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

October 2016 CoC Source

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Status Report: Survivorship Care Plan Research Study

The July issue of the CoC Source introduced the national study titled, “The Perceptions, Beliefs, and Practices of Cancer Center Program Administrators Regarding Cancer Survivorship Care Plans” (SCP) being conducted by the University of Toledo, OH.

The study results will yield significant benefits to the scientific literature in cancer survivorship. Furthermore, the results of the study could lead to the education of administrators on the development of better SCP procedures, staff training, delivery processes, methods, and materials. Improved SCP processes will likely have many benefits including assisting patients with understanding and following their SCPs; facilitating better communication among clinicians, patients, and other members of the medical team; and aiding administrators with cost containment and resource allocation.

Since July, the researcher has interviewed 22 Cancer Program Administrators. The administrators represented various program types, areas of the country, and organization sizes. The purpose of the interviews was to gather detailed information about administrators’ views, perceptions and policies regarding survivorship care plans. This information was analyzed to identify key themes and messages. From this information, the researcher has created a survey that will be emailed to all administrators. Before the final survey goes to all administrators, the survey instrument will be sent to a small group of volunteer administrators as a “pilot test”. After this test, changes will be made as needed, and all Cancer Program Administrators will be receiving the survey by email. The target time frame for emailing the survey to all administrators is late October through early November.

Once again, we are very excited about the opportunity to add to the scientific literature on this topic and encourage all Cancer Program Administrators to participate in this important activity. Watch the CoC Source for additional information on study progress.

CoC News

Cancer Program Events During Clinical Congress

If you are attending the ACS Clinical Congress October 16–20 in Washington, DC, make sure to visit the Cancer Programs booth located in the Resource Center in Exhibit Hall B, lower level of Walter E. Washington Convention Center.

In addition, the Cancer Programs are sponsoring a number of sessions:

Monday, October 17

9:45–11:15 am
Human Papillomavirus (HPV) Related Cancers: Vaccinate Early, Screen Regularly! What Surgeons Should Know (PS104)
Moderator: Michael Geoffrey Moore, MD, FACS, Indianapolis, IN
Co-Moderator: Maureen A. Killackey, MD, FACS, New York, NY
Sponsored by the Commission on Cancer

2:30–4:00 pm
Rectal Cancer Commission on Cancer Accreditation Panel 2016 (PS122)
Moderator: Steven D. Wexner, MD, PhD (Hon), FACS, FRCS, FRCS(Ed), Weston, FL
Co-Moderator: Feza H. Remzi, MD, FACS, FASCRS, FTSS (Hon), Cleveland, OH

4:15– 5:45 pm
Surgical Decision Making in Patients with Intraductatual Papillary Mucinous Neoplasms (PS131)
Moderator: Hisakazu Hoshi, MD, FACS, Iowa City, IA
Co-Moderator:  Nipun B. Merchant, MD, FACS, Nashville, TN
Sponsored by the Commission on Cancer 

Tuesday, October 18

7:00–7:45 am
Accruals to Oncology Clinical Trials (TH04)
Presenters: Gary W. Unzeitg, MD, FACS, and James W. Fleshman, MD, FACS
Sponsored by the ACS Clinical Research Program Education Committee 

9:45–11:15 am
Controversies in Barrett’s Esophagus (PS208)
Moderator: Leslie J. Kohman, MD, FACS, Syracuse, NY
Co-Moderator:  Robert C. G. Martin, MD, PhD, FACS, Louisville, KY
Sponsored by the Commission on Cancer

11:15–11:40 am
The New AJCC TMN Staging System
Presenter: Mahul Amin, MD, FCAP
Sponsored by the American Joint Committee on Cancer (AJCC)

12:45–2:15 pm
Management of Recurrent Gastrointestinal Stromal Tumors in the Era of Multidisciplinary Care (PS220)
Moderator: Chandrajit P. Raut, MD, FACS, Boston, MA
Co-Moderator: Ricardo J. Gonzalez, MD, FACS, Tampa, FL
Sponsored by the Commission on Cancer 

