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

August 2015 CoC Source

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CoC Spring Meetings Plenary Session Presentations Now Online

Learn more about the latest activities of the Commission on Cancer (CoC) and our member organizations by viewing the presentations given during the plenary session held in Chicago on May 8.

Presenters include: 

  • Daniel McKellar, MD, FACS – Chair, CoC
  • Jonathan C. Irish, MD, FRCSC, FACS, MSc - Professor of Otolaryngology-Head and Neck Surgery, University of Toronto, Ontario, Canada
  • Lawrence N Shulman, MD - Deputy Director for Clinical Services, Abramson Cancer Center, Director, Center for Global Cancer Medicine, University of Pennsylvania, Philadelphia, PA
  • James L. Connolly, MD, FCAP - Director of the Pathology Residency Program, Beth Israel Deaconess Medical Center, Boston, MA
  • Terry Sarantou, MD, FACS - Surgical Oncologist, Levine Cancer Institute, Charlotte,  NC
  • Helena Gutierrez-Richards, LCSW, ACSW, OSW-C, Nemours Children’s Clinic, Jacksonville, FL
  • Janice Zunich, MD - Director, Genetics Center, and Clinical Associate Professor of Medical Genetics, Indiana University School of Medicine-Northwest, Gary, IN

House Passes 21st Century Cures Act

House Resolution (H.R.)  6, the 21st Century Cures Act, was recently approved by an overwhelming vote of 344-77. The bill is the product of more than a year of listening to and working with experts from the Food and Drug Administration, National Institutes of Health, patients, and other leaders from across the country. Sandra Bond Chapman, PhD, founder and chief director of the Center for BrainHealth at the University of Texas at Dallas, recently wrote in The Hill about the collaborative spirit behind both 21st Century Cures and the Center for BrainHealth. “The result of this collaboration, H.R. 6, modernizes federal regulatory processes that often stand in the way of new products and treatments being made available to patients. The legislation expands funding for the National Institutes for Health and Food and Drug Administration to support promising new research and approval of new therapies. The legislation also recognizes and harnesses the tremendous potential of relatively new scientific concepts such as personalized medicine and the development of medical apps.”

Learn more about 21st Century Cures and share your thoughts on social media using #Cures2015. 

New Policy on Registry Reference Date Change Requests

The CoC has adopted a revised policy for allowing administrative changes of a registry’s reference date.

Effective immediately, reference dates may be changed only once every five (5) calendar years, and may only be requested if the registry has at least 10 years of complete data in the registry database. This new policy applies for any pending or newly requested changes in reference date.

Accredited programs are encouraged to maintain their original reference date and database whenever possible as changes to the reference date can have a negative impact. 

The National Cancer Data Base (NCDB) generates two main outcome measures—process and survival. In order to adequately assess survival outcomes, the NCDB needs complete follow-up information. This new policy will provide for submission of a rolling five years of data with 60 months of follow-up to NCDB, and will result in more robust survival statistics. 

The CoC recognizes that occasionally circumstances may cause a registry to petition for a change in reference date. In such cases, all requests must be discussed with the NCDB Manager of Information and Data Standards in advance of the submission of the formal request. The Reference Date Change Form must be completed, including justifications for the requested change, and submitted to the CoC. This form must be signed by an authorized cancer program leadership staff member before the implementation.

For detailed information on reference date changes as they relate to new programs, established programs, new mergers, and new integrated networks, read the complete policy revision on the CoC website.  

Using the Program Activity Record (PAR) - Beyond the Survey Year

The CoC's Accreditation and Standards staff receive many questions regarding years of cancer program activity data that appear in the PAR that have already been rated during a preceding survey, such as “Should this information be deleted if it is no longer needed for survey preparation?” 

Programs must NOT delete ANY years of data out of the PAR. This historical data is essential to the CoC for statistical and reporting purposes.

