Nearly a decade ago, the Alliance for Clinical Trials in Oncology/American College of Surgeons (ACS) Cancer Research Program set out to define operative standards that could improve documentation participating in clinical trials. In order to conduct research, we needed consistency from hospital to hospital, and clear documentation of what occurred during the operation. We specifically sought to define the critical elements of an operation that had an impact on oncologic outcomes. Out of this process, we quickly learned that we had an opportunity to standardize care not just for patients participating in clinical trials, but for every patient we treat.
That’s what we set out to do when we created the Cancer Surgery Standards Program (CSSP). The new program implements technical standards for cancer operations, provides tools to make adherence and documentation easy, documents in a consistent manner what occurred during an operation, and gathers data that can be used in new clinical trials.
We know many things surgeons do during an operation impact the patient’s quality of life, survival, chance of recurrence and other factors related to their care. In fact, multiple studies have shown that adherence to national standards improves care for patients with cancer. Patients with stage III or high-risk stage II colon cancer who receive care adhering to national treatment guidelines live longer than those whose care doesn’t follow the guidelines.2
But far too often, adherence to standards is poor. In one study, only about a third (36.5%) of stage 0/I patients with gastric adenocarcinoma and less than half (41.8%) of stage II/III patients received care that met minimum standards.
As surgeons, we need to do better, and we can do better. As a surgical community, we need to make it easier for surgical teams to meet these standards with every patient they see. Using the tools and resources of the CSSP, we can now do that.
The CSSP will provide hospitals with three tools:
- Evidence-based standards, developed by experts
- Synoptic operative reports that will help surgical teams document that they’ve adhered to the standards and collect data that can be used for new research
- Easily accessible educational materials for the entire surgical and quality team
These tools will increase consistency from one hospital to another, while helping surgical teams better communicate with the entire patient care team. They will also help new surgeons know they are taking the right steps in the operating room, while making it easier for experienced surgeons to document what they do.
Soon, compliance in the operative standards will be required for hospitals accredited by the ACS Commission on Cancer. As more hospitals implement these new tools, we will know that the care they provide meets the highest standards. Patients also will know that we’ve done all we can to give them a better, longer life.
Learn more about the Cancer Surgery Standards Program.
References
- Slote Morris Z, Wooding S and Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med. 2011 Dec;104(12):510-20. DOI:10.1258/jrsm.2011.110180.
- Zhao B, Tsai C, Hunt KK, et al. Adherence to surgical and oncologic standards improves survival in breast cancer patients. J Surg Oncol. 2019 Aug;120(2):148-159. DOI: 10.1002/jso.25506
- Zhao B, Blair SL, Katz MHG, et al. Adherence with operative standards in the treatment of gastric cancer in the United States. Gastric Cancer. 2020 May;23(3):550-560. DOI:10.1007/s10120-019-01028-5.
- Bidwell SS, Merrell SB, Poles G, Morris AM. Implementation of a synoptic operative report for rectal cancer: a mixed-methods study. Dis Colon Rectum. 2020 Feb;63(2): 190-199. DOI: 10.1097/DCR.0000000000001518.
