HL7 Europe Common Cancer Model, published by HL7 Europe. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7-eu/cancer-common/ and changes regularly. See the Directory of published versions
Logical Models
Overview
The figure below provides an overview of the main concepts and of their relationships
Warning: This is a preliminary draft subject to revisions. CancerCondition(AtDiagnosis) Patient CancerStage Imaging LastFollowUp ClinicalCancerProgression Surgery Active Surveillance Radiotherapy SystemicTreatment OverallCancerTreatmentResponse Figure 1: Cancer Common Logical Model Overview
ActiveSurveillance CancerConditionAtDiagnosis CancerPatient CancerStage ClinicalCancerProgression Imaging LastFollowUp OverallCancerTreatmentResponse Radiotherapy Surgery SystemicTreatment Figure 2: Cancer Common Logical Model (References)
Logical Models
CancerPatient
Represents the subject affected by one or more cancer conditions, including demographics, life status/cause, last check date, and comorbidities.
Patient birthDate : dateTime [1..1] sexAtBirth : CodeableConcept [1..1] observedSexGender : CodeableConcept [0..1] comorbiditiesAtCancerDiagnosis : CodeableConcept [0..*] Figure 3: CancerPatient logical model
FHIR Logical Model: StructureDefinition-CancerPatient.html
CancerConditionAtDiagnosis
Represents the cancer condition at first diagnosis and captures histology behaviour, body site, tumour grade, asserted date, and base of assertion.
CancerConditionAtDiagnosis subject : CancerPatient [1..1] histologyBehaviour : CodeableConcept [0..1] bodySite : CodeableConcept [1..1] tumourGradingSystem : CodeableConcept [0..1] tumourGradingValue : string [0..1] visitDate : dateTime [0..1] biopsyDate : dateTime [0..1] imagingDate : dateTime [0..1] labReportDate : dateTime [0..1] Figure 4: CancerConditionAtDiagnosis logical model
FHIR Logical Model: StructureDefinition-CancerConditionAtDiagnosis.html
CancerStage
Represents the stage at first diagnosis and tumour extent at the time of the first definitive treatment; clinical (imaging) or pathological (surgery), and it does not evolve.
CancerStage classificationType : CodeableConcept [1..1] value : Element [1..*] type : CodeableConcept [1..1] cancerConditionAtDiagnosisReference : Reference(CancerConditionAtDiagnosis) [1..1] surgeryReference : Reference(Surgery) [0..1] imagingReference : Reference(Imaging) [0..*] - type: It indicates whether the stage instance is of type Clinical or Pathological. Choice: Clinical | Pathological Figure 5: CancerStage logical model
FHIR Logical Model: StructureDefinition-CancerStage.html
Imaging
Referenced in the glossary as evidence/procedure used to detect the cancer condition, define body site, support clinical stage, and assess disease evolution.
Imaging type : CodeableConcept [1..1] bodySite : CodeableConcept [1..*] Figure 6: Imaging logical model
FHIR Logical Model: StructureDefinition-Imaging.html
LastFollowUp
Corresponds to the Last Check in the glossary: the date of the visit in which life status (and cause) is detected.
LastFollowUp subject : CancerPatient [1..1] vitalStatus : CodeableConcept [1..1] evidenceOfDisease : boolean [0..1] causeOfDeath : CodeableConcept [0..1] date : dateTime [1..1] deathDate : dateTime [0..1] Figure 7: LastFollowUp logical model
FHIR Logical Model: StructureDefinition-LastFollowUp.html
ClinicalCancerProgression
Represents disease over time and space; each evaluation creates a new instance with disease status, asserted date, and base of assertion, and may include disease extent and related findings.
ClinicalCancerProgression diseaseStatus : CodeableConcept [1..1] tumourGradingSystem : CodeableConcept [0..1] tumourGradeValue : string [0..1] assertedDate : dateTime [1..1] extentType : CodeableConcept [0..1] locoRegionalSites : CodeableConcept [0..*] metastaticSites : CodeableConcept [0..*] cancerConditionReference : Reference(CancerConditionAtDiagnosis) [1..1] - diseaseStatus: Choice: Progression | Stable Disease | Partial Remission | Complete Remission | Recurrence - extentType: Choice: Local | Loco-regional | Metastatic - locoRegionalSites: It must be present if the ExtentType is Loco-regional - metastaticSites: It must be present if the ExtentType is Metastatic Figure 8: ClinicalCancerProgression logical model
FHIR Logical Model: StructureDefinition-ClinicalCancerProgression.html
Surgery
Treatment type characterized by a date and a target site.
Surgery subject : CancerPatient [1..1] intent : CodeableConcept [1..1] date : dateTime [1..1] bodySite : CodeableConcept [1..*] cancerConditionAtDiagnosisReference : Reference(CancerConditionAtDiagnosis) [1..1] clinicalCancerProgressionReference : Reference(ClinicalCancerProgression) [0..1] Figure 9: Surgery logical model
FHIR Logical Model: StructureDefinition-Surgery.html
ActiveSurveillance
Treatment type characterized by start date and end date.
ActiveSurveillance subject : CancerPatient [1..1] startDate : dateTime [1..1] endDate : dateTime [0..1] cancerConditionAtDiagnosisReference : Reference(CancerConditionAtDiagnosis) [1..1] Figure 10: ActiveSurveillance logical model
FHIR Logical Model: StructureDefinition-ActiveSurveillance.html
Radiotherapy
Treatment type characterized by start date, end date, and target site.
Radiotherapy subject : CancerPatient [1..1] intent : CodeableConcept [1..1] startDate : dateTime [1..1] endDate : dateTime [0..1] bodySite : CodeableConcept [0..*] setting : CodeableConcept [0..1] cancerConditionAtDiagnosisReference : Reference(CancerConditionAtDiagnosis) [1..1] clinicalCancerProgresionReference : Reference(ClinicalCancerProgression) [0..1] Figure 11: Radiotherapy logical model
FHIR Logical Model: StructureDefinition-Radiotherapy.html
SystemicTreatment
Corresponds to drug administration treatment, characterized by start/end date and possible ongoing indication (e.g., immunotherapy).
SystemicTreatment subject : CancerPatient [1..1] intent : CodeableConcept [1..1] type : CodeableConcept [1..1] startDate : dateTime [1..1] endDate : dateTime [0..1] setting : CodeableConcept [0..1] cancerConditionReference : Reference(CancerConditionAtDiagnosis) [1..1] clinicalCancerProgresionReference : Reference(ClinicalCancerProgression) [0..1] Figure 12: SystemicTreatment logical model
FHIR Logical Model: StructureDefinition-SystemicTreatment.html
OverallCancerTreatmentResponse
Represents how well a cancer patient responds to a treatment (e.g., progression, stable disease, partial/complete remission) based on evidence and date.
OverallCancerTreatmentResponse treatmentResponseType : CodeableConcept [1..1] date : dateTime [1..1] cancerConditionReference : Reference(CancerConditionAtDiagnosis) [1..1] clinicalCancerProgressionReference : Reference(ClinicalCancerProgression) [0..1] - clinicalCancerProgressionReference: It is not only required at the time of diagnosis; it must be provided in the event of ClinicalCancerProgression. - treatmentResponseType: Choice: Progression | Stable Disease | Partial Remission | Complete Remission Figure 13: OverallCancerTreatmentResponse logical model
FHIR Logical Model: StructureDefinition-OverallCancerTreatmentResponse.html
