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

June 2017 CoC Source

(HTML Version)

Our Cancer Newsletters Are Changing

The Commission on Cancer (CoC) is adopting a new strategy that will streamline our communications with constituents and help us reach a wider audience.

The CoC Source is being retired; this is the last issue.

We have created a Cancer Programs News web page. Information that would normally be included in the CoC Source will be posted on this page as it becomes available. Look to TheBrief, distributed weekly, for the latest in cancer news as well as important information from Cancer Programs—the CoC, American Joint Committee on Cancer (AJCC), Clinical Research Program, National Accreditation Program for Breast Centers (NAPBC), National Cancer Database (NCDB), Oncology Medical Home (OMH), and National Accreditation Program for Rectal Cancer (NAPRC). Articles in The Brief will direct you to the appropriate page on our website for more information.

Urgent information will continue to be distributed via individual e-blasts. Our special Sources will now be called Updates (Education Update, NCDB Update, Cancer Liaison Physician Update, and so on). We will be using a new platform to send these updates, so you will need to whitelist the new e-mail address below.

Please note. Ask your institution’s IT department to whitelist the following IP address:

If you have any questions about this change, please e-mail us at

NAPRC Is Now Accepting Applications from Hospitals

Rectal cancer programs interested in earning accreditation from the new National Accreditation Program for Rectal Cancer (NAPRC) may now apply for participation in the program. The goal of the NAPRC is to ensure rectal cancer patients receive appropriate care using a multidisciplinary approach.

NAPRC is based on successful international models that have resulted in better outcomes and emphasize a multidisciplinary team approach to treat rectal cancer.

Read more in the press release.

Call for NAPRC Surveyors

The newly announced National Accreditation Program for Rectal Centers (NAPRC) is looking for surveyors. If you are an actively practicing (treating, teaching, or administrative role) physician who specializes in rectal cancer care we encourage you to review the information on the  Become an NAPRC Surveyor webpage and submit your application today!

CoC News

ACS Seeks to Fill Six Vacancies on the Commission on Cancer in 2017

The American College of Surgeons (ACS) is seeking six Fellows to fill vacancies on the Commission on Cancer (CoC). The initial term of appointment is for three years, with eligibility for reelection to a second term. Members may hold office or serve as a vice-chair of a committee or subcommittee during their second term. New members will be recommended by the Nominating Committee, selected in October by the Executive Committee, and then brought before the full CoC membership for approval at the CoC’s Annual Meeting on Sunday, October 22. The ACS Board of Regents will confirm the final list of new members, and the CoC will announce the new members in late October.

Surgeons who meet the criteria below and are interested in becoming a member of the CoC should contact to receive an application. The completed application, curriculum vitae, and letters of recommendation must be sent to the same e-mail address no later than Friday, August 18, 2017.

Eligibility Criteria

The CoC Nominating Committee uses the following criteria when selecting members and seeks individuals who:

  • Have never served on the CoC representing the ACS
  • Have full membership in the ACS (MD, FACS only)
  • Have staff appointments at a CoC-accredited cancer program and participate in cancer program activities
  • Have served as State Chair or Cancer Liaison Physician
  • Have knowledge of the CoC’s goals and objectives
  • Represent a surgical specialty, geographic area, or diverse group not currently represented by the CoC membership
  • Have interest in contributing to and enhancing CoC programs through committee work
  • Are willing and able to work with the various electronic platforms used by the committee (for example, SharePoint)
  • Can serve as a member of at least one CoC committee
  • Can attend at least two in-person meetings annually and participate in conference calls

Questions? Please contact

Accreditation Corner

SAR/PAR Orientation Webinars Now Available

A revised webinar series on the 2017 Survey Application Record (SAR) and Program Activity Record (PAR) orientation is now available to accredited cancer programs. The webinar series, which consists of six separate webinars, can be accessed through the Resources section of the Datalinks Activity Menu. The webinars, titled “SAR/PAR Orientation Webinar Series,” are available via YouTube.

