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
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] sexAtDiagnosis : CodeableConcept [0..1] comorbiditiesAtCancerDiagnosis : CodeableConcept [0..*] Figure 2: 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] tumourGradeSystem : CodeableConcept [0..1] tumourGradeValue : string [0..1] visitDate : dateTime [0..1] biopsyDate : dateTime [0..1] imagingDate : dateTime [0..1] labReportDate : dateTime [0..1] Figure 3: 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..*] - Indicates whether the stage instance is of type Clinical or Pathological. - Choice: Clinical | Pathological Figure 4: 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 5: 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 6: 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] tumourGradeSystem : CodeableConcept [0..1] tumourGradeValue : string [0..1] assertedDate : dateTime [1..1] extentType : CodeableConcept [0..1] locoRegionalSites : CodeableConcept [0..*] metastaticSites : CodeableConcept [0..*] cancerConditionAtDiagnosisReference : 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 7: 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 8: 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 9: 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 [1..*] setting : CodeableConcept [0..1] cancerConditionAtDiagnosisReference : Reference(CancerConditionAtDiagnosis) [1..1] clinicalCancerProgresionReference : Reference(ClinicalCancerProgression) [0..1] Figure 10: 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] ongoing : boolean [0..1] setting : CodeableConcept [0..1] cancerConditionAtDiagnosisReference : Reference(CancerConditionAtDiagnosis) [1..1] clinicalCancerProgresionReference : Reference(ClinicalCancerProgression) [0..1] Figure 11: 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] cancerConditionAtDiagnosisReference : 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 12: OverallCancerTreatmentResponse logical model
FHIR Logical Model: StructureDefinition-OverallCancerTreatmentResponse.html
Models' relationship
