APPENDIX C
Glossary, Abbreviations, and Acronyms

GLOSSARY OF TERMS


Adjuvant therapy:

Treatment given after the primary treatment to increase the chances of a cure. Adjuvant therapy may include chemotherapy, radiation therapy, hormone therapy, or biological therapy.

Ambulatory care:

The use of outpatient facilities—doctors’ offices, home care, outpatient hospital clinics, and day-care facilities—to provide medical care without the need for hospitalization. Often refers to any care outside a hospital.

Axillary nodes:

Lymph nodes in the armpit. In breast cancer, cancer cells usually spread to the axillary lymph nodes before the rest of the body.


Biopsy:

Refers to a procedure that involves obtaining a tissue specimen for microscopic analysis to establish a precise diagnosis.

Breast-conserving surgery:

Surgery to remove a breast cancer and a small amount of tissue around the cancer, but without removing the entire breast or surrounding tissues.


Cancer:

A general term for more than 100 diseases that are characterized by uncontrolled, abnormal growth of cells. Cancer cells can spread locally or through the bloodstream and lymphatic system to other parts of the body.

Cancer registry:

A system that monitors cancer cases that have been diagnosed or treated in one institution or a specific geographic area.

Chemotherapy:

The treatment of disease by means of chemicals that have a



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Assessing the Quality of Cancer Care: An Approach to Measurement in Georgia APPENDIX C Glossary, Abbreviations, and Acronyms GLOSSARY OF TERMS Adjuvant therapy: Treatment given after the primary treatment to increase the chances of a cure. Adjuvant therapy may include chemotherapy, radiation therapy, hormone therapy, or biological therapy. Ambulatory care: The use of outpatient facilities—doctors’ offices, home care, outpatient hospital clinics, and day-care facilities—to provide medical care without the need for hospitalization. Often refers to any care outside a hospital. Axillary nodes: Lymph nodes in the armpit. In breast cancer, cancer cells usually spread to the axillary lymph nodes before the rest of the body. Biopsy: Refers to a procedure that involves obtaining a tissue specimen for microscopic analysis to establish a precise diagnosis. Breast-conserving surgery: Surgery to remove a breast cancer and a small amount of tissue around the cancer, but without removing the entire breast or surrounding tissues. Cancer: A general term for more than 100 diseases that are characterized by uncontrolled, abnormal growth of cells. Cancer cells can spread locally or through the bloodstream and lymphatic system to other parts of the body. Cancer registry: A system that monitors cancer cases that have been diagnosed or treated in one institution or a specific geographic area. Chemotherapy: The treatment of disease by means of chemicals that have a

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Assessing the Quality of Cancer Care: An Approach to Measurement in Georgia specific toxic effect upon the disease-producing microorganisms (antibiotics) or that selectively destroy cancerous tissue (anticancer therapy). Claims data: Information on health care services provided that is generated from billing and reimbursement records. Clinical outcome: The end result of a medical intervention (e.g., survival or improved health). Clinical practice guidelines: Systematically defined statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. Clinical trial: A formal study carried out according to a prospectively defined protocol that is intended to discover or verify the safety and effectiveness of procedures or interventions in humans. The term may refer to a controlled or uncontrolled trial. Cohort study: An observational study in which outcomes in a group of patients that received an intervention are compared with outcomes in a similar group, that is, the cohort, either contemporary or historical, of patients that did not receive the intervention. In an adjusted- (or matched-) cohort study, investigators identify (or make statistical adjustments to provide) a cohort group that has characteristics (e.g., age, gender, disease severity) that are as similar as possible to the group that experienced the intervention. Colonoscopy: An endoscopic (fiber optic) investigation of the large intestine (colon). Comorbidity: A disease occurring in an individual in addition to the index disease being treated or studied. Diagnosis: Definitive confirmation of a specific disease, usually by imaging procedures and from the use of laboratory findings. Double-contrast barium enema: Procedure in which x-rays of the colon and rectum are taken after a liquid containing barium is put into the rectum. Barium is a silver-white metallic compound that outlines the colon and rectum on an x-ray and helps show abnormalities. Air is put into the rectum and colon to further enhance the x-ray. Ductal carcinoma in situ (DCIS): A very early form of breast cancer confined to cells lining the breast ducts, as opposed to the glandular tissue of the breast. Early detection: Identifying disease at an early stage, before it has grown large or spread to other sites. Epidemiology: Science concerned with defining and explaining the interrelationships of factors that determine disease frequency and distribution. External beam radiation therapy (EBRT): Radiation therapy that uses a machine to aim high-energy rays at the cancer.

