American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

June 2014 CoC Source

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CoC News

Special Study to Target Cancer Surveillance

Improving the current approach to surveillance after active treatment for cancer has been identified as a priority area by a number of organizations, including the Institute of Medicine, Patient-Centered Outcomes Research Institute, and DEcIDE Cancer Consortium. The current guidelines do not account for individual risk and are based on limited evidence. To help address this quality gap, a special study will be launched in the coming months to investigate follow-up and recurrence after cancer treatment with the intent of tailoring follow-up based on individual risk. This study will involve analyzing data from the National Cancer Data Base (NCDB) to determine surveillance patterns for colorectal, breast, and lung cancers. It will be funded by three grants from the Patient-Centered Outcomes Research Institute.

The goal of this study is to better understand how patients are currently being followed with surveillance testing and whether or not this is influencing outcomes. In addition, these studies will look at the accuracy of recurrence data within the NCDB and begin to develop strategies and create opportunities to improve the collection of this important outcome measure. Many tumor registrars are directly involved with helping to achieve these goals and we are looking forward to your participation.

The Commission on Cancer (CoC) has deemed this Special Study a priority area and an important initiative for improving patient-centered care. During this period, staff members with the Alliance/American College of Surgeons Clinical Research Program will be available as a resource for registrars and cancer liaison physicians (CLPs). Please watch your e-mail over the next month for an official announcement.

Advocacy Update

CoC Issues Statement at U.S. Senate Special Committee on Aging Hearing

In response to the May 7, the U.S. Senate Special Committee on Aging held a hearing, The Fight Against Cancer: Challenges, Progress, & Promise, the American College of Surgeons (ACS) Commission on Cancer (CoC) issued a statement. Click here to read the full statement.

Advocacy Committee Joins Statement on Indoor Tanning

The CoC Advocacy Committee and Executive Committee recently agreed to sign onto this position statement on indoor tanning. The CoC joins several other major professional organizations in this position, which follows:

Joint Position Statement on Indoor Tanning
Indoor tanning (use of tanning devices) has become increasingly popular, especially with teenage girls and young women. By age 17, more than 35 percent of white females use tanning beds and do so on average more than 25 times per year; almost one-quarter of white women aged 18-35 have used a tanning bed in the past year and 15 percent tan indoors frequently. There is clear and compelling scientific evidence that use of tanning devices is associated with an increased incidence of skin cancer including melanoma, basal cell cancer and squamous cell cancer. The World Health Organization’s International Agency for Research on Cancer has classified UV radiation from tanning devices as carcinogenic to humans, in the same category as asbestos, tobacco, and plutonium. Adolescents and young adults are at increased risk of developing melanoma and other forms of skin cancer by using tanning beds. In view of these significant risks, seven U.S. states have passed legislation banning indoor tanning for minors under 18 years of age, and several states have passed other restrictive legislation. Moreover, some countries (for example, Australia and Brazil) have passed legislation that bans indoor tanning altogether.

Given the rising incidence of melanoma and non-melanoma skin cancer in the U.S., as well as the increasing use of tanning devices for cosmetic purposes, we strongly support:

  1. State and federal legislation to ban the use of indoor tanning by minors under 18,
  2. Educational efforts that effectively communicate the risks of indoor tanning to teens and their parents, and
  3. Counter-advertising to de-normalize the perceived ‘beauty’ of tanned skin.

Advocacy Committee Comments on 5 of NPNC's Policy Recommendations

The CoC’s Advocacy Committee formed a subcommittee that convened to write comments to the National Patient Navigation Consortium’s policy recommendations. Comments submitted:

Recommendation #1: Establish a recognized job code for Patient Navigators.

The CoC developed an accreditation Standard 3.1: Patient Navigation Process defining a process driven by a community needs assessment and established to address health care disparities and barriers to care for patients. The standard is for programs to provide resources to address identified barriers and to work to eliminate resource gaps. The standard does not specify a service provider nor does it specify the level of complexity of the care that individual would provide. The CoC supports programs making decisions, based on their assessment, about the scope of practice needed to address identified barriers and if that practice is to be provided by an individual designated as a Patient Navigator. Because programs have identified a need for nurses, social workers, and other licensed professionals to be designated as Navigators, we would support the recommendation to establish a recognized job code for Patient Navigator as long as that code was specific to an unlicensed provider and/or would recognize that the training and licensing of a nurse, social worker, or other licensed professional can also be an appropriate provider of navigation services.

Recommendation #2: Create national standards for training and certification of Patient Navigation.