There are always four years displayed in the Survey Application Record (SAR) and PAR at any given time and the latest year is always the current year. As a new calendar year begins, a new year for data entry is added to the SAR/PAR and the oldest year will be removed from your view. This allows programs to only see the years of activity in the SAR that the survey will be reviewed on for compliance.

SAR/PAR Tidbits:

  • Remember, the PAR is completed and viewed during non-survey years. The SAR is completed and reviewed by the surveyor and CoC during the year that the program is due for survey.
  • The SAR is required to be completed 30 days before the confirmed survey date and will close for edits two weeks before survey. If you have important changes for the SAR during the two weeks before survey, you will need to communicate this to the surveyor. The SAR remains open for three business days post-survey for any changes that are specifically requested by the surveyor only. 
  • The Accession List link and the table in Standard 2.1 (CAP) for adding pathology report information for surveyor review will remain open even during the closure window.
  • Upcoming improvement for Standards 1.11 (CTR Education/5.1 CTR Credentials)
    • The table on registry staff information will soon ask programs to list hire and departure dates (as applicable) for registry staff. This change will help clear up any miscommunications regarding educational requirements of staff that were recently hired or left the facility. 
    • When a “local” or “state” educational activity is entered into the table of Standard 1.11, programs will be able to provide the name of the activity that was attended. This option is already available for “regional” and “national” educational activities.

More updates that will enhance the SAR/PAR will be provided throughout the year.

Thank you to all who responded to the Survey Monkey on CoC Datalinks functionality and customer service. Your feedback will help us improve our web portal and internal processes to help make the accreditation program more effective and valuable!

July 1 CLP Expirations Concerns for Accredited Facilities

At the end of June, an e-mail was sent to several accredited facilities regarding the term expiration of their Cancer Liaison Physician (CLP). Facilities were strongly encouraged to determine the reappointment or the new appointment of a CLP as soon as possible because CoC Datalinks access will be inaccessible for the CLP. We realize that many facilities will have their cancer committee meetings after July 1. Therefore, no deadline was given. This may cause concern and raise questions about accreditation. The cancer committee may decide to extend the current CLPs term until a decision is made to reappoint or replace before the actual meeting. This will allow the current CLP access to CoC Datalinks and the National Cancer Data Base (NCDB) tools. If the cancer committee decides to replace the CLP, the new appointment can be processed at any time with no consequences regarding accreditation.

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

New Appointment Process

1. Log into CoC Datalinks

2. Go under Manage Staff Contact. 

3. Under the Pending Contacts section select Add Contact. 

4. Enter the CLP name and contact information in this window. 

5. Click the Save button. The new information will be sent directly to the Cancer Liaison Program for processing. An appointment letter will be sent to the CLP and a notification will be sent to the cancer program staff via e-mail. 

Remove Former CLP

1. Log into CoC Datalinks

2. Go under Manage Staff Contact. 

3. Click on the former CLP’s name to expand his or her record. 

4. Click the Remove button. A box will open asking if you want to remove this contact. Select OK. 

Reappointment Process

Send an e-mail to, with your CLP’s name and e-mail address, which states that your program would like to reappoint the CLP to an additional term. An e-mail will be sent to the CLP and program staff confirming the reappointment.

What Every CLP Should Know

  • Each appointed CLP receives an e-mail with a user ID and password to CoC Datalinks. If you have a problem logging on, e-mail to obtain the user ID and password or to have a new one issued. Please be sure that you have 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 to include the current the CLP’s e-mail address.  
  • A CLP’s term is for three years. However, we realize that circumstances may prevent a CLP from serving a full term. It is permissible for the cancer committee to recommend another physician to complete the CLP term. The new CLP will serve a full three-year term. If this should happen, please send an e-mail to
  • CLPs serving in their role for less than six months do not have to complete the CLP activity report in the Survey Application Record. The former CLP should complete this report before being replaced. Please make sure this is done while the former CLP still has access to CoC Datalinks.

