Standard 5.3-5.6: Operative Standards
Site Visits Occurring in 2025 and 2026
For site visits occurring in 2025 and 2026, a site may meet CoC Standards 5.3-5.6 through an alternative compliance pathway by performing an internal audit of its compliance with Standards 5.3-5.6. If compliance is not met with any of these standards, an action plan must be developed, outlining the specific issue(s) affecting compliance and the interventions that will be implemented to achieve compliance. The results of the internal audit and the action plan must be documented in the cancer committee minutes. An action plan must be developed for each potentially non-compliant standard.
The internal audit must be conducted, and the resulting action plan must be documented in cancer committee minutes from a meeting during the year before or the year of the site visit and must be from before the Site Reviewer selects the cases that will be reviewed during the site visit. For example, if the site visit is in 2026, then the internal audit/action plan must be documented in the minutes from a 2025 or 2026 cancer committee meeting.
During the site visit, the medical record review will be conducted. If the expected compliance percentage is not met, the site reviewer will evaluate the results of the site’s internal audit and action plan as documented in the cancer committee minutes. A “deficient but resolved” rating may then be given.
Meeting Compliance with Operative Standards 5.3-5.6 in 2026
CoC Operative Standards 5.3-5.6 were updated in 2025, outlining new requirements for meeting compliance with these standards.
Beginning in 2026, programs must conduct an internal audit each calendar year to confirm eighty percent (80%) compliance with the technical requirements and synoptic operative reporting requirements of Standards 5.3-5.6. A separate audit must be conducted for each standard.
The internal audits must include thirty (30) eligible operative reports for each standard (or all applicable cases) and it must be documented using the appropriate CoC Operative Standards Audit Template. The CoC Operative Standards Audit Templates are forthcoming and will be accessible through the Quality Portal.
If the internal audit demonstrates less than 80% compliance, an action plan must be developed for each non-compliant standard, and the program must complete an additional internal audit six months after the initial audit.
The results of the internal audit and any action plans must be presented and discussed by the cancer committee and documented in the cancer committee meeting minutes.
Please note: these changes do not apply to Standards 5.7 and 5.8 and these changes will not impact site visits occurring during 2026.
Site Visits Occurring in 2027 and beyond
Beginning in 2027, site visits will only evaluate the annual internal audits (and if applicable, any required action plans) completed by the program to determine compliance with Operative Standards 5.3-5.6.
During the site visit, Site Reviewers will evaluate two operative reports for each standard to confirm the internal audits are being performed correctly. This evaluation during the site visit is for educational purposes only. The operative reports evaluated and the results of this evaluation will not impact the compliance ratings awarded for Standards 5.3-5.6, if the required annual internal audits are completed and include documentation of any necessary action plans and follow-up audits for any applicable standard.
Standard 5.9: Smoking Cessation for Patients with Cancer
The CoC has released Standard 5.9: Smoking Cessation for Patients with Cancer, effective January 1, 2026.
Starting January 1, 2026, programs are expected to develop the protocol and initiate the process. An audit must be completed to establish baseline compliance. If the required threshold is not met, no action plan is required.
Starting January 1, 2027, programs are expected to demonstrate compliance with the standard. The annual audit must show that 90% of cancer patients with newly diagnosed cancer are screened for current smoking status and 80% of active smokers are treated or referred. If either of these metrics are not met, the program must develop an action plan to achieve these targets.
Standard 6.4: Rapid Cancer Reporting System: Data Submission
- In 2021, Standard 6.2: Data Submission and Standard 6.3: Data Accuracy were retired and replaced with Standard 6.4:Rapid Cancer Reporting System (RCRS) Data Submission.
- Starting January 1, 2025, the RCRS data and quality measure performance reports to the cancer committee cannot also satisfy the CLP reporting requirements for Standard 2.2: Cancer Liaison Physician.
Standard 6.5: Follow-up of Patients
Starting January 1, 2022, Standard 6.5 requires a rolling 15-year requirement for long-term follow-up. Follow-up on cases older than 15 years from the most current year of completed cases will no longer be required for submission to the National Cancer Database.
