Mei-Shu Lai, M.D, Ph.D.
Institute of Preventive Medicine, College of Public Health, National Taiwan University 3
3UHVHQWDWWK-$&50HHWLQJ
╙㪈㪐࿁ቇⴚ㓸ળ䈏䉖⊓㍳䈫␠ળ䈫䈱⺞
2FWREHU<RNRKDPD-DSDQ
Taiwan Cancer Registry
บḧ䈮䈍䈔䉎䈏䉖⊓㍳䈱ᓎഀ䋺 䈏䉖䊝䊆䉺䊥䊮䉫 - 䉰䊷䊔䉟䊤䊮䉴䊶䉲䉴䊁䊛
z䈏䉖⊓㍳䈱ᛛⴚ⊛㕙
z㔚ሶ䊂䊷䉺䊔䊷䉴䈮䈍䈇䈩ᚻน⢻䈭ⶄᢙ䈱ᖱႎḮ䈎䉌 䈱ᖱႎ㓸
z䈏䉖⊓㍳䊂䊷䉺䈱⾰
Taiwan Cancer Registry
The work of cancer registration in Taiwan:
Cancer monitoring-surveillance system
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LQHOHFWURQLFGDWDEDVHV z4XDOLW\RIFDQFHUUHJLVWU\GDWD
Taiwan Cancer Registry
บ
บḧ䈱䈏䉖⊓㍳䉲䉴䊁䊛䈱⇛
̒䊃䊧䊷䊆䊮䉫䉮䊷䉴
̒⣲≌⊓㍳჻䈱ቯ บḧ 䈏䉖⊓㍳ቇળ 䋨บἨ䈏䉖∝⊓⸥ቑᦩ䋩
ਛᄩ䈏䉖⊓㍳
⍴䊂䊷䉺䊔䊷䉴
ਛᄩ䈏䉖⊓㍳
㐳䊂䊷䉺䊔䊷䉴
࿖┙บḧᄢቇ 0CVKQPCN6CKYCP7PKXGTUKV[067
࿖᳃ஜᐽዪ ⴕ㒮ⴡ↢⟑
$WTGCWQH*GCNVJ2TQOQVKQP$*2
&GRCTVOGPVQH*GCNVJ
̒╷┙᩺
̒䊂䊷䉺䊝䊆䉺䊥䊮䉫
̒ຠ⾰⋙ᩏ
̒ቯ
̒䊂䊷䉺㓸
̒䊂䊷䉺▤ℂ
̒⸃ᨆ
̒ቇⴚ⊛↪
Taiwan Cancer Registry
Overview of Cancer Registry system In Taiwan
Training course
Certified cancer registrars Taiwan Society of Cancer Registry Central Cancer Registry
(Short Form Database) Central Cancer Registry (Long Form Database) National Taiwan University
(NTU) Bureau of Health Promotion
Department of Health
Policy Making
Data Monitoring,
Audit Quality
Accreditation
Data Collection
Data Management
Analysis
Academic use
Taiwan Cancer Registry
࿖
࿖┙บḧᄢቇ䈻䈱บḧ䈏䉖⊓㍳䈱ᬺോᆔ⸤
䋨㪈㪐㪐㪍ޯ䋩
ਥછ⊓㍳჻䈫කᏧ䈫䈱✕ኒ䈭දജ
䊂䊷䉺▤ℂ䈫ዯ䉕ක≮ᯏ㑐䈮ଦ䈜䈱䈮චಽ䈭ੱ᧚
ቯᦼ⊛䈭㆚䉍⺞ᩏታᣉ䊶ቢోᕈ㪐㪎䋦䈫䈭䉎
ක≮ᯏ㑐䈻䈱㔚ሶᇦ䈮䉋䉎ዯ䈱ផᅑ
ቯᦼ⊛䈭䊂䊷䉺䉼䉢䉾䉪䈫ୃᱜ䊶 ක≮ᯏ㑐䈮䈍䈔䉎ዯ
೨䊂䊷䉺䉼䉢䉾䉪
ᣂ䈢䈭⛔⸘䊂䊷䉺䉕ട䈋䈢ᐕᰴႎ๔ᦠᡷ⸓
Taiwan Cancer Registry
To commission TCR to NTU since 1996
Closely work with senior registrars and doctors
