Surgeons Can Help—or Hinder—Compliance with Commission on Cancer Operative Standards

Baskin AS, Kravchenko T, Funk EC, et al. Site Reviewer Perspectives on the Implementation of the Commission on Cancer Operative Standards. J Am Coll of Surg. 2025; in press.

In 2020, the Commission on Cancer (CoC) added six operative standards (5.3-5.8) to its national accreditation program to help ensure technical consistency in cancer surgery. Implementation across all 1,400 CoC-accredited institutions requires visits by site reviewers. This qualitative study interviewed these reviewers on their perspectives on key determinants of site compliance with these standards.

The authors interviewed 20 site reviewers, surpassing data saturation, using a semi-structured format based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework and thematic analysis based on the updated Consolidated Framework for Implementation Research.

Interviewees represented numerous surgical and nonsurgical specialties. They generally found compliance with standards easy to evaluate during visits, but half were uncertain about whether compliance reflected surgical quality. Nonetheless, they commonly viewed standards as the best option for evaluation and for standardizing care.

Site reviewers generally found sites willing to come into compliance, although success was acknowledged to be dependent on root causes of deficiencies. They described engagement of administrators and leaders, as well as inclusion of surgeons on cancer committees, as key facilitators of compliance. Disciplinary measures were viewed less favorably. Most notably, individual surgeons’ noncompliance was regarded as a key barrier to site-wide success. 

The authors noted the need for behavioral change among surgeons was an unsurprising barrier; they also identified opportunities for improvement via partnership between reviewers and sites.