Standard 7.1: Accountability and Quality Improvement Measures
Beginning in 2025, the CoC programs must resume meeting compliance with Standard 7.1 by reviewing their performance against the updated quality measure performance benchmarks, identifying any deficiencies with expected performance rates, and documenting the review of the quality measures and any necessary action plans in the cancer committee meeting minutes.
Starting January 1, 2026, CoC Site Visits will evaluate compliance with Standard 7.1: Quality Measures based on activity in 2025.
The four required quality measures include:
- C12RLN: For patients undergoing a colon resection for colon cancer, at least 12 regional lymph nodes are removed and pathologically examined at time of resection.
- Performance benchmark for C12RLN: 95%
- ACT: For patients under the age of 80 with surgically-managed pathologic stage III colon cancer (N>0), adjuvant chemotherapy is initiated within 4 months (120 days) of diagnosis, or recommended.
- Performance benchmark for ACT: 90%
- LCT: For patients with surgically managed NSCLC, pathologically staged T2 and >4cm, or T>=3, or N>0, systemic therapy (chemotherapy, immunotherapy or targeted therapy) was initiated within the 4 months prior to surgery or after surgery, or was recommended.
- Performance benchmark for LCT: 70%
- BCSdx: For patients with AJCC Clinical Stage I-III breast cancer, the first therapeutic surgery in a non-neoadjuvant setting is performed within and including 60 days of diagnosis.
- Performance benchmark for BCSdx: 70%
The program’s expected performance benchmark for each quality measure can be found in the Rapid Cancer Reporting System (RCRS).
For more information, please review this recent Cancer Program News article and the National Cancer Database Quality Measures webpage.
Standard 9.1: Clinical Research Accrual
The CoC is offering an alternative pathway for Standard 9.1: Clinical Research Accrual compliance for activity from 2025 through 2028.
Programs unable to accrue patients to clinical research at the required percentages outlined in Optimal Resources for Cancer Care (2020 Standards) may receive a "Deficient but Resolved" rating if the following requirements are met:
- Provide an annual report to the cancer committee that includes the following:
- Number of subjects enrolled in eligible clinical research studies (numerator)
- Total number of annual analytic cancer cases (denominator)
- Categories of clinical trials to which patients are accrued and number per category
- Develop and report on a meaningful action plan to achieve the required level of accrual. At a minimum, this plan must include:
- Open clinical research studies with identification of those with a nearing end/closing date
- Discussion of potential future clinical trial availability, if needed, required to achieve expected accrual percentages
- Review of current resources used for clinical trial accrual and assessment of any additional resources required to achieve expected accrual percentages
- Discussion of strategies to increase clinical trial accrual to expected accrual percentages
The report and action plan must be provided at a cancer committee meeting held in the first quarter of the subsequent year and must include the full calendar years’ worth of data. For example, the report on 2025 accruals must be given at a meeting during the first quarter of 2026.
If accrual percentages are not met for multiple years within the accreditation cycle, reports and action plans must be developed each year that the accrual percentage is not met.
This alternative pathway process may also be used for corrective action, including corrective actions due in 2025. Programs with corrective action due dates before the end of 2025 may provide a year-to-date report and action plan to resolve the deficiency.
Standard 9.2: Commission on Cancer Special Studies
Special Study | 2027
The Assessing the Effectiveness and Significance of the Operative Standards Program (AESOP) grant seeks to evaluate the impact of the Commission on Cancer (CoC) Operative Standards (Standards 5.3-5.8) on short-term cancer care outcomes. One of the grant aims includes a CoC Special Study, which involves Oncology Data Specialists collecting additional data from the medical record on patients included in their cancer registry that underwent cancer surgery at their facility. The Special Study will launch in early 2027. Oncology Data Specialists will receive training and an instructional guide in advance of the Special Study.
Questions may be submitted to AESOP@facs.org.
Standards Specifications by Category
The Specifications by Category section of Optimal Resources for Cancer Care (2020 Standards) has updated standards requirements for Integrated Network Cancer Programs (INCP), NCI-Designated Network Cancer Programs (NCIN), CoC-Pediatric Specialty (CoC-PS), and Pediatric Cancer Programs (PCP). Please review the Specifications by Category section for full details.