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Assessing the Quality of Cancer Care: An Approach to Measurement in Georgia Fecal occult blood test (FOBT): A test to check for blood in the stool. Flexible sigmoidoscopy: Inspection of the lower colon using a thin, lighted tube called a sigmoidoscope. Functional status: A measure of an individual’s ability to perform normal activities of life. Encompasses a wide variety of patient-focused outcomes including physical functioning (e.g., walking and climbing stairs), emotional well-being (e.g., anxiety, fear of recurrence), and social functioning (e.g., isolation, ability to work). Gleason score: Grade of tumor of the prostate; based on glandular differentiation Histology: The study of the microscopic structure of tissue. Hormonal therapy: Treatment that adds, blocks, or removes hormones. To slow or stop the growth of certain cancers (such as prostate and breast cancer), synthetic hormones or other drugs may be given to block the body’s natural hormones. Sometimes surgery is needed to remove the gland that makes hormones. Also called hormone therapy, hormone treatment, or endocrine therapy. Hormone receptor: Protein on the surface of a cell that binds to a specific hormone. Hospice: A discrete site of care in the form of an inpatient hospital or nursing home unit or a free-standing facility; an organization or program that provides, arranges, and advises on a wide range of medical and supportive services for dying patients and their families and friends; an approach to care for dying patients based on clinical, social, and metaphysical or spiritual principles. Incidence: The number of new cases of a disease that occur in the population per unit of time. Lead-time bias: Overestimation of survival time because of the backward shift in the starting point for the measurement of survival as a result of early detection. Length bias: The tendency of screening to detect slowly growing cancers more readily than aggressive cancers. Mammogram: X-ray image of the breast produced for screening or diagnostic purposes in detecting or diagnosing cancer. Margin: Border between a tumor and regular tissue. Mastectomy: Excision of all or part of the breast.

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Assessing the Quality of Cancer Care: An Approach to Measurement in Georgia Medicare: A program that provides health insurance to people aged 65 and over, those who have permanent kidney failure, and people with certain disabilities. Metastasis: Spread of cancer from its original site to one or more additional body sites. Morbidity: A diseased condition or state, the incidence of a disease or of all diseases in a population. Mortality rate: Expresses the number of deaths in a unit of population within a prescribed time and may be expressed as crude death rates or as death rates specific for diseases and, sometimes, for age, sex, and other attributes. Needle biopsy: Procedure in which a hollow needle is used to remove small cylinders of tissue from a suspected cancer. Neoadjuvant therapy: Use of anticancer drugs before initial surgery or radiation treatment Oversampling: A sampling procedure designed to give a demographic or geographic population a larger proportion of representation in the sample than the population’s proportion of representation in the overall population. Palliative care: Treatment of symptoms associated with the effects of cancer and its treatment. Pathology report: Description of cells and tissues made by a pathologist based on microscopic evidence, and often used to make a diagnosis of a disease or determine prognosis. Pharmacotherapy: Treatment or therapy using drugs. Prevalence: The number of cases of disease, infected persons, or persons with some other attribute, present at a particular time and in relation to the size of the population from which drawn. Primary cancer prevention: Prevention of the development of cancer. Prostate-specific antigen (PSA) test: A blood test that measures the level of SA, a substance produced by the prostate and some other tissues in the body. Increased levels of PSA may be a sign of prostate cancer. Quality measure: Quantitative indicators that reflect the degree to which care is consistent with the best available, evidence-based clinical standards. Quality of care: The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.

