Update on the Commission on Cancer Program Standards Revisions

by Luana Lamkin, RN, MPH, ACCC Immediate Past President

Look what’s coming: final development of the American College of Surgeons Commission on Cancer Program Standards by the Cancer Program Standards Leadership Team and a working draft to be published in early 2011.

As your ACCC representative to this accrediting body, I’d like to update you on the progress of the new standards development.

The standards published in the working draft will guide the on-site testing and evaluation of the newly developed standards during the surveys performed at 50 programs during the first six months of 2011. The Leadership Team anticipates that the last changes to the standards can be completed in early 2011 with release of the final version of the new manual targeted for July 1, 2011. All CoC-accredited programs and those programs seeking accreditation will implement the new standards beginning January 1, 2012.

Want to take a look? Check out the Wiki page updated as of November 9, 2010, to reflect the Leadership Team’s work.

Highlights of the eligibility standards include:

• Standard 2.2 now requires that a Genetic Counselor be a member of the Cancer Committee.
• The Attendance at Cancer Committee standard (2.4) now requires that 75 percent of appointed members (physicians and staff) attend each meeting. One can be present or attend by conference call or may be represented by the same specialty.
• The accrual to clinical trials requirement has been strengthened, and is to be implemented entirely by 2015. It now gives required percentages and recommended percentages of analytic patients being entered onto protocols. For instance, NCI programs are required to enter 15 percent; 20 percent is recommended. Community Comprehensive programs must enter 4 percent, and 6 percent is recommended. Community programs must enter 2 percent with 4 percent recommended. The definition of “entered” now includes being referred to another center where the patient is eventually entered into a trial. This is all in standard 5.2.
• To be eligible for a site visit the program must show that all abstracting of cases is performed by a Certified Tumor Registrar. The standard allows 3 years for current registrars to complete their education. This standard has been hotly debated on the floor of the Commission meetings. Many still believe this may not be feasible given the current shortage of Certified Registrars.

Highlights of the clinical standards include:

• Cancer conference must now review at least 15 percent of new patients and 80 percent of those must be a discussion prior to the first course of treatment. Standard 2.8.
• Standard 4.6 calls for 95 percent of all pathology reports to contain all required data elements according to CAP Protocol.
• Standard 4.4 calls for the Cancer Committee to review the education and competency of all RNs annually. The standard on nursing leadership appears to have disappeared, even in light of ONS and ACCC representative’s objections.
• New standards require that risk assessment, genetic counseling, genetic testing and palliative care be available to patients either at the site or by referral. Earlier versions did not allow for referrals.

Highlights of continuity of care include:
There are two new standards in this area requiring that services be available on site or by referral. The services are patient navigation and psychosocial distress management. Additionally survivorship care plans must be provided to all patients completing treatment within 12 months of the standards going into effect. This, too, has been debated by the Commission.

Highlights of outcomes include:
Each program must offer at least one prevention and one screening program annually. These programs must be planned as the result of an identified need in the community.

Two new standards emphasize the role of the Quality of Care Coordinator role and their reporting the Cancer Committee. In one standard there must be quarterly reports by the coordinator monitoring measures defined by the Commission on Cancer. A second standard requires an annual review by the Cancer Committee of the Quality of Patient Care Measures, again as defined by the Commission. It is clearly stated that this standard is intended to give the Commission flexibility to introduce and rotate new measures. The annual plan must show a study indicating need for change, the change implemented and the outcome of the intervention.

Finally, the commission is offering educational sessions. Registration has just opened for Survey Savvy in 2011. The next Survey Savvy Workshop will focus on the new standards for accreditation to be implemented in 2012. It will be held at The Fairmont Hotel in Chicago, Illinois, from Thursday, March 3, 2011, to Friday, March 4, 2011. Click here for more information.

I encourage ACCC members to go to the Wiki page mentioned above to look at specific standards and see how each program might be impacted. If you have questions or concerns, comment on this blog or contact me via email at keonelu@aol.com.