  • Session one reviews general information and Eligibility Requirements.
  • Session two reviews chapter one.
  • Session three reviews chapter two.
  • Session four reviews chapter three.
  • Session five reviews chapter four.
  • Session six reviews chapter five and post-survey activities.

The webinars were created to help users prepare for survey, provide correct documentation, learn about the functions and fields of the SAR/PAR, and understand the post-survey procedures and timelines. The webinars have been separated by chapter so that viewers can easily find and view the areas of the SAR/PAR they’d like to watch.

National Cancer Database News

New Quality of Care Measures Released

This summer, the National Cancer Database (NCDB) will release three new quality measures along with updates to existing measures within the Cancer Program Practice Profile Reports (CP3R) and Rapid Quality Reporting System (RQRS).

New CP3R Measures

Bladder Surveillance Measures

  • Neo-adjuvant or adjuvant chemotherapy offered or administered for patients with muscle-invasive cancer undergoing radical cystectomy (BLCT)
  • Radical or partial cystectomy; or tri-modality therapy (local tumor destruction/excision with chemotherapy and radiation) for clinical T234N0M0 patients, first treatment within 90 days of diagnosis (BLCSTRI)

Kidney Surveillance Measure

  • Pediatric Measure: At least one regional lymph node is removed and pathologically examined for primarily resected unilateral nephroblastoma (PD1RLN)

The purpose of surveillance measures is to identify the status quo as well as monitor patterns and trends of cancer care to guide decision making and resource allocation. These measures are available for all diagnosis years reported in the application. Estimated performance rates for surveillance measures are not assessed by the CoC.

New Colon Measure Censor Implemented

A new censor for the Colon 12RLN measure was also implemented to enable the manual recategorization of specific incomplete cases following review.

  • Code 43: Positive FNA; nodes removed surgically were negative due to neo-adjuvant chemo

This censor allows registrars to recategorize records from Incomplete to Not Eligible if:

  • Regional lymph node(s) were positive upon FNA (95), but lymph nodes removed surgically are negative due to administration of neoadjuvant chemotherapy

Measure-specific censors may be assigned within the individual case review function in the exclusions column in CP3R and in the Case List tab in RQRS.

All quality of care measure specifications, measure changes, and release notes are posted on the CoC Quality Measures website.

Additional questions may be directed to or

NCDB Committee Meeting Updates

The Commission on Cancer (CoC) held its annual Spring Meetings in May. The National Cancer Database (NCDB) worked with our dedicated volunteers to discuss our work over the past year and our future direction. During this meeting, the Quality Integration Committee (QIC), which clinically informs NCDB work, reviewed the following items.

The Site-Specific Leader Program

Last year, the QIC introduced the Site-Specific Leaders (SSLs) program. SSLs are disease-specific clinical experts who review clinical questions about CoC Quality of Care measures and assist the Measure Subcommittee by ensuring measures remain up to date with clinical evidence. Since January, SSLs have responded to one to two questions a month and are becoming more fully integrated in the measure development and maintenance process.

Future Directions of the NCDB

Ryan McCabe, Senior Manager of the NCDB, reviewed the work the NCDB is doing with QuintilesIMS, the registry vendor for the American College of Surgeons. Over the coming years, NCDB submissions and many of the NCDB reports will be updated and made available through QuintilesIMS in a system that is easy to use and captures data in near-real time. We expect limited disruptions to the daily work of CoC programs. As additional details become formalized they will be communicated to our programs.

Measure Development

Seven new quality measures were presented for QIC review and approval.

Rectal Measures

  • Measure 1: 30-day mortality rate after surgery
  • Measure 2: 90-day mortality rate after surgery
  • Measure 3: At least 12 regional lymph nodes are removed and pathologically examined for resected rectal cancer
  • Measure 4: Rate of involved Circumferential Margin for Rectal Resections

Kidney Measures

  • Measure 1: Tissue sampling/diagnosis should precede systemic therapy for metastatic disease
  • Measure 2: Patients undergoing nephrectomy in the setting of N+ disease should undergo LN dissection, biopsy or sampling to establish the diagnosis of pN+ disease
  • Measure 3: Patients undergoing ablation should have a biopsy to confirm the diagnosis

Following approval, these measures will be prioritized for release.

