Shop Talk with Laura P. Ruppert, M.H.A., R.T. (R) (M), Director of the Cancer Surveillance Section at the Indiana State Department of Health


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Q:     The Death Clearance follow back process is something the hospital registrars are contacted about yearly. Can you tell us when that process is begun and when is the call for data?

A:     The Indiana State Cancer Registry (ISCR) was established in 1985 [“for the purpose of recording all cases of malignant disease and other tumors and precancerous diseases required to be reported by federal law or federal regulation or the National Program of Cancer Registries that are diagnosed or treated in Indiana, and compiling necessary and appropriate information concerning those cases, as determined by the state department, in order to conduct epidemiologic surveys of cancer and to apply appropriate preventive and control measures.” (IC 16-38-2-1)] With federal funding from the Centers for Disease Control and Prevention in 1992, and Indiana’s membership with the North American Association of Central Cancer Registries, which has awarded Indiana with gold or silver status since 1998, the ISCR has grown into a strong and robust central cancer registry.

To lessen the “crunch” time work load while preparing for the annual November Call for Data, two years ago the ISCR started the process of conducting Death Clearance year round. To accomplish this, we needed to increase our linkage with the state’s Vital Statistics Department for records of Indiana deaths from once a year to twice a year. Additionally, the ISCR needed to put together a systematic schedule of contract CTRs to be available to work on this project year round. Although we are continually fine tuning the process, this has been a successful venture that not only evens out the work load, thus improving quality, but has made us more prepared for the Call for Data.


Q:      Can you briefly describe why it is important to follow back with physicians and hospitals for more information than what is on the death certificate?

A:     The importance of follow back to obtain more information than is listed on the death certificate holds many advantages for a cancer registry. In a nutshell it allows the registry to obtain more complete cancer data, especially diagnosis date for incidence reporting. In tandem it improves the quality of the data for both the state and reporting facilities by verifying the diagnosis is a reportable disease, assists reporting facilities and the state in identifying missed cases, and identifying incorrect diagnosis coded on the Death Certificate.


Q:      What percentage of your cancer cases are identified from death certificates?

A:      Roughly 5-6% of cases for each year are identified from death certificates -this includes facility reported cases, cases entered by state registry and Death Certificate Only (DCO) cases. I will have to say that we are unable to determine what percentage of cases reported from hospitals would not have been reported if death clearance follow-back was not completed as cases can, at times, be reported late to the ISCR.

Nevertheless, less than 3% of the ISCR annual case load represents DCO cases.


About Laura:

Laura P. Ruppert, M.H.A., R.T. (R) (M) serves as the Director of the Cancer Surveillance Section at the Indiana State Department of Health. As director, the Indiana State Cancer Registry (ISCR) falls under her direction and she serves as the resident expert and public health specialist for cancer surveillance initiatives (including the federal and state mandated ISCR, pediatric cancer surveillance, and Indiana cancer cluster response). Laura earned her B.A.S. from Siena Heights University, Adrian, MI, with a major in radiology and an M.H.A. from Ohio University, Athens, OH. She worked for over 30 years as certified radiologic technologist, specializing in mammography and has been responsible for cancer registries both at the hospital and state level. She serves as the Chair of the North American Association of Central Cancer Registries Communications Steering Committee; is a Board member of the Indiana Cancer Registrars Association, serving as the state liaison; is a member of the Indiana Cancer Consortium, serving on the Data Committee; and a member of the American Society of Radiologic Technologists.