FHIR Chat · PrimaryCancerCondition

Stream: implementers

Topic: PrimaryCancerCondition

Alex Goel (Aug 19 2020 at 16:22):

For the Integrating Cancer Reporting use case in the September Virtual Connectathon https://confluence.hl7.org/display/FHIR/Integrating+Cancer+Reporting

We were looking at the PrimaryCancerCondition (http://hl7.org/fhir/us/mcode/StructureDefinition-mcode-primary-cancer-condition.html) and CancerDiseaseStatus (http://hl7.org/fhir/us/mcode/StructureDefinition-mcode-cancer-disease-status.html) profiles and were struggling with a few values.

Does anyone have an idea how to use PrimaryCancerCondition to represent an active an active prostate cancer?

Here’s the example we were trying to build
Example Patient:
assertedDate = YYYY-MM-DD
clinicalStatus = active
bodySite = Prostate (side note: Why is subject in bodySite?)
stage = an AJCC value

We ran into 2 questions:
How do we represent a patient with a progressive disease using CancerDiseaseStatus

How would we store data on the most recent PrimaryCancerCondition and CancerDiseaseStatus? For example if we wanted to be able to find all active Prostate Cancer patients in a list for MIPS measures, where the patients condition is stable (not progressive)?

@May Terry can you or your colleagues help us out?

May Terry (Aug 19 2020 at 16:57):

@Alex Goel - thanks for the great questions. Lots to unpack though... :-)

Does anyone have an idea how to use PrimaryCancerCondition to represent an active an active prostate cancer?
we have an mCODE example which shows how one represents an active cancer in the IG, but for lung cancer: http://hl7.org/fhir/us/mcode/Condition-mCODEPrimaryCancerConditionExample01.html

Why is subject in bodySite?
You might be reading it wrong. subject is outside of body site. if you collapse Condition.bodySite, you'll see that subject resides outside of that structure.

How do we represent a patient with a progressive disease using CancerDiseaseStatus?
This is an ongoing discussion. Currently, the scope of CancerDiseaseStatus was related to an overall assessment of the patient. "progression" was considered more of a status specific to a response to treatment and not included in the mCODE 1.0 STU1 release. We should be considering an explicit way to specify "progression" or "remission" for a possible STU2 release. While it's not optimal by far (and clinically ambiguous if one considers wholistic patient care), I suppose you can loosely infer cancer progression as "Patient's condition worsened" in the mcode-condition-status-trend-vs value set until there is a better approach. (cc: Mark Kramer to weigh in if needed).

How would we store data on the most recent PrimaryCancerCondition and CancerDiseaseStatus? For example if we wanted to be able to find all active Prostate Cancer patients in a list for MIPS measures, where the patients condition is stable (not progressive)?
It's possible today in mCODE to represent PrimaryCancerCondition for active prostate cancer patients and a "stable" CancerDiseaseStatus. I think one should be able to create a FHIR REST call with out-of-box search parameters that should be able to return your cohort. Let me see if I or one of our mCODE shr-spec team members can quickly prototype this on our mCODE Logicahealth sandbox instance and show how it can be done.

Alex Goel (Aug 19 2020 at 17:43):

Thanks May! This is really helpful to try out making the Prostate sample. I might ask if we can just use the existing Lung example.

And my bad about reading subject wrong!

May Terry (Aug 19 2020 at 19:20):

@Alex Goel You can definitely use the existing Lung example currently in the IG. You can inspect the bundle for that patient in our mCODE Logicahealth instance: https://api.logicahealth.org/mCODEv1/open/Patient/16831/$everything

May Terry (Aug 19 2020 at 19:22):

We'll still create the prostate cancer example and provide some guidance on the REST call. I have a couple of folks on our team working on this and should have it in the next day or so. They'll post it when it's done.

Caroline Potteiger (Aug 21 2020 at 19:00):

@Alex Goel Hi Alex! We uploaded the prostate cancer example to the mCODE Logicahealth instance. These are the ids: PrimaryCancerCondition =17303, CancerPatient=17302, CancerDiseaseStatus=17304