12.3 Vital Status, Date of Last Contact, Cancer Status & Death Clearance
Key Takeaways
Date of Last Contact or Death [1750] is the last date the patient was known to be alive, or the date of death; it cannot be blank, and it is the same on every primary for the patient.
Vital Status [1760] is 0 = dead or 1 = alive, as of the Date of Last Contact or Death; failure to find a patient on a death list does not prove the patient is alive, so neither item changes.
Cancer Status [1770] is tumor-level: 1 = no evidence of this tumor, 2 = evidence of this tumor, 9 = unknown; it is updated only from a physician or official source such as a death certificate, never from the patient or family.
Date of Last Cancer (Tumor) Status [1772], required for 2018+ diagnoses, records when Cancer Status was last updated and can differ between a patient's primaries.
Death clearance links death certificates to the central registry, follows back unmatched cancer deaths to certifiers and facilities, and registers the rest as death certificate only (DCO) cases; NAACCR Gold certification allows at most 3% DCO.
Patient-level versus tumor-level items
| Item | Level | Codes | Who can update it |
|---|---|---|---|
| Date of Last Contact or Death [1750] | Patient: same for all primaries | CCYYMMDD; blanks not allowed | Any reliable source, including the patient or family |
| Vital Status [1760] | Patient: same for all primaries | 0 = dead, 1 = alive | Any reliable source |
| Cancer Status [1770] | Tumor: can differ by primary | 1 = no evidence of this tumor, 2 = evidence of this tumor, 9 = unknown or indeterminate | Only the patient's physician or an official source, such as a death certificate |
| Date of Last Cancer (Tumor) Status [1772] | Tumor | CCYYMMDD, blank allowed; required for 2018+ | Updated when Cancer Status is updated |
STORE rules for Date of Last Contact and Vital Status
- Record the last date the patient was known to be alive, or the date of death.
- "Failure to find a patient on a list of deceased individuals does not constitute evidence that the patient is alive." In that case, neither Vital Status nor Date of Last Contact changes. Unless more information is found, follow-up of that patient has failed.
- If a patient has multiple primaries, all records carry the same Date of Last Contact and the same Vital Status.
- STORE examples: death confirmed by death clearance information from the state central registry, so Vital Status 0. A follow-up letter to the physician shows the patient is alive, so Vital Status 1.
STORE rules for Cancer Status
- It records whether there is clinical evidence of this tumor as of the Date of Last Cancer Status.
- Change it only on new information from the patient's physician or another official source. Information from the patient, a family member or other non-physician does not update Cancer Status.
- Cancer Status changes if the patient has a recurrence or relapse.
- A patient with a hematopoietic disease in remission is coded 1 (no evidence).
- STORE example: a physician saw the patient on February 2 with no evidence of tumor. The registry later reaches the patient by phone in August of the next year. The Date of Last Contact is updated, but Cancer Status and its date are not.
- STORE example: prostate cancer with bone metastasis diagnosed in April, and the patient's death found in an obituary in June. Cancer Status stays 2 (evidence of tumor), because the last physician information showed disease.
Death information sources
| Source | What it gives | Notes |
|---|---|---|
| Facility records | Deaths during admission, autopsy reports | Autopsy discovery of an unsuspected cancer is Class of Case 38 |
| State vital records and the central registry | Death certificates with cause of death | Central registries return death information to hospitals for follow-up |
| National Death Index (NDI) | NCHS national file of death records, used for research and registry linkage | Matches deaths that occurred in other states; requires an approved application |
| Social Security death data | Date of death | The public Death Master File has excluded state-reported deaths since November 2011, so it is incomplete |
| Obituaries and online indexes | Date and place of death | CoC lists these under "internet sources" |
The underlying cause of death on the death certificate is coded in ICD-10 by NCHS and state vital statistics. SEER programs record it in Cause of Death [1910], together with ICD Revision Number [1920], for cause-specific survival.
Death clearance at the central registry
Death clearance finds cancers that were never reported during life and confirms deaths of registered patients. The steps are:
- Link the state's death certificate file, and NDI results for residents who died out of state, to the registry database, using name, date of birth, SSN and other identifiers.
- Matched deaths: update Vital Status and Date of Death for the registered patients.
- Unmatched deaths that mention a reportable cancer anywhere on the certificate are possible missed cases.
- Follow back to the certifying physician, hospital, hospice or nursing home listed, and ask for a report of the cancer. Many are found to be real cases missed by casefinding, and the follow-back often exposes a casefinding gap at a facility.
- Cases that stay unconfirmed after follow-back are registered as death certificate only (DCO), with Date of Diagnosis = date of death and Diagnostic Confirmation = 9, or Class of Case 49 in hospital terms.
Why DCO is a quality indicator
A high DCO percentage suggests incomplete casefinding among living patients. NAACCR certification criteria limit DCO cases to 3% or less for Gold and 5% or less for Silver, and NPCR's 24-month data standard also uses 3%. The death certificate is also a poor source for site, histology and stage, so DCO cases lower the quality of the whole data set.
Putting it together: a follow-up update
A registrar finds that a patient with two primaries (breast 2019, colon 2023) died on June 3, 2026, from a state registry death clearance report listing "metastatic breast cancer" as the cause.
- Date of Last Contact or Death = 20260603 on both records.
- Vital Status = 0 on both records.
- Cancer Status for breast = 2, updated from the death certificate, which is an official source. The colon record keeps its last physician-based status unless the certificate or a physician shows colon disease.
- Follow-Up Source = 7, death certificate (or 8 if the information came from another registry without the certificate).
- Follow-up stops once the death and all care before it are recorded.
A registry calls a patient who says, "I feel great and my cancer is gone." The last physician note, 20 months ago, documented residual disease. What should the registrar update?
Date of Last Contact, Vital Status and Cancer Status (to 1)
Date of Last Contact and Vital Status only; Cancer Status is not updated from the patient
Nothing, because only physicians can supply follow-up information
Cancer Status only, because the patient reported no disease
A registrar searches an online death index for a patient last seen three years ago and does not find the patient. What should happen to Vital Status and Date of Last Contact?
Change Vital Status to 1 and set Date of Last Contact to the search date
Change Vital Status to 0 because the patient is probably deceased
Leave both unchanged; failure to find a patient on a death list is not evidence that the patient is alive
Change Date of Last Contact to the search date but leave Vital Status unchanged
In central registry death clearance, what happens to a cancer death that is not matched to a registry record and for which follow-back produces no medical record?
It is deleted from the data set.
It is coded as a recurrence of the patient's last known cancer.
It is registered as a death certificate only case, which counts against the registry's DCO percentage.
It is reported to the NCDB as Class of Case 38.
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