Enough manpower to manage data and remind hospitals to report
Trace back unreported potential cases regularly and completeness reach to 97%
Encourage hospital report by electronic form
Data check and corrigendum run regularly and hospitals proceed data check before sent out
Revised annual report by adding more statistics
Taiwan Cancer Registry
บ
บḧ䈏䉖⊓㍳䈱㗴ὐ
ක≮ᯏ㑐
ఝవ㗅䈱ૐ䈘䊶ੱ᧚ਇ⿷䈫䊃䊧䊷䊆䊮䉫䈘䉏䈩䈇䈭 䈇ੱ᧚䊶ዯㆃ䉏䉦䊦䊁⸥タ䈱ṳ䉏
⊓㍳჻
䊃䊧䊷䊆䊮䉫䈱ᰳᅤ䇮කᏧ䉇ห䈎䉌䈱䉰䊘䊷䊃䈏 ฃ䈔䉌䉏䈭䈇䇮 ⾰䈜䉎వ䈏䈭䈇䇮ኾ㐷⡯䈫䈚䈩
⼂䈘䉏䈭䈇
ⴕ㒮ⴡ↢⟑
ఝవ㗅䈱ૐ䈘䇮▤ℂ⠪䈏㪈ੱ䈱䉂䇮䊂䊷䉺䉼䉢䉾䉪 䈚䈩䈇䈭䈇
Taiwan Cancer Registry
Problems of TCR
Hospitals
Low priority , insufficient and untrained manpower, long lag of reporting, missing data in chart
Registrars
Lack of training, no support from doctors/peers, and hospitals
Department of Health
Low priority, 1 person manage, prelimary data check
Taiwan Cancer Registry
⊓
⊓㍳჻䈱ᒝൻ
⎇ୃ䉕ୃੌ䈚䈢⚖⊓㍳჻䈮䉋䉎䉼䊠䊷䉺䊷䉫䊦䊷䊒 䈱⚿ᚑ
9ᓟ䈱⸘↹䈱┙᩺ᡰេ䇮䊃䊧䊷䊆䊮䉫䉮䊷䉴䈱ឭ ଏ䇮䉋䈒䈅䉎⾰䈫䈠䈱࿁╵䉕䉁䈫䉄䈢㪨㩽㪘㓸 䋨㪝㪘㪨㪀䈱⛽ᜬ䇮∛㒮⋙ᩏ
ቯ⊓㍳჻䋨⍴䈱䉮䊷䊂䉞䊮䉫䋩䇮㪉㪇㪇㪋ᐕ䈎䉌
㪉㪇㪇㪍ᐕ䇮บḧ䈏䉖⊓㍳ቇળ䋨บἨ≸∝⊓⸥ቑᦩ䋩⸳┙
9⋙ᩏ䇮ᢎ⢒䇮ቯ䉇㪝㪘㪨䉕䉃㪙㪟㪧䊒䊨䉫䊤䊛䈱 ታᣉ
Taiwan Cancer Registry
Consolidate registrars
Trained senior registrars and organize a tutor group 9Help to form future plan, provide training courses,
maintain FAQ, hospital audit
Certify registrar (coding short form) since 2004
Taiwan Society of Cancer Registry was established in 2006
9 Carry out BHP programs including audit, ducation, certification and FAQ
Taiwan Cancer Registry
╙
╙ੑᦼ 䋨㪉㪇㪇㪉ᐕએ㒠䋩
䈏䉖ኻ╷ᴺ䋨㪉㪇㪇㪊ᐕᏓ䋩㪑㩷ⴕ㒮ⴡ↢⟑䈮ኻ䈚䈩䇮 䈏䉖ᴦ≮䈱⾰䈱Ⴧㅴ䉕ⷐ᳞䈚䈩䈇䉎
ᴦ≮䊌䉺䊷䊮䉕ᛠី䈜䉎䈢䉄䇮ዯ㗄⋡䉕㪉㪇㪇㪉ᐕ䈮㪉㪇 䈎䉌㪍㪌䇮䈘䉌䈮㪉㪇㪇㪎ᐕ䈮䇮䉝䊜䊥䉦䈱㪝㪦㪩㪛㪪䉕ర䈮ᡷᄌ 䈚䈢㪐㪌㗄⋡䈻ᒛ䈚䈢