The CoC would support the creation of national standards for training of unlicensed Patient Navigators. National training standards should only be mandated for those providing navigation services who are not licensed professionals. We think that it is premature to support the establishment of a certification process.

Recommendation #3: Demonstrate that Patient Navigation contributes to the development of improved quality measures.

The mission of the CoC is to support quality improvement processes that lead to improved cancer care and patient outcomes. We therefore support research and development/monitoring of quality outcomes but are unsure of the meaning of this recommendation. Specifically, this recommendation and recommendation #4 must be linked and will evolve as programs implement navigation processes and monitor those processes through their quality improvement programs.

Recommendation #4: Support research in Patient Navigation.

See Recommendation #3

Recommendation #5: Explore reimbursement models for Patient Navigation.

The CoC supports the recommendation to explore reimbursement models for Patient Navigation as long as they are appropriate to the provider and the scope of work delivered.

Accreditation Corner

Deficiency Resolution Requirements

The Deficiency Resolution Documentation document has been removed from the Cancer website. The link is no longer accessible.

The resolution information now more conveniently includes the information on the deficiency resolution screen, which is located on the Survey Application Record (SAR) menu. Click on the deficiency resolution ribbon and you will see a table with your deficiency, or deficiencies, displayed. To the right of each standard is an icon with an ‘R.’ Click on the icon, and you will see a pop-up box with requirements of what is to be submitted for resolution of that particular standard.

Instructions to submit resolutions:

  1. From the deficiency resolution screen, click on ‘select additional standard for resolution’ button
  2. Select standard from drop-down box
  3. Enter comments about resolution in comment box
  4. Upload supporting documentation by clicking on ‘browse’
  5. Click on ‘save’
  6. When all documentation has been uploaded for all deficiencies, click on ‘Submit to CoC’

Deficiency resolutions are processed within 30 days of their submission. Cancer programs will receive an e-mail notification that a facility's Performance Report has been updated and is accessible through CoC Datalinks.

National Cancer Data Base News

FORDS Revision Project - Your Input is Needed

Facility Oncology Registry Data Standards (FORDS) is a manual that contains all of the data items with rules and coding options for cancer registrars to collect data in their hospital registry. These data are then submitted to the National Cancer Data Base (NCDB). The data available in the NCDB come from FORDS, Collaborative Stage (CS), and the American Joint Committee on Cancer (AJCC) Cancer Staging Manual.

The CoC is seeking input from registrars, data users, physicians, and others to modernize the current FORDS manual through a project that started in April 2014. An electronic survey, which will be open through September 2014, will gather respondents’ input.

Please submit one FORDS Revision Survey for each suggestion. The survey can be submitted multiple times per user.

The PDFs below contain the questions for the survey based on whether you want to add, change, or remove a data item:

Resources for Cancer Liaison Physicians

July 1, 2014 Expiring Terms for Cancer Liaison Physicians

CLPs serve a three-year term and are eligible to serve an unlimited number of terms based on performance and evaluation data collected at the time of survey. Terms of more than 250 CLPs will expire on July 1, 2014, and each cancer committee must determine whether their current CLP is appropriately serving in this role or if another candidate would better suit the position.

Notification and instructions will be sent to the cancer committee chairs of programs with a CLP whose term is expiring; cancer registrars will be notified as well. The facility must either reappoint the CLP for another three-year term or recommend a replacement to fill the role.

Please update and confirm your CLP’s contact information in the CoC database.

If you have questions or concerns, please e-mail us at

NOTE: If your accredited facility does not have a CLP in place, you are in jeopardy of noncompliance with CoC accreditation Standards 1.3 and 4.3. It is important that an appointment is made as soon as possible and that an individual is designated as the CLP in CoC Datalinks. If a CLP is not appointed for your facility and recorded in CoC Datalinks, the CoC recommends that the cancer committee chair be listed as the interim CLP until an official appointment is made.

What Every CLP Should Know!

  • Each appointed Cancer Liaison Physician (CLP) receives an e-mail with a user ID and password to CoC Datalinks. If the CLP has problems logging on, please e-mail to obtain the user ID and password or to have a new one issued. Please be sure that the CLP has a working e-mail address on file that is checked regularly.
  • You can contact us at to get the term dates for your current CLP at any time.
  • If the cancer committee has made a decision to retain the current CLP for another term before that CLP’s term has expired, a request may be made through an e-mail to Make sure the current e-mail address of the CLP is included.
  • A CLP’s term is for three years. However, we realize that circumstances arise that may prevent a CLP from serving a full term. It is permissible for the cancer committee to recommend another physician to take over the CLP term in this case. Please send an e-mail to in this event.
  • CLPs serving in their role for less than six months do not have to complete the CLP activity report in the SAR. The former CLP should complete this report before being replaced.