CoC Welcomes New State Chairs

We are happy to announce the following new State Chairs with the CoC.

Hank Hill, MD, FACS

Florida (Jacksonville) State Chair

Lynne Jalovec, MD, FACS

Illinois State Chair

Richard Bell, MD, FACS

Oregon State Chair

Register Now for Fall Accreditation 101 in Baltimore

Accreditation 101: Learning the Basics of CoC Accreditation and Standards is the only program developed and taught by CoC surveyors and staff that reviews the CoC Standards, provides practical information on how to achieve compliance, and discusses the important role you and your cancer team play throughout the continuum of cancer care. Get the information you need from the people involved in standard development and the survey process.

Date: Friday, September 11, 2015

Time: 7:00 am - 4:30 pm

Location: Hilton Baltimore,  401 W. Pratt St., Baltimore, MD  21201

To learn more, visit the Accreditation 101 web page. There you'll find more information, including program agenda and hotel information. Register now as space is limited.

Registration Fees:

$750 on or before July 31

$850 after July 31

This fee includes a copy of the latest issue of the Standards Manual, ($50.00 value), resource materials, breakfast, lunch, and breaks.


Reserve your hotel by August 14, for the group rate of $199/night + tax. Reference Commission on Cancer Accreditation 101 to receive the discounted rate. 

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

Continuing education credit will NOT be offered for this program. 


AJCC Registrar Curriculum: Module IV Lessons Now Available 

Two continuing education (CE) credits are being offered for each remaining American Joint Committee on Cancer (AJCC) Curriculum for Registrars module, II–IV. Recordings for Module I, Module II and Module III are available through the AJCC website. Module I Introduction is not eligible for CE credits.

The Module IV lessons are now available and the webinar will be held August 25. Mark your calendar and visit the AJCC site to register to attend live! As a reminder, there is a limit of 1,000 spots for the live webinar. If you are not able to participate in the live webinar, you can still earn two CE credits for the recorded webinar.

The AJCC Curriculum for Registrars launched in January 2015 and was designed to provide education in a step-wise learning environment, complete with additional resources to reinforce the information and webinars with interactive quizzes to prompt discussion and serve as a self-assessment. This is self-guided, adult learning, and you are expected to review the lessons before attending the live or recorded webinars.

Please remember to use the CAnswer Forum for questions related to the webinars.

ACS Clinical Research Program News

New Operative Standards for Cancer Surgery Manual Released

To address the technical aspects of standardizing surgical care, the American College of Surgeons Clinical Research Program—a program of the Alliance for Clinical Trials in Oncology and the College—formed the Cancer Care Standards Development Committee. For the last three years, the committee, led by Kelly K. Hunt, MD, FACS, worked to develop a manual that details the critical elements of cancer surgery as first envisioned by Heidi Nelson, MD, FACS.  The resulting manual, Operative Standards for Cancer Surgery, is now available for purchase.  

The manual was developed in response to the need for a standardized description of minimum standards for various cancer operations to serve as a reference for clinical trials that include surgical interventions. Specifically, the idea was to create a standards manual that could serve as a reference in the development of clinical trials that include operations such as breast-conserving surgery, pancreaticoduodenectomy, or lobectomy, rather than require investigators to establish or re-establish the basic principles of these operations with the development of each new trial. The goal was to minimize variability across study sites and improve adherence to minimum standards for patients treated both on and off a clinical trial. As the project matured, it became clear that this manual could serve many purposes, ranging from surgical education to providing a basis for operative report templates and quality improvement databases.

