First Course Treatment

First Course of Treatment encompasses all types of treatment documented in the treatment plan and given to the patient prior to progression of disease or recurrence of disease.

• Active surveillance – Active surveillance or watchful waiting can be first course of treatment for some types of cancer. For example, early stage prostate cancer is recorded as no therapy in “RX Summ – Treatment Status” field in the abstract.
• Chemotherapy as primary treatment, neoadjuvant treatment, adjuvant treatment, or in combination with other modalities.
• Concurrent – Concurrent treatment means treatments given during the same timeframe. Often both radiation and chemotherapy are given for rectal cancers prior to surgical intervention. Advanced stage laryngeal cancers in an effort to preserve voice are often treated with radiation and concurrent chemotherapy.
• Deferred treatment – Deferred treatment is treatment that is delayed in patients without symptoms until some later point. For example, in patients with chronic lymphocytic leukemia (CLL), they will be monitored, and treatment may be deferred until the patient becomes symptomatic.
• Hormone treatment alone or in combination with other modalities.
• Immunotherapy/biologic treatment.
• Induction therapy/remission induction – Induction/ Remission induction is the initial or first treatment given for a particular disease. This is first line therapy, or the anticancer drug treatment given to reduce the signs and symptoms of cancer. For a patient being treated with acute myeloid leukemia this would be the first phase of chemotherapy which is designed to get the disease under control quickly. The goal of induction is to put the disease into remission.
• Maintenance treatment/post-remission induction/consolidation treatment – this is the treatment that is received after the induction therapy. In the instance of a patient being treated with acute myeloid leukemia this would be the second phase of chemotherapy. Once the patient is in remission, consolidation treatment is designed to keep the patient from relapsing and to eliminate any remaining tumor cells.
• Palliative – The focus of palliative care is to improve the quality of life for persons with illnesses that threaten life. Radiation therapy as primary treatment, or in combination with other modalities, including systemic therapy and surgery.
• Surgery as primary treatment or in combination with other treatment modalities.

All first course treatments are documented in the registry abstract in the specific data field as well as in the appropriate text fields. Use SEER Rx if it is unclear about the category a specific drug or treatment should be coded.

Treatment documented in the registry abstract includes active surveillance and palliative care. If a treatment modality is provided as both treatment and palliation, in addition to documenting in the appropriate treatment field, the treatment should also be documented in the palliative care field in the abstract.

Summary First Course of Treatment

First course of treatment can include many options including

• Active surveillance
• Chemotherapy
• Concurrent treatment
• Deferred treatment
• Hormone Therapy
• Immunotherapy
• Induction therapy/remission induction
• Maintenance treatment/post-remission induction/consolidation treatment
• Palliative Care
• Radiation Therapy
• Surgery

Any of the first course treatments can be done in combination with other first course treatment modalities. All treatments listed as part of the initial treatment plan is first course treatment. All first course treatment is documented in the cancer registry abstract in the respective treatment fields and the text fields.

Updated: December 21, 2023