4:15–5:45 pm
Clinical Trial Results and Implementation into the Surgical Oncology Practice Today (PS232)
Moderator: Nancy Baxter, MD, FACS, Toronto, Canada
Co-Moderator:  Judy Boughey, MN, BChir, FACS, Rochester, MN
Sponsored by the ACS Clinical Research Program Education Committee

Wednesday, October 19

9:45–11:15 am
Contemporary Management of Breast Cancer: The Definition of Adequate Margins in Breast Conservation Surgery and the Role of Sentinel Lymph Node Biopsy (PS310)
Moderator: Monica Morrow, MD, FACS, NY
Co-Moderator: David J. Winchester, MD, FACS, Evanston, IL
Sponsored by the Commission on Cancer 

12:45–1:45 pm
Oncology Lecture:  Finding the Evidence in Real World Evidence: Moving from Data to Information to Knowledge (NL11)
Speaker: Richard L. Schilsky, MD, FACP, FASCO
Sponsored by the Commission on Cancer 

2:30–4:30 pm
The Value of Patient Reported Outcome Measures for Surgeons and Their Patients (PS330)
Moderator: Juliane Bingener, Rochester, MN
Co-Moderator: Benjamin Brooke, MD, PhD, FACS, Salt Lake City, UT
Sponsored by the ACS Clinical Research Program Education Committee

Attend the Commission on Cancer Annual Meeting

The Commission on Cancer (CoC) invites all Fellows of the American College of Surgeons (ACS) and other Clinical Congress attendees to attend the CoC Annual Meeting 3:00–5:00 pm on Sunday, October 16 at the Marriott Marquis Washington, DC, Liberty Ballroom, Salons N−P, Level 4.

The CoC Annual Meeting features:

  • An update on CoC activities
  • Keynote Address by Greg Simon, Executive Director, White House Cancer Moonshot Taskforce
  • CoC paper competition winners
  • Recognition of outgoing CoC members

At this meeting, CoC Chairman Daniel P. McKellar, MD, FACS, Wayne Healthcare, Greenville, OH, will pass leadership of the CoC to Lawrence N. Shulman, MD. Dr. Shulman is professor of medicine, Hospital of the University of Pennsylvania (UP), Philadelphia, and deputy director, Clinical Services at the Abramson Center, UP.

Immediately following the CoC Annual Meeting, attendees are invited to attend the CoC Reception in the Liberty Ballroom, Salons L-M, Level 4 of the Marriott Marquis Washington, DC.

Theatre Session at Clinical Congress Will Highlight AJCC 8th Edition

If you are attending Clinical Congress, don't miss the ACS Theatre session on the new AJCC Cancer Staging Manual, Eighth Edition. The New AJCC TNM Staging System: Vision, What's New, and Preparing for Implementation will be presented by Editor-in-Chief Mahul Amin, MD, FCAP. Dr. Amin will provide an overview of the staging changes that go into effect January 1, 2017. His presentation will cover the new staging systems, unique paradigms for existing systems, updated General Staging rules, prognostic factors, and AJCC-endorsed risk-assessment models. The presentation will take place Tuesday, October 18, 11:15–11:40 am at the ACS Theatre in the Exhibit Hall.

The AJCC Cancer Staging Manual, Eighth Edition, is scheduled for release at the end of October 2016 but you can pre-order your copy today.

Free Breast Cancer Awareness Month Poster

October is Breast Cancer Awareness Month. The National Accreditation Program for Breast Centers (NAPBC) and the CoC encourage you to promote Breast Cancer Awareness Month and use it as an opportunity to display and publicize your program's accreditation status with the CoC and NAPBC.

The NAPBC and the CoC have created a poster to use within your program and community.