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Assessing the Quality of Cancer Care: An Approach to Measurement in Georgia Radical prostatectomy: The removal of the prostate and the surrounding tissue as a treatment for prostate cancer. Randomized controlled trial: A true prospective experiment in which investigators randomly assign an eligible sample of patients to one or more treatment groups and a control group and follow patients’ outcomes (also know as randomized clinical trial). Recall bias: Bias created in survey data due to individuals’ inaccurate or incomplete memory of an event. Relative survival rate: A specific measurement of survival. For cancer, the rate is calculated by adjusting the survival rate to remove all causes of death except cancer. The rate is determined at specific time intervals, such as 2 years and 5 years after diagnosis. See also survival rate. Response bias: Bias created in survey data when individuals do not respond truthfully (e.g., underestimate risky lifestyle behaviors such as smoking, or overestimate healthy behaviors such as exercise). Sampling frame: List or other organized record of a population from which a survey sample is drawn. Screening: Systematic testing of an asymptomatic population to determine the presence of a particular disease. Staging: The determination of the anatomic extent of a cancer. Clinical stage is based on physical examination and tests done before surgery. Pathological stage is based on examination of surgical specimens. Survival rate: The percentage of people in a study or treatment group who are alive for a given period of time after diagnosis. This is commonly expressed as 5-year survival. See also relative survival. Tumor, node, metastasis (TNM): Standard nomenclature for the staging of tumors according to three basic components: the size of the primary tumor (T), involvement of regional lymph nodes (N), and metastasis (M). Numbers are used to denote size and degree of involvement; for example, 0 indicates undetectable and 1, 2, 3, and 4, a progressive increase in size or involvement. Vital records: Legal records of events, such as birth, death, or marriage documents.

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Assessing the Quality of Cancer Care: An Approach to Measurement in Georgia ACRONYMS AND ABBREVIATIONS ACoS American College of Surgeons ACR American College of Radiology ACS American Cancer Society AHRQ Agency for Healthcare Research and Quality AJCC American Joint Committee on Cancer APS American Pain Society ASCO American Society of Clinical Oncology BCS Breast-conserving surgery BCSC Breast Cancer Surveillance Consortium BI-RADS Breast Imaging and Reporting Data System BMI body mass index BRFSS Behavioral Risk Factor Surveillance System CAHPS Consumer Assessment of Health Plans CAP College of American Pathologists CaPSURE Cancer of the Prostate Strategic Urologic Research Endeavor CDC Centers for Disease Control and Prevention CMS Centers for Medicare and Medicaid Services CoC Commission on Cancer DCIS ductal carcinoma in situ DHHS Department of Health and Human Services EBRT external beam radiation therapy ER estrogen receptor FACT Functional Assessment of Cancer Therapy FOBT fecal occult blood test GA-CORE Georgia Center for Oncology Research and Education GCC Georgia Cancer Coalition GCCR Georgia Comprehensive Cancer Registry Gy gray (unit of absorbed radiation) HEDIS Health Plan Employer Data and Information Set HP 2010 Healthy People 2010 ICSI Institute for Clinical Systems Improvement IOM Institute of Medicine

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Assessing the Quality of Cancer Care: An Approach to Measurement in Georgia JCAHO Joint Commission on Accreditation of Healthcare Organizations NAACCR North American Association of Central Cancer Registries NAS National Academy of Sciences NCCN National Comprehensive Cancer Network NCI National Cancer Institute NCPB National Cancer Policy Board NCQA National Committee for Quality Assurance NHQR National Healthcare Quality Report NIH National Institutes of Health NQF National Quality Forum NVSS National Vital Statistics System OMB Office of Management and Budget ONS Oncology Nursing Society PR progesterone receptor PSA prostate-specific antigen test SEER Surveillance, Epidemiology, and End Results TNM Tumor, Node, Metastasis USPSTF U.S. Preventive Services Task Force WHO World Health Organization YRBSS Youth Risk Behavior Surveillance System