HL7 FHIR Implementation Guide: minimal Common Oncology Data Elements (mCODE), v0.9.0

- Local Development build (v0.9.0). See the Directory of published versions

Treatment

The Treatment domain includes procedures and medications administered in the treatment of a cancer patient.

Procedures

Procedures are further categorized as:

  • Surgical therapies which involve the removal of cancer tumors from the body.
  • Radiation therapies which use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to all cancer cells and shrink tumors (source: NCI).
  • Imaging procedures which are used for diagnostic purposes as well as image-guided surgical procedures (source: NCI).
  • Medication therapies are treatments with any substance, other than food, that is used to prevent, diagnose, treat, or relieve symptoms of a disease or abnormal condition (source: NCI).
mCODE does not currently constrain surgical, radiation, and imaging procedures to cancer-specific therapies. Extensible value sets for each are being considered for a future release, pending further requirements from clinical subject matter experts.

 

Medication Therapies

Medication therapies in mCODE are further categorized as:

  • Chemotherapy agents which stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.
  • Targeted therapy agents identify and attack specific types of cancer cells with less harm to normal cells. Some agents block the action of certain enzymes, proteins, or other molecules involved in the growth and spread of cancer cells. Others help the immune system kill cancer cells or deliver toxic substances directly to cancer cells and kill them (source: NCI).
  • Hormone therapy agents which add, block, or remove hormones as a means of slowing or stopping the growth of certain cancers.

Chemotherapy and hormone therapy agents are not specified as constraints within the profile. Rather, we provide a means of deriving the list of relevant drug integredients pertaining to the therapeutic drug class (as Rxnorm RXCUIs) on-demand using RXCLASS.

  • for all antineoplastic agents, including chemotherapy and targeted therapy agents: https://rxnav.nlm.nih.gov/REST/rxclass/classTree.json?classId=L01
  • for all endocrine/hormone therapy agents: https://rxnav.nlm.nih.gov/REST/rxclass/classTree.json?classId=L02

Clinical Trial Drugs

The mCODE model gives preference to representing medications using the National Library of Medicine (NLM) RxNorm terminology - a coding standard established by the Office of the National Coordinator (ONC) for the exchange of drugs. RxNorm however is restricted to FDA-approved drugs and does not include clinical trial drugs.

To address this limitation, mCODE allows for the inclusion of other coding systems like the NCI Thesaurus (NCIT) to represent clinical trial oncology drugs.

 


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