9 ∝ၮᧄᖱႎ䇮⸻ᢿᤨᐕ㦂䇮⸻ᢿᣇᴺ䇮ㇱ䇮⚵❱ቇ⊛
⸻ᢿ䇮㪫㪥㪤䉴䊁䊷䉳䇮⚦䈭ᴦ≮ᖱႎ䇮↢ᱫᖱႎ
ක≮ᯏ㑐䋨ᐕ㑆㪌㪇㪇એ䈱ᣂⷙ䈏䉖ᖚ⠪䉕⸻ᢿ䊶 ᴦ≮䋩䈎䉌䇮ਥⷐ㪍㪄㪈㪋ㇱ䈱㐳䈱ᖱႎ䈏ዯ䈘䉏䉎
㐳䈮䉋䉍ዯ䈔䉌䉏䈢∝䈲䇮บḧ䈱ో䈏䉖䈱㪏㪇䋦 䈮䈱䈿䉎
Taiwan Cancer Registry
Phase II (after 2002)
Cancer Control Act promulgated in 2003 which requests DOH to promote the cancer care quality
To know the treatment patterns, we extended reported items from 20 to 65 in 2002 and further to 95 in 2007 which modified from US FORDS
9Case demography, diagnostic age and methods, site and morphology, TNM Staging, more detail treatment information and follow-up
53 hospitals (҈500 annual incident cases) report long form information on 6 to 14 major cancers
Long form cases are counted for 80% of total national cancer cases
Taiwan Cancer Registry
⋡⊛
ⴕ㒮ⴡ↢ᚲ䈮䈏䉖ᴦ≮䈱⾰䈱ะ䈱ଦㅴ䉕ⷐ᳞䈜䉎䈖䈫 ක≮㒾ᡷ㕟䋺บḧ 䈏䉖ኻ╷ᴺ 㪉㪇㪇㪊
Taiwan Cancer Registry
Aim:
requests DOH to promote the cancer care quality Health reform : National cancer control act 2003
Taiwan Cancer Registryg y Taiwan Cancer Registry 䈏
䈏䉖∝䈱㔚ሶ⊛ዯ䇮䊂䊷䉺ୃᱜ䇮
㆚䉍∝䈱⏕ቯ
⊓㍳ක≮ᯏ㑐 㪌㪇ᐥએ䈱∛㒮
ୃᱜ䊂䊷䉺 䊂
䊂䊷䉺䉼䉢䉾䉪䋧ୃᱜ
䊂 䊂䊷䉺ജ䋧ᾖว ᱫ⸻ᢿᦠ
⥌ᱫ⊛∔ᖚ䊂䊷䉺䊔䊷䉴 䈏䉖ᬌ⸻䊂䊷䉺䊔䊷䉴 䈫䈱䊂䊷䉺䊥䊮䉬䊷䉳
䈏䉖ᖚ⠪
⊓㍳ක≮ᯏ㑐䈻䈏䉖ᖚ⠪䈱
㆚䉍⺞ᩏ
T T T T T T T T T T T T T T T T T T T T T T T T
Taaaaaaaaaaaaaaiiiiiiiiiiiiiiwwwwwwwwwwwwwwaaaaaaaaaaaaaannnnnnnnnnnnnn CCCCCCCCCCCCCCaaaaaaaaaaaaaannnnnnnnnnnnnncccccccccccccceeeeeeeeeeeeeerrrrrrrrrrrrrr RRRRRRRRRRRRRReeeeeeeeeeeeeeggggggggggggggiiiiiiiiiiiiiissssssssssssssttttttttttttttrrrrrrrrrrrrrrrrrrrrrrrrryyyyyyyyyyyyyyyyyyyyyyyyyy 䊂䊷䉺⛔ว
䈏 䈏䉖
⊓㍳ቶ
ਇ⏕䈎䈭䊂䊷䉺䈱
䈇ว䈞
࿖
࿖┙บḧᄢቇบḧ䈏䉖⊓㍳䈮䈍䈔䉎䊂䊷䉺㓸䊶▤ℂ䈱ᵹ䉏