Participant Use Files (PUFs)

The PUF program continues to be successful, and there is increased interest in NCDB PUF applications. A total of 872 applications were approved for the most recent file (2004–2014).

Collaborative Research Proposals

The QIC also discussed the importance of developing a process to evaluate, prioritize, and respond to research proposals involving NCDB data that are neither Special Studies nor able to be completed through a PUF application.

The NCDB staff would like to thank our QIC volunteer members for the time, support, participation, and passion you bring to your work. We could not serve our programs without the time and dedication of our volunteer leadership.

Educational Program Updates

Register to Attend Cancer Programs Conference: Creating a Culture of Quality

Register today to attend the 2017 Cancer Programs Conference: Creating a Culture of Quality on September 8-9 in Rosemont (Chicago), IL. This conference was developed by the American Joint Committee on Cancer (AJCC), Commission on Cancer (CoC), American College of Surgeons Clinical Research Program (ACS CRP), National Accreditation Program for Breast Centers (NAPBC), and National Cancer Database (NCDB). The content is targeted for health care providers committed to providing high-quality, comprehensive, multidisciplinary, patient-centered care to patients with cancer and breast disease.

See past and present Cancer Programs leadership discussing working together for better cancer care, creating a learning culture, evolution of clinical trials, big data, survivorship care plans, and more. In addition, you can hear industry peers discussing best practices on topics such as patient navigation, patient-reported outcomes, quality improvement and creating a palliative program. For more information please see the current agenda on the event web pages.

Register before July 14 to receive the early bird rate of $1300.

E-mail with any questions.

News from Cancer Programs

ACS Clinical Research Program News

New Special Study Announced

Ductal carcinoma in situ (DCIS), or stage 0 breast cancer, is diagnosed in more than 50,000 women in the U.S. each year. Current National Comprehensive Cancer Network (NCCN) guidelines dictate that DCIS be treated upon diagnosis with a combination of surgery, radiation, and hormonal therapy treatments similar to those recommended to patients with invasive cancer. However, there is an emerging debate around whether “active surveillance” for DCIS may also be a safe and less morbid option in women with some subtypes of DCIS.

In February 2017, the Alliance for Clinical Trials in Oncology Comparison of Operative to Monitoring and Endocrine Therapy (COMET) clinical trial was activated to look at the risks and benefits of active surveillance compared with usual care in the setting of a pragmatic prospective randomized trial for low risk DCIS. As an important adjunct to this trial, a Commission on Cancer (CoC) Special Study will be launched in 2018 to investigate outcomes from DCIS treatment retrospectively. A pilot study will take place in the fall of 2017 with a small number of sites in an effort to garner feedback from registrars on data collection for patients with DCIS. Participating sites will be asked to abstract clinical information to be entered into a secure web-based form through CoC Datalinks. The data being requested include updates on specific clinical information currently in the National Cancer Database as well as abstraction of surveillance and recurrence data for patients with DCIS.

Each site will be requested to enter data for 20 preselected patients with a diagnosis of DCIS. Sites will have eight weeks to submit follow-up information through the website for these 20 patients. As in previous special studies, detailed instructions for the data abstraction will be provided. At the completion of the study, participating pilot sites will be requested to enter feedback on data collection via a short survey and share suggestions on how we can improve the process for accurately capturing this information for the 2018 Special Study.

When the pilot study is completed, participating sites will receive credit for Standard 4.7, Studies of Quality. This pilot study will also fulfill the requirements set forth by Standard 5.7 for Special Studies. Sites participating in the pilot study will not be required to participate again in the DCIS Special Study in 2018. Please e-mail if you are interested in participating in the pilot study. Note that participation in the pilot study is not required. We will notify sites of the status of their participation by early July. We look forward to working with you.