Becoming a Cancer Liaison Physician Orientation Video

The CoC's Cancer Liaison Program orientation video for CLPs, is a requirement for new and reappointed CLPs. This video features an overview of the CLP Information Board on the CoC website. The information board serves as the primary source for information to help CLPs perform their role at their facility and ultimately improve the quality of care provided to their patients. Visit the CLP Information Board to download the video.

NOTE: CME’s are no longer offered for this video and will be self-reported in the Cancer Liaison Activity Report within the Survey Application Record (SAR). The orientation video is no longer on the CoC education portal.

Selected Readings in Oncology for General Surgeons

The American College of Surgeons (ACS) Division of Education recently published two issues of Selected Readings in General Surgery (SRGS®) that summarize the best current general oncology literature. Part I (Volume 40, No. 1) reviews the molecular and genetic bases of cancer, cancer prevention and detection, imaging, cutaneous oncology, and sarcoma. Part II (Volume 40, No. 2) examines head and neck and thoracic oncology, gynecologic conditions and malignancies, genitourinary cancers, and managing radiation and chemotherapy complications. Learn more about SRGS and how you can order these issues (click on “Back Issues”).

Educational Programs and Resources

Save-the-Date: Accreditation 101: Learning the Basics of CoC Accreditation Workshop

Friday, September 12, 2014
San Antonio, TX

To meet numerous requests made after the first program in February 2014 sold out, the CoC will repeat Accreditation 101 on September 12 in San Antonio. Plan now to attend the only program developed by the professionals involved in CoC standards development and the survey process.

An e-mail will announce the opening of registration for this program in the near future.

Early registration (on or before August 11): $395
Registration after August 11: $450

For further information, contact Andréa Scrementi
For exhibit opportunities, contact Eunice Oh at

New Webinar: Navigating CP3R Version 3

American College of Surgeons (ACS) staff member, Erica McNamara, MPH, MM, presents a 15-minute pre-recorded webinar, Navigating CP3R Version 3 on the ACS Cancer Programs Online Education Portal. This presentation describes strategies for documenting and discussing activity, as well as creating an educational and evaluative survey environment. The following areas are also covered:

  • Basic navigation techniques for the new Cancer Program Practice Profile
  • Reports Version 3 (CP3R) application
  • Comparisons between the previous version of CP3R with the new version to allow users to understand what changes have been made to the CP3R application

This webinar is complimentary to CoC-accredited cancer program staff using their CoC Datalinks user ID and is $50 for all other participants. For more information and to register, click on this link.

Make sure to bookmark the ACS Cancer Programs Online Education Portal, where you will find all CoC educational webinars.

Register Today for the RQRS and CoC Workshops - June 18-20, 2014

Two Programs—One Location
Get the information you need to meet the CoC standards and learn how you can achieve commendation for RQRS participation.

June 18, 2014
11 am–4 pm
“Strengthening Your Cancer Program…Utilizing the Rapid Quality Reporting System to Comply with the New Commendation Standard (5.2)”

Ensure your program’s compliance with the new commendation standard that requires programs, from initial enrollment and throughout the three-year accreditation period, to participate in RQRS. This includes the submission of eligible cases for all valid performance measures, and adherence to RQRS terms and conditions. Whether you are new to using RQRS or an experienced user, this optional half-day program will help you integrate RQRS into your program making it a valuable addition to your quality improvement toolbox. ($300 after May 15) Lunch will be served at 11 am, with an Intro to RQRS from 11:15 – 11:45 am for those of you completely new to RQRS in need of a bit of basic training.


June 19–20, 2014
CoC Workshop “Strengthening Your Cancer Program…Enriching the Coordinators’ Role”

Plan now to join more than 300 of your peers and colleagues at the newly designed CoC Workshop, “Strengthening Your Cancer Program…Enriching the Coordinators’ Role.” This new education program, formerly known as Survey Savvy, provides a deep-dive into the important role that the various coordinators serve in the delivery of quality care for cancer patients. Hear experienced coordinators share their experiences and leave this program with the tools and resources you need to increase the efficiency and effectiveness of your cancer committee. ($750 after May 15)

Visit the CoC Workshop web page for further meeting information, hotel information, and to register. Space is limited.

Please share this information with other members of your staff who would benefit from the information that is being presented. Team attendance is encouraged for the workshop.