Reporting cancer cases electronically, data correction, trace-back cases confirmed R
Registry Hospitals with over 50 beds
Correct data Data Check & Corrigendum
Data Input & Consolidation Data Linkage from
profiles of Death Certificates, Catastrophic Illnesses, and Cancer Screening Program
Potential cancer cases
Trace potential cancer cases back to Registry Hospitals
Data Integration
C Cancer Registry
Office
Return questionable data to reconfirm
D
Data Collection and Management Procedure of TCR in NTU
Taiwan Cancer Registry
䈏
䈏䉖ኻ╷ᴺቯᓟ䈱บḧ䈏䉖⊓㍳䈱♖ᐲᜰᮡ
ၮḰ 2002 2003 2004 2005 2006 2007 ቢోᕈ㪃㩷㩼 92.80 95.46 94.27 96.69 97.59 97.82
㪛㪚㪦㩷㩼㩷㪈 2.89 2.57 2.32 1.67 1.38 1.40
㪤㪆㪠㩷㩼㩷㪉 54.59 55.85 51.18 51.65 49.98 52.04 㪤㪭㩷㩼㩷㪊 87.37 87.05 88.51 88.06 88.91 89.78 හᤨᕈ㪃㩷 24 24 23 17 17 17
Note: 1. Death Certificate Only percentage䋨ᱫ䈱ᖱႎ䈱䉂䈱∝䇮䋦䋩 2. Mortality : Incidence ratio䋨ᱫ䋺⟕ᖚᲧ䋩
3. Microscopically Verified percentage䋨㗼ᓸ㏜ቇ⊛⸻ᢿ䈱ታᣉഀว䇮䋦䋩 Taiwan Cancer Registry
Data Quality Indices for Taiwan Cancer Registry Subsequent
to “Cancer Control Act” enacted
g g g yyy T
T T T T T T T T T T T T
Taaaaaaaaaiiiiiiiiiiiiiiwwwwwwwwaaaaaaaaannnnnnnnn CCCCCCCCCCCCCCaaaaaaaaannnnnnnnnccccccccceeeeeeeeerrrrrrrrr RRRRRRRRRRRRRReeeeeeeeeggggggggggiiiiiiiiiiiiiisssssssssttttttttttttttrrrrrrrrryyyyyyyyy
Criterion 2002 2003 2004 2005 2006 2007
Completeness, % 92.80 95.46 94.27 96.69 97.59 97.82
DCO % 1 2.89 2.57 2.32 1.67 1.38 1.40
M/I % 2 54.59 55.85 51.18 51.65 49.98 52.04
MV % 3 87.37 87.05 88.51 88.06 88.91 89.78