The manual provides concrete recommendations on the proper conduct of operations and detailed information on the oncologic principles, avoidable pitfalls, and quality of the evidence on which these recommendations are based. The manual is focused on the range of decisions that are made—from  skin incision to skin closure, and the recommendations are based on the strongest available evidence. Because randomized trials have not addressed all of the components of operations within each disease site, it was important to draw on the experience and consensus of the experts writing the individual chapters. Identifying the lack of evidence on certain topics has been an unintended consequence of writing this manual and has galvanized the authors into establishing standards where none currently exists. With the participation of more than 120 surgeons in this first edition, it is perhaps the best resource currently available on the proper conduct of an operation for cancer of the breast, colon, lung, and pancreas.

In anticipation of continued evolution in surgical oncology, these initial four disease site sections will be updated every two to three years. Planning is already under way for the manuals second edition, which will include procedures in melanoma, gastric cancer, esophageal cancer, rectal cancer, and thyroid cancer.

Order your copy of Operative Standards for Cancer Surgery today. 


Submit Abstracts for NCRA’s Annual Conference by August 19

Share your expertise with the cancer registry community at the National Cancer Registrars Association (NCRA) 42nd Annual Educational Conference. Oral presentation and poster abstracts will be accepted through the NCRA Online Collection Center. The deadline is August 19. All submissions will be acknowledged and reviewed by the 2016 Program Committee. Selected presenters will be notified by October 15. Learn more at If you have any questions, contact Mary Maul, NCRA's Education Manager, at

Apply by September 18 for Last 2015 CTR Exam Testing Window

The deadline to submit an application to take the CTR Exam in fall 2015 is September 18. The last 2015 testing window is October 17–November 7. Learn more and download the 2015 CTR Exam Candidate's Handbook at

NCRA Needs Mentors

The NCRA Mentoring Program has grown significantly since it began three years ago, but seasoned registrars are still needed to help with those new to the profession. Interested? Learn more about NCRA's Mentoring Program at or contact Mary Maul, NCRA's Education Manager, at

APOS Webinar: End of Life: Assessment and Intervention

Wednesday, September 23, 12:00–1:30 pm (Eastern)
Presented by: Sharla Wells-Di Gregorio, PhD, The Ohio State University 

People living with advanced disease or approaching end of life often have multiple symptoms and psychosocial concerns requiring more complex and well-integrated care.  In this webinar we will review the importance and challenges of understanding patient prognosis. We will review some of the most common and distressing problems at end of life and how to manage these. We will discuss how psychological diagnosis and intervention may differ for patients with advanced disease, including empirically supported psychological interventions at this phase of life. We will also examine strategies for helping patients and families prepare for end of life and understand the dying process, including advance care planning. Finally, we will identify several key self-care strategies for providers when offering care for patients and families experiencing anticipatory grief and bereavement.

Learning Objectives

  1. State four of the most common symptoms and problems faced by people at the end of life
  2. Describe how psychological diagnosis and treatment differ for patients with advanced disease
  3. Compare and contrast end of life preparation and advance care planning
  4. Create a self-care plan to reduce burnout when providing end of life care

APOS Members - No cost
Non-Members - $45/each

Sharla Wells-Di Gregorio, PhD, is an assistant professor of psychiatry and behavioral sciences at The Ohio State University Wexner Medical Center in Columbus. She is a clinical psychologist in psychosocial oncology and palliative medicine at the James Cancer Hospital, a comprehensive cancer center. She completed her clinical internship at the University of California, Los Angeles, in medical psychology, her PhD in clinical psychology from Northwestern Medical Center, and a three-year research fellowship in biobehavioral oncology at The Ohio State University. Dr. Wells-Di Gregorio is director of the Psychosocial Oncology Fellowship at the Wexner Medical Center. She chaired the committee at the James responsible for developing the James Supportive Care Screening, a distress screening method currently implemented at the James. She serves on the American Psychosocial Oncology Society Professional Development Committee, tasked with development of a psychosocial oncology curriculum and also serves on the Ohio Pain Initiative to develop standards of care to relieve suffering from pain. Her research interests include distress screening, psychological and communication interventions for families living with advanced cancer, and the neuroimmunologic mechanisms of symptom clusters.