Evolving Practice Standards for Cancer Programs from the Commission on Cancer

May 2012, Vol 3, No 3

What is the most important challenge faced by a person who is diagnosed with cancer today? Opinions will differ, but most patients want to be assured that they will work with a group of multispecialty physicians who will provide recommendations for care that provide the best possible outcomes, that all options for effective treatment will be available to them, that care will be provided in a safe and comfortable hospital or other facility, and that the healthcare staff will care about their problems and concerns with managing treatment, professional issues, and family issues.

How did we come to expect this level of care, and what can patients expect in the future?

The Commission on Cancer (CoC) of the American College of Surgeons is dedicated to improving survival and quality of life for patients with cancer through setting of standards, prevention, research, education, and the monitoring of comprehensive quality care. Beginning with the first standards for cancer clinics created in 1930, the CoC has taken the lead to ensure that patients will receive high-quality cancer care in US hospitals and freestanding, nonhospital facilities.

The goal of the CoC is to ensure that every patient with cancer can access the full scope of diagnostic and treatment services needed to manage their cancer in a setting that is close to their home. Today, more than 1500 facilities across the country are members of the CoC Accreditation Program, which provides external evaluation and recognition of performance to each participating facility.

The Commission’s Focus

The first iterations of the CoC standards focused on surgical care, the only treatment option available to patients with cancer at that time. Over time, the CoC standards have been revised to include radiation and medical oncology treatments, as well as quality improvement activities, among others. The 4 cornerstone requirements for the committee are:

  1. To address the cancer committee’s leadership of the program
  2. To hold cancer conferences for multidisciplinary discussion of treatment options
  3. To have a cancer registry that provides diagnostic and treatment information on each patient
  4. To include patient care and quality evaluations that evaluate and improve performance.

The Evolving Standards

The updated standards for cancer programs released in 2004, which were revised in 2005 and again in 2009, took the first major step forward to require true improvements in patient care. The standards required that cancer committees in CoC-accredited programs must ensure that the stage of disease; sitespecific prognostic factors, such as histology and tumor-specific markers; and nationally accepted treatment guidelines are used to plan the treatment for patients with cancer. The treatment guidelines developed by recognized and authoritative national organizations, such as the National Comprehensive Cancer Network and the American Society of Clinical Oncology, were designed to achieve the best possible treatment outcome for patients. Pathologists were expected to follow the cancer protocols developed by the College of American Pathologists. These protocols required that specific information needed for treatment decisions were to be included in the pathology reports.

The commission created tools to facilitate an evaluation of the CoCaccredited programs’ performance based on the accountability measures that are endorsed by the National Quality Forum. For the first time in the commission’s history, the performance at each CoCaccredited program was compared with care practices that have proved effective through clinical research. The commission also introduced a set of standardized quality improvement measures that evaluate each program’s performance based on care accepted as good clinical practice.

Although all of these changes are important steps forward in promoting high-quality care for cancer programs, physicians, and patients, the CoC standards did not address patient needs outside of direct intervention to cure or control the cancer.

In 1999, a joint publication of the National Cancer Policy Board, National Institute on Medicine and Commission on Life Sciences, and the National Research Council (Ensuring Quality Cancer Care. Washington, DC: National Academy Press; 1999) described the state of cancer care in the United States. The findings can be summed up as “for many Americans with cancer, there is a wide gulf between what could be construed as the ideal and the reality of their experience with cancer care.” The publication cited issues regarding:

  • Poor access to care
  • Excessive use of tests, examinations, and treatments
  • Limited use of some of the same tests, examinations, and treatments
  • Nonstandard treatment decisions
  • Measuring and assessing the qual - ity of care
  • Ensuring that patients are in - formed about all aspects of and options for their treatment
  • Providing services that support patients and their needs beyond direct cancer intervention
  • Ensuring care for patients who are approaching the end of life.

The New Standards Although the 2004 edition of the CoC’s Cancer Program Standards already addressed some of these issues, gaps still existed in many areas. Therefore, the commission undertook to revise and rebuild the standards to address the patient-centered issues identified in the 1999 joint report mentioned above.

The outcomes of this 2-year project are the new standards that address many of the patient-centered issues identified in that report. The Cancer Program Standards 2012: Ensuring Patient-Centered Care includes standards that address:

  1. A patient navigation process to identify and address barriers to care
  2. Genetic assessment and counseling for patients who are at risk of family or hereditary syndromes, thus guiding informed decision-making
  3. Expected performance rates that will be met for each of the 6 performance measures
  4. A treatment summary and survivor plan for each patient who is completing initial treatment
  5. Psychosocial distress screening and intervention
  6. A palliative care team to ensure that patients have access to pain management, hospice care, and other services during and after treatment.

As cancer programs implement the new standards, they are looking to the CoC for guidance, assistance, and best practice examples that can assist their work. The CoC standards are designed to allow for significant latitude and customization so that activities meet the needs of the CoC-accredited facilities and the patients and communities that they serve.

Best Practices

The CoC is working with its member organization partners to provide examples of policies, procedures, and tools, as well as successful strategies developed by CoC-accredited programs that have already implemented the standards to enable programs to learn from their peers. The CoC encourages programs to submit their best practice examples and tools to the best practice repository so that all programs can benefit from the successful experiences of others.

Conclusion

The CoC is a longstanding leader in the effort to improve the care of patients with cancer. Its historical work created the first standards for cancer diagnosis and treatment. The standards have evolved over time to address advances in care and bring a new focus on addressing patient needs. The new standards put the CoC in a unique position to establish quantitative and qualitative benchmarks that can be used to measure performance and ensure that highquality care is provided to every patient with cancer.

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