Scenario: 08-27-2021 patient diagnosed with metastatic pancreatic carcinoma on CT scan. 08-27-2021 Med Onc Consult: Explained our concerns for pursuing aggressive measures for his cancer given his co-morbidities and frailty. Patient decided to make himself DNR with goals to transition to comfort focused care once discharged from the hospital. Family is interested in hospice options. Palliative Care has been consulted. 08-29-2021 patient admitted to hospice
Question: How would the Date of First Course Treatment be assigned?
Rationale: STORE: In cases of non-treatment (RX Summ–Treatment Status  = 0), in which a physician decides not to treat a patient, a patient’s family or guardian declines all treatment, or patient receives palliative care for pain management only, the date of first course of treatment is the date this decision was made.
*Make sure to note the date the decision not to treat was made in your text. This date will have to be manually entered into the registry software.
More Notes: Palliative care would also be coded to 7 in this scenario.
STORE- Palliative Care (Palliative Procedure) Identifies any care provided in an effort to palliate or alleviate symptoms. Palliative care is performed to relieve symptoms and may include surgery, radiation therapy, systemic therapy (chemotherapy, hormone therapy, or other systemic drugs), and/or other pain management therapy.
CAnswer Forum Posts -Patient was presented with treatment options for the cancer, and the patient selected hospice http://cancerbulletin.facs.org/forums/forum/fords-national-cancer-data-base/store/first-course-of-treatment-aa/palliative-aa/95610-hospice
NAACCR Webinar Coding Pitfalls 09-2019 Slide 25 (available on himagine Cancer Registry SharePoint site)