Timeliness, months 24 24 23 17 17 17
Note: 1. Death Certificate Only percentage 2. Mortality : Incidence ratio
Taiwan Cancer Registry
䈏
䈏䉖ᴦ≮䈱⾰䈱ቯ
㪉㪇㪇㪉ᐕ䈎䉌㪉㪇㪇㪎ᐕ䈮䇮ක≮ᯏ㑐䈮ኻ䈚䇮䈏䉖⊓㍳䈮䈍䈔䉎䌄䌏䌈
䊦䊷䊦䉕ḩ䈢䈚䈏䉖ᴦ≮䈱⾰䉕ᡷༀ䈜䉎䈢䉄䈱ഥ䉕䈚䈢
䈏䉖⊓㍳䈱⾰䈫ㆡ↪䈮䈧䈇䈩⋙〈䈚䈩䈇䉎䈏䉖ᆔຬળ䈱䊧䊔 䊦䈻䈏䉖⊓㍳䉕ะ䈘䈞䉎
ਥዉ⠪䈪䈅䉎කᏧ䈮䉋䉎⊓㍳჻䈫⥃ᐥක䈫䈱ᯅᷰ䈚
ᐕ䈎䉌䇮ක≮ᯏ㑐䈮ኻ䈚䈩䈏䉖ᴦ≮䈱⾰䈱ቯ䉕䈚䈩䈇䉎
䊘䉟䊮䊃ਛ䇮㪍䊘䉟䊮䊃䈏䈏䉖⊓㍳䈮㑐ㅪ䈜䉎䈖䈫
䌁䊧䊔䊦䈱ක≮ᯏ㑐䈲䇮࿖᳃ஜᐽ㒾䈱ᡰᛄ䈇䈮ᓇ㗀䉕ਈ 䈋䉎ක≮䉶䊮䉺䊷䈱ቯ䉕↳⺧䈜䉎䈖䈫䈏䈪䈐䉎
Taiwan Cancer Registry
Accreditation cancer care quality
Subsidize hospitals to fulfill DOH rules on CR and improve care quality during 2002-2007
Upgrade CR to the level of cancer committee which is in charge of its quality and application
Doctor leader bridges registrars and clinicians
Accredit hospitals for cancer care quality since 2007
6 of 30 points are related to CR
“A level” hospitals can apply medical center accreditation which influence NHI payment
Taiwan Cancer Registry
⍴
⍴䊂䊷䉺䊔䊷䉴 㐳䊂䊷䉺䊔䊷䉴
2JCUG + +++ ++ +++
ᒰᐕ
䉁䈪
䉁䈪 ዯኻ⽎ ో䈏䉖
ᔅ㗇
ሶች㗪ㇱ ᔅ㗇
ᚱ䇮⢄䇮⢖䇮ญ
⣧䇮⚿⣺䊶⋥⣺
છᗧ
ሶች㗪ㇱ䇮ᚱ䇮
⢄䇮⢖䇮ญ⣧䇮⚿
⣺䊶⋥⣺
ᔅ㗇
ሶች㗪ㇱ䇮ᚱ䇮⢄䇮⢖䇮 ญ⣧䇮⚿⣺䊶⋥⣺
ᔅ㗇(2007) ೨┙⣼䇮㘩䇮⢗䇮⣾⢲
ᔅ㗇(2008䈮ㅊട)
༄㗡䇮ሶችㇱ䇮ෆᎽ䇮 䊥䊮䊌⣲䇮⊕ⴊ∛
ᔅ㗇(2009䈮ㅊട)
⊓㍳ක≮
ᯏ㑐 ක≮ᯏ㑐 ක≮ᯏ
㑐 ක≮ᯏ
㑐 ක≮ᯏ㑐
䊂䊷䉺 㗄⋡ᢙ
⸻ᢿ䇮ᴦ≮
⸻ᢿ䇮ᴦ≮
⸻ᢿ䇮ㅴⴕᐲ䇮 ᴦ≮䇮↢ᱫᖱ ႎ䋺
⸻ᢿ䇮ㅴⴕᐲ䇮 ᴦ≮䇮↢ᱫᖱ ႎ䋺
⸻ᢿ䇮ㅴⴕᐲ䇮ᴦ≮䇮
↢ᱫᖱႎ
ਛᄩ䈏䉖⊓㍳䊂䊷䉺䊔䊷䉴䈱䉁䈫䉄
Taiwan Cancer Registry Short Form Database Long Form Database
Phase I III II III
Data Available Year
1979 2007
until now 2002-2003 2004-2006 2007 until now Reporting
Cancers
All Cancers REQUIRED Cervix:
REQUIRED Breast, liver, lung, oral cavity, colon
& rectum:
OPTIONAL
Cervix, breast, liver, lung, oral cavity, colon &
rectum:
REQUIRED
