Special article on tumor registries: the hospital tumor registry. Present status and future prospects

The use of hospital registries in orthopaedic surgery

A hospital registry is a collection of prospectively recorded information about patients who have a specific condition or who received a specific type of treatment. Hospital registries are beneficial for the patient, physicians, and administrators and serve several purposes, with the primary purpose being quality control. This article focuses on the role of registries at the hospital level and their advantages compared with other data sets. We also discuss how to implement a hospital registry and how to ascertain registry quality. Finally, we describe the problems inherent in any hospital-based registry and the ways in which the data collected in a registry can be appropriately analyzed.

Brain cancer risk and electromagnetic fields (EMFs): assessing the geomagnetic component

Cancer cluster studies in North Carolina identified several communities in which there existed an elevated risk of brain cancer. These findings prompted a series of case-control studies. The current article, which originated from the results of the 3rd of such studies, is focused on inclusion of the earth's own geomagnetic fields that interact with electromagnetic fields generated from distribution power lines. This article also contains an assessment of the contribution of confounding by residential (e.g., urban, rural) and case characteristics (e.g., age, race, gender). Newly diagnosed brain cancer cases were identified for a 4-county region of central North Carolina, which the authors chose on the basis of the results of earlier observations. A 3:1 matched series of cancer cases from the same hospitals in which the cases were diagnosed served as the comparison group. Extensive geographic information was collected and was based on an exact place of residence at the time of cancer diagnosis, thus providing several strategic geophysical elements for assessment. The model for this assessment was based on the effects of these two sources of electromagnetic fields for an ion cyclotron resonance mechanism of disease risk. The authors used logistic regression models that contained the predicted value for the parallel component of the earth's magnetic field; these models were somewhat erratic, and the elements were not merged productively into a single statistical model. Interpretation of these values was difficult; therefore, the modeled values for the model elements, at progressive distances from the nearest power-line segments, are provided. The results of this study demonstrate the merits of using large, population-based databases, as well as using rigorous Geographic Information System techniques, for the assessment of ecologic environmental risks. The results also suggest promise for exposure classification that is compatible with the theoretical biological mechanisms posited for electromagnetic fields.

Rapid reporting of cancer incidence in a population-based study of breast cancer: one constructive use of a central cancer registry

To support a study of genetic risk factors for breast cancer, the North Carolina Central Cancer Registry has implemented a rapid reporting procedure for hospitals in the study area. This system permits the identification of newly diagnosed breast cancer cases within a very short time period (less than one month). The procedures are straightforward, cost-effective, and greatly benefit the objectives of tissue collection and interviews with the cases. This article describes the rapid reporting procedures and their potential impact for population-based research. For the objective of making generalizable risk statements, the necessity of population-based research is stressed; participation with central cancer registries is endorsed for this and other molecular epidemiologic applications.

A computerised cancer registry data and validation system in India--its implications for developing countries

The cancer registration system in India, and an appropriate computer program to validate the cancer patient data it generates, are described, with the resource inputs, and outputs of research, training, awareness creation and cancer control, in the context of local health care systems. Computer packages already available mostly address the type of data obtainable from western health care systems. The same factors that limit health care systems in India, and probably most other developing countries--inadequate health care facilities, skeletal medical records systems, meagre and unavailable vital statistics, few trained staff, funding and computer facilities--also limit the data sent to the National Cancer Registry Programme. The computer program we developed checks for the reliability and validity of various cancer diagnostic, spread, therapeutic and outcome variables. The program is in HIBASIC for a CPM operating system with a minimum of 64 kB memory, adaptable to MS-DOS systems, population-based cancer registry data, and perhaps to other types of chronic disease registries, with relevant modifications. Since reliable cancer registry data are needed for effective cancer control measures, this program may help in such efforts in developing countries.

A new automated tumor registry and clinical research system and its application to gynecologic oncology patients

Every physician at one time or another wishes that he could quickly recall, group and stratify elements of his past practice and apply that experience toward solving a current problem. In Oncology attempts to use hospital registries for this purpose are often disappointing, as few are computerized and most lack the detail, accuracy, and flexibility to be truly responsive. The development of our current Gynecologic Oncology Tumor registry began in 1982. The final product results from the cooperation of a computer specialist, a registrar, physicians, and nurses. In addition, three independent programs have been incorporated to expand the statistical and reporting functions of the registry. The result is a tumor registry that is the foundation of a clinical research system.

An information system for head and neck tumors: optimal use of abstracting and retrieval resources

This report describes a symbiotic interaction between a hospital tumor registry and the physicians in a medical school department of otolaryngology. The tumor registry is responsible for collecting central registry data, entering both central registry and department-specific data, performing routine data maintenance functions, and tracking the patients over time. The departmental physicians collect site-specific data and, after entry into a computer-based data base management system, can access the information without intermediaries and at their convenience. The result is a comprehensive information resource for head and neck cancer. The development of a medical subspecialty information system, as a satellite to the central registry mechanism, is noteworthy in its low cost, frequent physician use, better patient tracking, improved patient care, and increased clinical relevance of registry activities. A subtle but pervasive benefit is the increased sense of mission experienced by all concerned.

A novel method of assessing completeness of tumor registration

A random sampling method of measuring the completeness of registration of cancer patients was tested at a university referral hospital. The target population consisted of all inpatients and nonprivate outpatients with in situ or invasive malignancies. The medical records of a random sample of all hospital records active in the last five years were reviewed to determine their reportability and inclusion in the tumor registry (Method A). Traditional casefinding assessment methods were also employed by conducting a complete review of four commonly used hospital sources for a short time period (Method B). The primary purpose of the study was methodologic; namely, to test the feasibility of Method A and to characterize it relative to the more traditional Method B. The estimated missed case rates using Methods A and B (3% and 5%, respectively) are not directly comparable because not all outpatient information is recorded in the medical record. It is concluded that as a means of completeness assessment, Method A can be feasible, cost effective, and useful in other institutions provided certain conditions are met: (1) an appropriate random sample of the target population can be obtained; (2) all relevant information is available in a unit medical record; (3) the reviewer is fully aware of the reportability criteria.

Design considerations for a medical school hospital cancer patient data system

Tumor registries abound, but there are few that successfully incorporate information age data management resources. This article describes the evolutionary process of designing, implementing, and maintaining a computer-based cancer patient information system for a medical school hospital. The primary requirement was that accurate information about the cancer experience at University of Texas Medical Branch (UTMB) be readily available. Since the tumor registry staff were not data processing professionals, this system had to use commonly available, well documented, readily maintained, and easily used data management resources. The UTMB registry, as documented by the marked increase in frequency and scope of use, demonstrates that a quality information resource can have a significant impact on hospital cancer programs and could serve as a prototype for other institutions having similar needs.