The treatment information provided in the PUF is limited to "first course of treatment", which is defined as all methods of treatment recorded in the treatment plan and administered to the patient before disease progression or recurrence. "No therapy" is a treatment option that occurs if the patient refuses treatment, the family or guardian refuses treatment, the patient dies before treatment starts, or the physician recommends no treatment be given. Treatment plans describe the type(s) of therapies intended to modify, control, remove, or destroy proliferating cancer cells. Cancer registries are directed to review documentation confirming a treatment plan which may be found in several sources. Examples include medical or clinic records, consultation reports, and outpatient records. In addition:
- All therapies specified in the physician(s) treatment plan are a part of the first course of treatment if they are actually administered to the patient.
- A discharge plan must be part of the patient's record in a Joint Commission-approved program and may contain part, or all, of the treatment plan.
- An established protocol or accepted management guidelines for the disease can be considered a treatment plan in the absence of other written documentation.
- If there is no treatment plan, established protocol, or management guidelines, and consultation with a physician advisor is not possible, use the principle: "initial treatment must begin within four months of the date of initial diagnosis."
- The first course of treatment includes all therapy planned and administered by the physician(s) during the first diagnosis of cancer. Planned treatment may include multiple modes of therapy and may encompass intervals of a year or more. Any therapy administered after the discontinuation of first course treatment is subsequent treatment, and is not reported to the NCDB.
- The variable RX_SUMM_TREATMENT_STATUS indicates whether patients received any treatment or are under active surveillance. This variable was implemented in 2010 and is not available for prior diagnosis years.
- Starting with the 2012 PUF (first released in 2014), new treatment variables are now included, which indicate whether treatment was received at the reporting facility included in the PUF. Versions prior to the 2012 PUF only included summary treatment variables, which indicated whether treatment was received at any CoC accredited facility, including facilities not included in the PUF data (see PUF Multiple Source Explanation above). The new treatment variables include “Surgery at this Facility”, “Chemotherapy at this Facility”, and “Other Treatment at this Facility”.