How to Access the Poster

  • Programs accredited solely by the NAPBC should use the Marketing Resources website link that was provided in their performance report e-mail notification.
  • Programs accredited solely by the CoC or both the CoC and NAPBC should go to CoC Datalinks and click on Marketing Resources.

Keep us informed about your celebration by sending photos and event information to Susan Rubin, Business Development Manager, ACS Cancer Programs.

Advocacy Update

Cancer Moonshot Blue Ribbon Panel Report

The Blue Ribbon Panel presented its report to the National Cancer Advisory Board on September 7, 2016. The report describes ten transformative research recommendations for achieving the Cancer Moonshot's ambitious goal of making a decade's worth of progress in cancer prevention, diagnosis, and treatment in just five years.

  1. Establish a network for direct patient involvement.
  2. Create a clinical trials network devoted exclusively to immunotherapy.
  3. Develop ways to overcome resistance to therapy.
  4. Build a national cancer data ecosystem.
  5. Intensify research on the major drivers of childhood cancers.
  6. Minimize cancer treatment’s debilitating side effects.
  7. Expand use of proven prevention and early detection strategies.
  8. Mine past patient data to predict future patient outcomes.
  9. Develop a 3D cancer atlas.
  10. Develop new cancer technologies.

Find the complete report and watch videos about the recommendations on the National Cancer Institute website.

Accreditation Corner

How a Community Outreach Coordinator Can Ensure Compliance: The Basic Steps

Tips for Understanding and Implementing Standard 1.8 

Standard 1.8: “Each calendar year, the Community Outreach Coordinator, under the direction of the cancer committee, monitors the effectiveness of prevention, screening, and outreach activities. The activities and monitoring results are documented in an annual community outreach activity summary that is presented to the cancer committee at the end of each calendar year.”

Standards 4.1 (Cancer Prevention) and 4.2 (Cancer Screening) require that cancer programs provide at least one cancer prevention and one screening program each year based on the identified cancer prevention and screening needs of the program’s community/local population. Standard 1.8 is focused on monitoring the effectiveness and value of these activities and events, ensuring that the prevention and early-detection screening programs meet the needs of the community and follow national guidelines and evidence-based interventions. The cancer committee must discuss if the activities are or are not producing the intended results of the prevention and screening programs. Standard 1.8 is the final step to completing your Standard 4.1 and 4.2 programs.

The issues we frequently see when reviewing a program’s Survey Application Record (SAR) and the community outreach summary are:

  • The annual summary report is not provided.
  • Programs may provide a marketing flyer or a basic Excel spreadsheet listing only what programs were held and the dates.
  • Programs provide a document with descriptions of the events and the number of attendees, but no effectiveness evaluation.
  • Nonapplicable community outreach activities are listed (for example, survivorship events, wig programs, open houses, health fairs unrelated to cancer).
  • The summary report is not shared with the cancer committee and documented in the meeting minutes.
  • The most common deficiency criterion is the summary reports that do not document that the coordinator and cancer committee are monitoring the effectiveness of the activities and programs offered each year. The report must do more than describe the program and report  on the number of attendees.

When discussing and analyzing the effectiveness of your cancer program’s prevention and screening events, think of it as “Lessons Learned.” The coordinator can lead the discussion with the cancer committee to ask questions such as:

  • How many participants? Is this less or more than the last activity? Why did the attendance change?
  • How do you measure if activities are valuable and useful to your community? What is the impact?
  • How effective was the marketing/communication strategy to inform the public of the events?
  • Were the activities appropriately designed to reduce the incidence of a specific cancer type or decrease the number of patients with late-stage diseases?
  • How many participants were referred for suspicious findings at your screening event? How many diagnoses were made as a result of the screening program?
  • How are you ensuring (tracking) that participants with positive findings at screening programs are following up with the appropriate health care professionals? Are people being notified of positive results?
  • Is your follow-up process functioning properly? Could your referral processes be confusing or unhelpful to the screened individuals? 
  • Based on the results of your analysis/monitoring, do you need to make any changes to the outreach activities? 

