Stream: implementers
Topic: tracking cancer progress
Patrick Werner (Mar 19 2020 at 09:55):
How would you capture the progress/current state of a cancer disease? (Stable, initial diagnosis, new metastasis)
Updating the Condition.stage field?
Patrick Werner (Mar 19 2020 at 10:11):
Feels weird to update this field all the time. Alternative would be just creating Observations or ClinicalImpressions without updating the condition and using the workflow-episodeOfCare Extension to point to the EpisodeOfCare of the cancer desease
Halina Labikova (Mar 19 2020 at 13:00):
I think it's a combination of multiple fields. For "stable" it would be Disease Status (you could use mCODE's http://build.fhir.org/ig/HL7/fhir-mCODE-ig/StructureDefinition-mcode-cancer-disease-status.html , though a more common way to capture this in EHRs is "Disease Response to Treatment" with the valueset that loinc offers). New metastasis would be reflected in the code itself (assuming that you use ICD10?). For initial (not the same as 'primary') diagnosis and similar flags, we use extensions.
Halina Labikova (Mar 19 2020 at 13:05):
Feels weird to update this field all the time. Alternative would be just creating Observations or ClinicalImpressions without updating the condition and using the workflow-episodeOfCare Extension to point to the EpisodeOfCare of the cancer desease
Wouldn't pointing the observation at the cancer through focus reference suffice?
Jose Costa Teixeira (Mar 19 2020 at 13:21):
I think the right place is to update the condition, if that is where you capture the details of the disease
Jose Costa Teixeira (Mar 19 2020 at 13:22):
although "initial diagnosis" and "stable" are rather different concepts.
Jose Costa Teixeira (Mar 19 2020 at 13:24):
if you do have to update current state, I'd say it's in the condition.
If you want to provide details, you can use observations.
Lloyd McKenzie (Mar 19 2020 at 14:44):
@Michelle (Moseman) Miller
Patrick Werner (Mar 20 2020 at 07:46):
Jose Costa Teixeira said:
although "initial diagnosis" and "stable" are rather different concepts.
yes. You are very right.
Initial Diagnosis is a timestamp in the episode of care, same for "start systemic treatment". How would you capture these events? It is like a coded dateTime element
Jose Costa Teixeira (Mar 20 2020 at 08:03):
"initial diagnosis" can be a timestamp, but I guess in cancer it could also be the whole information set that is found at initial diagnosis: lesion size and location etc. at the time of first diagnosis.
Jose Costa Teixeira (Mar 20 2020 at 08:03):
so not just "when was this diagnosed" but "what was this when it was diagnosed"
Jose Costa Teixeira (Mar 20 2020 at 08:05):
in any case, there is status of the treatment process, and the clinical assessment of the status of the disease. I'd think those should be distinguished
Last updated: Apr 12 2022 at 19:14 UTC