News from ACoS Cancer Programs


Collaborative Stage Version 02.05 New Education Videos

The American Joint Committee on Cancer (AJCC) recently released 13 new Collaborative Stage (CS) education videos in tandem with v02.05.

These CS Moments videos can be viewed directly on the CS Education Page or on the AJCC YouTube channel.

Cancer registrars are encouraged to view these latest educational resources and provide feedback, especially regarding topics for future coverage. Send feedback to


NAPBC Accreditation Criteria for Women’s Choice Award for Breast Centers

The Women’s Choice Award program has announced its 2014 list of Women’s Choice Award for America’s Best Breast Centers. The NAPBC notes proudly that one of the primary award criteria is NAPBC accreditation. In addition to being NAPBC-accredited, the breast center must carry the seal of the American College of Radiologists as a Breast Imaging Center of Excellence (BICOE), and score well on the Centers for Medicare and Medicaid Services patient satisfaction measures, or their equivalent.

NAPBC Responds to Canadian Study

Earlier this year, a number of media outlets, including the New York Times, reported on a paper that appeared in the British Journal of Medicine (February 19) that referenced the findings of a Canadian study that contends that annual mammography in women ages 40 to 59 does not reduce death from breast cancer. The CoC and the NAPBC, both programs of the American College of Surgeons (ACS), issued the following statement in response.

Vast Study Casts Doubt on Value of Mammograms by Gina Kolata (Feb. 11, 2014):

As leaders of two nationally renowned cancer care organizations, we think it’s important to emphasize that our groups will continue to endorse routine screening mammography for U.S. women. We are deeply concerned about findings published from the recent Canadian National Breast Screening Study (British Medical Journal) that suggest no benefit to women who undergo routine screening mammography. Both of our organizations feel the conclusions in this study were based on flaws in the scientific design and that study results are in complete contradiction to several well-documented studies showing the benefit of screening mammography. Moreover, as practicing physicians, we continue to treat patients whose lives have been saved because they had mammograms.

In view of broad-based input from multiple medical disciplines that we collaborate with on a continual basis, our organizations continue to endorse routine screening mammography with the goal of decreasing mortality due to breast cancer in U.S. women.

Cary S. Kaufman, MD, FACS
Chair, National Accreditation Program for Breast Centers (NAPBC)

James Connolly, MD, FCAP
Vice Chair, NAPBC

Daniel P. McKellar, MD, FACS
Chair, Commission on Cancer of the American College of Surgeons

News from the Oncology Community


NCRA Offers Special Subscription to its Center for Cancer Registry Education

The National Cancer Registrars Association (NCRA) is marking its 40th anniversary in 2014 by offering a special $100 subscription to its Center for Cancer Registry Education (CCRE). The CCRE is an online Learning Management System with more than 40 educational products designed specifically for cancer registrars. The products support individuals who are new to the cancer registry field, as well as seasoned professionals seeking continuing education to expand their knowledge. The subscription will allow NCRA members to access a variety of training products and earn up to 40 continuing education credits for $100. The many available learning modules include Confidentiality in the Registry; Coding Instructions for the Grade Data Item; Strategic Abstracting of the Bladder, Hematopoietics, and Non-Malignant Brain and Central Nervous System; and Treatment Modalities for Lung and Prostate/Bladder. All the Journal of Registry Management quizzes are available, and access to the course on the immune system is provided. The subscription needs to be purchased by June 30, 2014, but members have access to the subscription products through December 31, 2014. To learn more, go to

Get Ready for the CTR Exam with NCRA’s Exam Readiness Webinars

NCRA’s online certified tumor registrar (CTR) exam preparatory webinars are developed and facilitated by a team of experienced CTRs and allied-health educators. The 90-minute webinars provide a comprehensive review of exam topics with hands-on exercises and instructor interaction. The remaining topics in the spring series include: AJCC Staging and Quality Assurance (May 29); Analysis and Data Usage (May 29); Operations and Management, HIPAA, Confidentiality and Privacy (June 3); CoC Standards, Cancer Committee and Cancer Conference (June 5); Central Cancer Registries, Exam Content, and Study Tips (June 10). To learn more and register, go to

Monthly Spotlight: LIVESTRONG Foundation

The CoC regularly collaborates with more than 50 member organizations in its mission to provide quality cancer care. This month we focus on the LIVESTRONG Foundation.