One of the most common reasons for a deficiency is that the cancer program is not evaluating the effectiveness of its Standard 4.1 prevention program. For compliance, the cancer committee must discuss and analyze the effectiveness of both its 4.1 activity and its 4.2 activity.

Examples for monitoring the effectiveness of prevention activities are:

  • To monitor the effectiveness of a prevention activity on weight management and its relation to the risk of developing a specific cancer, a pre- and post-test are given to participants. The committee then analyzes the results by determining what information was or was not retained by participants and why.
  • For a smoking cessation class, track how many patients signed up for the class and compare it to how many completed it. Additionally, there must be a determination of how many participants actually quit smoking as a result of your prevention activity. This can be done by a phone call to the participants several months after conclusion of the class.
  • At a skin cancer prevention event where sun avoidance and sunscreen use are taught, participants are polled at the end of the summer about who did or did not change habits based on information learned at the prevention event.

The annual Community Outreach Summary must include, at a minimum:

  • Name of the program and type of activity
  • Identified areas (type of cancer) of need for screening and prevention
  • Date the program took place and the number of participants (how did you track attendance and/or participation?) Note, tracking attendance is not the same as monitoring the effectiveness of your program.
  • National guidelines and/or evidence-based interventions that the screening and prevention programs are designed to follow
  • Outline the mechanisms and processes to ensure that follow-up occurs for all positive findings identified through early-detection/screening activities and that participants have access to appropriate referrals
  • Results and summary of the effectiveness of each activity

REMEMBER: Standards 4.1 and 4.2 require the cancer committee to provide at least ONE prevention and ONE screening program each year, which in turn require thorough monitoring and documentation. The CoC does not require programs to produce and monitor a “laundry list” of all facility-wide community outreach programs.

At the time of survey, relevant activities, reports, minutes, and documentation must be uploaded in the Survey Application Record (SAR) for all three years of the survey cycle. Prior to survey, the documentation will be reviewed by the surveyor, followed by discussions with the Community Outreach Coordinator and members of the cancer committee at the survey visit. These activities will assist in determining if a program has fulfilled all of the criteria for Standards 1.8, 4.1, and 4.2.


An Excel file template for the Community Outreach Summary is located on the Standard Resource Library under Standard 1.8.

Important Facts and Tips Regarding the CoC's Annual Accreditation Fee

  • The annual accreditation fee invoices are sent from to the Cancer Program Administrator at each accredited program. Please establish this e-mail address as a safe domain with your e-mail provider to ensure timely receipt of annual invoices. Do Not Reply to this e-mail address.  All accreditation fee inquiries should be sent through the new Contact CoC form.
  • The Cancer Program Administrator is the role assigned by the CoC as the billing contact for all accredited programs. If the Cancer Program Administrator role in CoC Datalinks is vacant at any time, this could result in billing delays and, subsequently, Performance Report delays. It is essential that all contact information under the "Manage Staff Contacts" section in CoC Datalinks be continually updated and accurate.
  • There is no longer an annual Maintenance Fee (this was discontinued in 2015). The Annual Maintenance Fee and Survey Fee (previously billed triennially) have been combined and replaced by one single annual accreditation fee invoiced every year. The annual fee structure went into effect January 2016 with billing beginning in November 2015.

For detailed information on the CoC accreditation fee, visit the Accreditation Fees page.

Resources for Cancer Liaison Physicians

2016 Commission on Cancer Paper Competition Winners

The CoC hosts an annual paper competition for physicians-in-training to foster the importance of oncologic research in support of its mission:

“The Commission on Cancer is a consortium of professional organizations dedicated to improving survival and quality of life for cancer patients through standard setting, prevention, research, education and the monitoring of quality care.”

Residents and fellows-in-training submitted abstracts  that cover topics specific to oncology and directly relate to the CoC mission. Papers were submitted through several of the American College of Surgeons (ACS) chapters and CoC State Chairs. After careful review and scoring by the Committee on Cancer Liaison, the following individuals will receive honors at the CoC Annual Meeting on Sunday, October 16.

