be coded as refused if a patient makes a blanket refusal? Or should none of the treatment modalities be coded as refused because we do not know what would have been recommended? See Discussion.
Coding instructions for immunotherapy and for hematologic/endocrine procedures state that Code 87 is to be assigned if either of the following circumstances apply: 1) If the patient made a blanket refusal of all recommended treatment. 2) If the patient refused all treatment before any was recommended. These instructions are not included for other treatment modalities.
When the patient refuses treatment, the first course of therapy is no treatment. Code all treatments as refused.
First Course Treatment: What code is used to represent each treatment modality field when there is no indication that a particular modality of treatment was recommended or started?
Code the individual treatment fields to 0 or 00 [None] when the modality is not addressed in the treatment plan (or when a treatment plan is lacking) and there is no indication that a particular modality of treatment was recommended or started.
First Course of Cancer-Directed Therapy--All Sites: How do we code retinoic acid?
The code for retinoic acid depends upon the primary site and histology of the tumor. Code retinoic acid (also called Vitamin A, tretinoin, ATRA, all-transretinoic acid or Vesanoid) in the Immunotherapy field as 01 [Immuno administered as first course therapy] for acute promyelocytic leukemia. This drug is given to patients as an alternative to chemotherapy.
For all other sites/histologies, code retinoic acid in the Other Cancer-Directed Therapy Field. Use code 2 [Other experimental cancer-directed therapy] or 3 [Double-blind clinical trial, code not yet broken] if the drug is given as part of a protocol. If the drug is not being given as part of a protocol or you don't know whether it is part of a protocol, use code 1 [Other cancer-directed therapy].
First course treatment--Corpus Uteri: Should Arimidex be coded as hormone therapy for an endometrioid adenocarcinoma? See Discussion.
Per the SEER Manual, endometrial cancers may be treated with progesterone which is coded as hormone therapy for these primaries. As endometrioid adenocarcinomas are hormonally-dependent carcinomas, should an aromatase inhibitor or anti-estrogen agent also be coded as hormone therapy?
Arimidex has not been approved to treat endometrial cancer. It is not prescribed for pre-menopausal women. Clarify with the physician why the drug was being used. If the physician states Arimidex was given to reduce tumor burden, code as hormone therapy.
First course treatment--Heme & Lymphoid Neoplasms: Is the use of the corticosteroid, Clobetasol, cancer-directed treatment for mycosis fungoides or is it only used to treat the side effects of that disease?
Clobetasol is not cancer-directed treatment at this time.
Note: Question originally submitted in 2010. During 2014 review, this was checked and Clobetasol is still not cancer directed treatment for Mycosis Fungoides.
First course treatment--Heme & Lymphoid Neoplasms: How is a "donor lymphocyte infusion" that is used in the treatment of CLL coded?
Donor lymphocyte infusion (DLI) is coded as immunotherapy. The lymphocytes are donated by the same person who donated the original stem cell transplant. The lymphocyte infusion creates an immune response in which the T-cells are activated to attack the cancer cells.