The LIVESTRONG Foundation strives to improve the lives of people affected by cancer now. Created in 1997, the Foundation is known for providing free cancer support services and advocating for policies that improve access to care and quality of life. Known for its powerful brand – LIVESTRONG – the Foundation has become a symbol of hope and inspiration around the world. Since its inception, the Foundation has served 2.5 million people affected by cancer and raised more than $500 million to support survivors. One of America's top not-for-profit organizations, the Foundation has been recognized by industry leaders including Charity Navigator, the National Health Council, and the Better Business Bureau for its excellent governance, high standards, and transparency. For more information, visit

Staff at the LIVESTRONG Foundation talk to cancer survivors about their needs, and develop programs and form partnerships to help meet those needs. Fourteen million Americans have been diagnosed with cancer, and there are thousands more diagnosed every day making the work of the foundation more critical than ever. provides hundreds of topics and stories that health care professionals can use with their patients or that patients can review on their own. Additionally, adult cancer survivors have access to the LIVESTRONG Care Plan powered by Penn Medicine’s OncoLink, a one-of-a kind tool, based on answers to a brief questionnaire that provides an individualized survivorship care plan to be shared by the patient and the health care team. This year, we are working with the CoC and other key partners on a research study to test the feasibility of synchronizing the LIVESTRONG Care Plan with the National Cancer Data Base (NCDB).

Through or by contacting 855-220-7777, the foundation provides free patient navigation services to help people affected by cancer cope with the financial, practical, and emotional challenges that accompany the disease. Resources are offered to patients throughout the care, including the LIVESTRONG Care plan.

In communities throughout the country, LIVESTRONG has invested more than $1.4 million to provide proven cancer support programs, including the LIVESTRONG, at the YMCA program. This cancer rehabilitation program helps individuals diagnosed with cancer reduce the aftereffects of cancer treatment. Learn more at, and check back often as we are continually adding new programs.

LIVESTRONG helps cancer programs implement the Continuum of Care Services with resources available online, on the phone, and in your community.

Recent Publications and/or Products

Staff at the LIVESTRONG Foundation review the experiences of the cancer community and develop solutions to help more people. By leveraging a committed constituency, government and non-government partners in cancer advocacy, and a trusted reputation built over the past 14 years, the Foundation executes research projects that are not always possible in other settings. Our research is informed by the most pressing questions in the evolving field of survivorship research, and by what we hear on a daily basis from the people affected by cancer. Our research program is unique in that we hear—and respond to—the voices of people affected by cancer, whether from constituents who follow us online, participate in events and initiatives, or use our navigation services.

  • Gayer C, Gardiner H, Miller N, Stephanie Van Winkle S, Weindling N, Arvey S, Kennedy V, Rechis R. “Readiness to Implement Continuum of Care Standards by Commission on Cancer-accredited Programs.” Poster presented at the American Psychosocial Oncology Association Annual Conference, February 13–17, 2014. Tampa, FL. Awarded Best Research Poster Session 2.
  • Rechis R, Beckjord EB, Nutt S. Potential benefits of treatment summaries for Survivors' health and information needs: Results from a LIVESTRONG survey. Journ. of Onc Practice. September 2013: doi:10.1200/ 2013.000973
  • Beckjord E, Reynolds KA, van Londen GJ, Burns R, Singh R, Arvey SR, Nutt S, Rechis R. Population-level trends in post-treatment cancer survivors’ concerns and associated receipt of care: Results from the 2006 and 2010 LIVESTRONG surveys. Journ. of Psychosocial Onc, in press.
  • Rechis R, Bann C, Nutt S, Squiers, L, Rao, N. “Who is receiving survivorship care plans: Results from the 2012 LIVESTRONGSurvey.” Poster presented at the American Society of Clinical Oncology Annual Conference, May 31-June 4 2013, Chicago, IL.
  • Nutt S, Bann C, Squiers L, Eargle E, Arvey S, Rechis R. “Fertility preservation cost and use: Results from the 2012 LIVESTRONGSurvey” Poster presented at the American Society of Clinical Oncology Quality Symposium, November 1–2, 2013, San Diego, CA.
  • Rechis R, Eargle E, Arvey S, Nutt S, Koenings A, Hemingway B. “LIVESTRONG Fertility: Helping Cancer Patients Preserve their Fertility.” Poster presented at the American Society of Clinical Oncology Quality Symposium, November 1–2, 2013, San Diego, CA.
  • Nutt S, Bann C, Squiers L, Arvey S, Rechis R. “Younger survivors' insurance concerns: Results from the 2012 LIVESTRONG Survey.” Poster presented at the American Society of Clinical Oncology Quality Symposium, November 1–2, 2013, San Diego, CA.