First Place
Kendall Keck, MD
University of Iowa Hospitals and Clinics
Iowa City, IA
Higher Tumor Grade in Neuroendocrine Tumor Metastases Negatively Impacts Survival

Dr. Keck is a fourth-year general surgery resident at the University of Iowa Hospitals and Clinics. He is in his second of two years of dedicated research with his mentor James Howe, MD, FACS. His primary research is on the genetic basis and clinical outcomes of neuroendocrine tumors and juvenile polyposis.

Second Place
Ahsan Raza, MD
University of Florida, Gainesville
Gainesville, FL
Variability in Radiation Therapy for Rectal Cancer between Academic and Community Center

Dr. Raza was born and raised in Karachi, Pakistan. He went to medical school at the Aga Khan University in Pakistan before joining the University of Florida Health as a surgical resident. He developed a love for colorectal surgery after joining the University of Florida and working with excellent mentors to whom he attributes his success.

Third Place
Justin Wilkes, MD
University of Iowa Carver College of Medicine, Iowa City
Iowa City, IA
Pharmacologic Ascorbate (P-AscH-) Induces Cell Death and Inhibits Hypoxic Response Elements in Pancreatic Adenocarcinoma

Dr. Wilkes has completed three years of general surgery residency at Maine Medical Center, Portland. He joined the research lab at the University of Iowa in 2016 as a T32 research fellow, studying high-dose Vitamin C in pancreatic cancer. He will return to Maine Medical Center with an anticipated graduation date of June 2019 and hopes to pursue a fellowship in surgical oncology.

News from ACoS Cancer Programs


AJCC Disease Site Webinars Based on AJCC 7th Edition

The American Joint Committee on Cancer (AJCC) scheduled five disease site webinars for summer and early fall this year. The webinars--provided at no cost--will provide highlights of the five most common site chapters for AJCC 7th edition staging and include: Melanoma, Lung, Breast, Colorectum, and Prostate. There will be pre- and post-education quizzes to serve as a self-assessment for the information learned. The webinars will provide information on the uniqueness, differences, exceptions, or special concerns for the disease sites.

Each lecture will contain the following topics:

  • Overview and Learning Objectives
  • Anatomy Affecting Stage
  • Classification Issues
  • Assigning T, N, M Stage Group
  • Information and Questions on AJCC Staging and Summary

All five webinar recordings for Melanoma, Lung, Breast, Colorectum, and Prostate are available now on the AJCC website.

You can visit the AJCC website to learn more about the Disease Site webinars and to stay up-to-date.

Implementation of the AJCC 8th Edition Cancer Staging System

Download the letter

September 13, 2016

The latest edition of the AJCC Cancer Staging Manual, the 8th Edition, will be published by Springer on October 31, 2016 and will replace the 7th Edition for use in clinical care effective January 1, 2017. The 8th Edition Cancer Staging System is the culmination of the work of more than 400 volunteers, representing all members of the multidisciplinary cancer care team from across the world.

Patient Care

The 8th Edition AJCC Cancer Staging System will be used for cancer cases diagnosed January 1, 2017 or later. As is expected with any significant update to tumor staging, there will be a several month transition period in which other professional and stakeholder organizations such as College of American Pathologists (CAP) and the National Comprehensive Cancer Network (NCCN), will begin to incorporate changes into their clinical practice guidelines. During this transition process, pathology reports may still contain material based on the 7th Edition. Up-to-date staging by providers is critical for optimal patient management and the 8th Edition AJCC Cancer Staging Manual will be accessible and should be used at multidisciplinary conferences, and individual practices, starting in January.  Tumor registrars, chairs of multidisciplinary conferences and providers should be vigilant for any reports or other data based on the previous edition during the transition period.

