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

CoC Quality of Care Measures

CoC Measures for Quality of Cancer Care

Cancer registry data elements are nationally standardized and considered open source. Each of these measures was developed by the CoC with the expectation that cancer registries would be used to collect the necessary data to assess and monitor concordance with the measures. Extensive assessment and validation of the measures was performed using cancer registry data reported to the National Cancer Data Base (NCDB).

All measures are designed to assess performance at the hospital or systems-level, and are not intended for application to individual physician performance.

Primary Site

Measure Type

Measure Specifications






(NQF #219) Radiation therapy is administered within 1 year (365 days) of diagnosis for women under age 70 receiving breast conserving surgery for breast cancer.



(NQF #0559) Combination chemotherapy is considered or administered within 4 months (120 days) of diagnosis for women under 70 with AJCC T1cN0M0, or stage IB - III hormone receptor negative breast cancer.



(NQF #0220) Tamoxifen or third generation aromatase inhibitor is considered or administered within 1 year (365 days) of diagnosis for women with AJCC T1cN0M0, or stage IB - III hormone receptor positive breast cancer..



Radiation therapy is considered or administered following any mastectomy within 1 year (365 days) of diagnosis of breast cancer for women with ≥ 4 positive regional lymph nodes.


Quality Improvement

Image or palpation-guided needle biopsy (core or FNA) is performed to establish diagnosis of breast cancer.



Breast conservation surgery rate for women with AJCC clinical stage 0, I, or II breast cancer.






(NQF #0223) Adjuvant chemotherapy is considered or administered within 4 months (120 days) of diagnosis for patients under the age of 80 with AJCC Stage III (lymph node positive) colon cancer.


Quality Improvement

(NQF #0225) At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer.






Radiation therapy is considered or administered within 6 months (180 days) of diagnosis for patients under the age of 80 with clinical or pathologic AJCC T4N0M0 or stage III receiving surgical resection for rectal cancer.





Quality Improvement

At least 15 regional lymph nodes are removed and pathologically examined for resected gastric cancer.

Non-Small Cell Lung





At least 10 regional lymph nodes are removed and pathologically examined for AJCC stage IA, IB, IIA, and IIB resected NSCLC


Quality Improvement

Systemic chemotherapy is administered within 4 months to day preoperatively or day of surgery to 6 months postoperatively, or it is considered for surgically resected cases with pathologic, lymph node-positive (pN1) and (pN2) NSCLC.

Breast Measure Specifications

Colon Measure Specifications

Rectum Measure Specifications

Gastric Measure Specifications

Non-Small Cell Lung Measure Specifications

Current Reporting Activities

The Cancer Program Practice Profile Reports (CP3R) were first released in January 2005, and since then have been updated annually. This reporting tool has demonstrated that improvements in data quality can demonstrate the quality of patient care when the entire cancer committee supports system-level enhancements to ensure complete and precise documentation.

The Rapid Quality Reporting System (RQRS) was developed to assist CoC-accredited cancer programs in promoting evidence-based cancer care at the local level. It is a Web-based, systematic data collection and reporting system that advances evidence-based treatment through a prospective alert system for anticipated care that supports care coordination required for breast and colorectal cancer patients at participating cancer programs. 

CoC Standards 4.4 and 4.5 Implementation

The Quality Integration Committee has revised expected Estimated Performance Rates (EPR) for accountability and quality measures assessed with Commission on Cancer (CoC) Standards 4.4 and 4.5. These standards require performance levels be met annually according to the specified accountability and quality improvement measures defined by the CoC.

Information on expected compliance rates are found in a special CoC Source article, “CoC Standards 4.4 and 4.5 Implementation for Surveys in 2015.”

History of the NQF Endorsed Measures for Quality of Cancer Care for Breast and Colorectal Cancers

The Commission on Cancer (CoC) submitted quality of care measures for breast and colorectal cancer to the National Quality Forum (NQF) in response to its calls for proposed breast measures in late 2004 and colorectal measures in early 2005. Measures were reviewed by the CoC’s breast and colorectal disease site teams prior to submission to the NQF for consideration.

NQF Evaluation Criteria

An NQF Steering Committee for quality of cancer care measures was charged with ensuring that pertinent stakeholders had appropriate opportunity to review and provide input on the measures under consideration. Two technical panels made up of breast and colorectal experts in the areas of surgery, radiotherapy, medical oncology, health care consumers, and health services research—assembled by the NQF—provided technical evaluation of the proposed measures. The NQF Steering Committee and technical panels reviewed measures using four criteria:

  • Importance: The extent to which a measure reflects variation that has the potential for improvement
  • Scientific acceptability: That a measure is reliable, valid, precise, and adaptable to patient preference
  • Usability: Information produced as part of the measure could be used to make decisions and/or take actions, and that reported performance levels were statistically, and clinically, meaningful
  • Feasibility: That data can be obtained within the normal flow of clinical care and that implementation of the measure was achievable.

The CoC's Proposed Measures

Eight measures proposed by the CoC (four breast cancer, three colon cancer, and one rectal cancer) were reviewed by the NQF. In response to specific comments from the NQF, the CoC examined additional data and made revisions to the originally proposed measures. Five measures were determined to meet the evaluation criteria established by the NQF.

Four measures were endorsed by the NQF as accountability measures, meaning that these measures can be used for such purposes as public reporting, payment incentive programs, and the selection of providers by consumers, health plans, or purchasers. Quality improvement measures are intended to be used for internal monitoring of performance within an organization or group so that analyses and subsequent remedial actions can be taken, as appropriate. Surveillance measures can be used at the community, regional, and/or national level to monitor patterns and trends of care in order to guide policymaking and resource allocation.

Through a parallel process the American Society for Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) developed a similar set of measures for breast and colorectal cancer. Facilitated by the NQF, CoC, ASCO, and NCCN agreed to synchronize their developed measures to ensure that a unified set were put forth to the public. 

The National Quality Forum

The National Quality Forum (NQF) is a not-for-profit membership organization that develops and implements national strategies for health care quality measurement and reporting. Membership in the NQF has broad public and private participation, including but not limited to health care consumers, purchasers (both private and public), employers, health care professionals, health plans, and organizations involved in health care research or quality improvement. The members of the NQF work to promote common approaches to measuring health care quality and promoting quality improvement. Funding support for the development of the National Voluntary Consensus Standards for Diagnosis and Treatment of Breast and Colon Cancer was provided by the following Federal agencies: Agency for Healthcare Research and Quality, the National Cancer Institute, the Centers for Medicare and Medicaid Services, and the Centers for Disease Control and Prevention.

For questions related to the release of these quality measures, please contact the NCDB at