Cervix, breast, liver, lung, oral cavity, colon & rectum:
REQUIRED (2007) Prostate, esophagus, stomach, bladder: ADD REQUIRED (2008) Nasopharynx, Corpus, ovary, Lymphoma & Leukemia:
ADD REQUIRED (2009) Registry
Hospitals
From 100 to 223 hospitals
15-17 hospitals
27- 33
hospitals 42-53 hospitals Data &
Item Numbers
Diagnosis, treatment:
20
Diagnosis, treatment:
33
Diagnosis, stage, treatment, follow-up: 65
Diagnosis, stage, treatment, follow-up: 65
Diagnosis, stage, treatment, follow-up: 95
Summary of Central Cancer Registry Database
Taiwan Cancer Registry
บ
บḧ䈏䉖⊓㍳䈱♖ᐲ䈮ኻ䈜䉎 䈏䉖ኻ╷ᴺ䈱䊙䉟䊦䉴䊃䊷䊮
䈏䉖ኻ╷ᴺ䈲䇮ක≮ᯏ㑐䈮ⴕ㒮ⴡ↢⟑䋨㪛㪦㪟䋩䈱ቯ䉄 䉎䊦䊷䊦䈮ೣ䈦䈢䈏䉖⊓㍳䈱ታᣉ䉕ⷐ᳞䇯㩿ዯ䉕䈚䈭䈇 ႐ว㪑㪊㪇㪇䊄䊦䈎䉌㪈㪍㪇㪇䊄䊦䈱⟏㊄㪀
䈏䉖⊓㍳䈱㪛㪦㪟䊦䊷䊦㩿㪉㪇㪇㪌㪀
කᏧ䈏₸వ䈚䇮⸻ᢿ䈎䉌㪈ᐕએౝ䈮ዯ䈚䈭䈔䉏䈳䈭 䉌䈭䈇
ੱ᧚䋺㪈㪇㪇㪇㪄㪈㪌㪇㪇∝䈮ኻ䈚䇮⊓㍳჻㪈ੱ
⥄Ꮖ⋙ᩏ䉕ⴕ䈉䈖䈫䈫䇮ዯ䈱㪈㪇㩼䈮ኻ䈚䈩䈏䉖ᆔຬ
ળ䈮䉋䉎ክᩏ䈏ⴕ䉒䉏䈩䈇䉎
㪎㪇䋦એ䈱∝䈱↢ᱫ⏕䈏䈪䈐䈩䈇䉎䈖䈫䈫䇮
㪈㪌䊱䈪↢ᱫ⏕䈏䈪䈐䈩䈇䈭䈇∝䈲㪊㪇䋦એਅ
䊂䊷䉺䈲䇮ක≮䈱⾰䈱ᡷༀ䈮↪䈘䉏䉎䈼䈐䈪䈅䉎 Taiwan Cancer Registry
Cancer Control Act milestone for TCR quality
Cancer Control Act requires hospitals to follow DOH rules on cancer registration, $300-1600 penalty for not reporting
DOH’s rules for cancer registration (2005)
Dr lead and report before 1 year after diagnosis
Manpower: 1 registrar/1000-1500 cases
Perform self-audit and 10% reviewed by cancer committee
҈70% case FU, чϯϬйůŽƐƚ&hŝŶϭϱŵŽŶƚŚƐ
Should be used in care quality improvement
Taiwan Cancer Registry
บ บḧ 㖧࿖䇮䉸䉡䊦 ᣣᧄ䇮ᄢ㒋 ਛ࿖䇮㚅᷼
ਛ࿖䇮ᶏ 䊐䉞䊥䊏䊮䇮䊙䊆䊤 䉲䊮䉧䊘䊷䊦 䉟䉺䊥䉝䇮䊯䉢䊈䊃 䉴䉟䉴䇮䊁䉞䉼䊷䊉 䊐䊤䊮䉴䇮䉟䉷䊷䊦 䉴䊕䉟䊮䇮䉝䉴䊃䉠䊥䉝䉴 䉺䉟䇮䉸䊮䉪䊤䊷 䉪䉡䉢䊷䊃䋺䉪䉡䉢䊷䊃ੱ
䉼䉢䉮࿖
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