Data Collection

The AJCC is dependent on data collected by the National Cancer Database (NCDB), Centers for Disease Control and Prevention (CDC), National Cancer Institute – Surveillance Epidemiology, and End Results Program (NCI-SEER), and the Canadian registries to implement the changes in the 8th Edition beginning in January 2017. The AJCC is well aware of the challenges this will present for cancer surveillance and clinical data collection registrars. It is recognized that some data inaccuracies may result, as experience has demonstrated in previous AJCC edition transitions. The AJCC, the CAP and all parties involved are committed to minimizing this possibility. Rapid software modifications are encouraged and should serve to reduce this possible exposure.

The surveillance standard setters, professional organizations and governmental agencies have all been communicating, and continue to do so, to synchronize efforts.


The AJCC recognizes that accreditation is a critical component of quality patient care. The CoC and the CAP coordinate their accreditation standards to support each other. However, the AJCC recognizes that there may be a window in 2017 where the updated CAP Cancer Protocols are still under development and will not be have been implemented for clinical care or accreditation purposes.

The CAP is making every effort to accelerate the revision of its protocols. This will be facilitated by prioritization of the protocols for the most prevalent cancers in 2016, followed by the revisions to the remaining protocols in the first quarter of 2017. For CAP accreditation, laboratories will NOT be surveyed for patient reports using the AJCC 8th Edition until eight months after the official release of the specific revised CAP Cancer Protocols. The AJCC encourages laboratories and vendors utilizing the CAP Cancer Protocol and electronic Cancer Checklist (eCC) content to plan for expedient implementation for their users once the CAP content is released.

CoC Surveys performed in 2017 will not be affected by the 8th edition change because surveyors will review pathology reports generated during 2014, 2015, and 2016. CoC Surveys performed in 2018 and beyond will continue to review cancer pathology reports for Standard 2.1 based on the usual 8 month window for implementation of CAP Cancer Protocol required data elements.

The NCCN is also on a tight timeline for updating and publishing their guidelines. The AJCC and NCCN are collaborating on access to the 8th Edition content to accelerate this process.


Register Today: Pursuing Excellence through NAPBC Accreditation

Register today for the Pursuing Excellence through NAPBC Accreditation workshop at the American College of Surgeons headquarters in Chicago on Saturday, November 12.

This workshop is designed for members of the multidisciplinary breast health care team (physicians, nurses, administrators, cancer registrars) newly employed at an NAPBC-accredited program or working at a non-accredited breast center considering NAPBC accreditation.

By attending this workshop, you will be able to:

  • Discuss the current NAPBC standards, the accreditation process, and the value of accreditation in terms of quality care, patient satisfaction, staff support, and clinical outcomes.
  • Identify the roles and disciplines that need to be included in the accreditation process and discuss the need for their support.
  • Apply the required breast center components, accreditation standards, and compliance strategies to successfully achieve NAPBC accreditation.
  • Maximize your on-site NAPBC survey visit.
  • Optimize resources to maintain NAPBC accreditation.

Registration Fee
$550—Registration and payment is received by November 4, 2016
$600—On-site registration

The registration fee includes attendance, resource materials, a copy of the National Accreditation Program for Breast Centers Standards Manual ($50 value), breakfast, lunch, and breaks.

Continuing Education
The NCRA Program Recognition Committee has determined “Pursuing Excellence through NAPBC Accreditation” supports 6.25 continuing education hours.

Workshop Location and Hotel Accommodations 

American College of Surgeons Headquarters
633 N. Saint Clair
28th Floor
Chicago, IL 60611

Hyatt Chicago Magnificent Mile
633 N. St Clair
Chicago, IL  60611

Reservations can be made at the Hyatt Chicago Magnificent Mile online or by calling 888-591-1234 and asking for the NAPBC Workshop room block. Be sure to book in this room block to get the group rate of $229/night, plus tax.

Guest rooms must be reserved by Monday, October 10 by 12:00 noon (Central), to secure the group rate and availability. Reservations made after this date are subject to availability and rate.