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

From the Director's Desk

Inter-Programmatic Coordination and Communication

Heidi Nelson, MD, FACS

Heidi Nelson, MD, FACS
Medical Director, ACS Cancer Programs

For the past two years we have paid deliberate attention to the manner and ways in which the individual programs that comprise the American College of Surgeons (ACS) Cancer Programs are interdependent. We started by seeking to understand, at a more granular level, how advancements in diagnostic or therapeutic best cancer practices impact all the products and services of the Cancer Programs. In this one scenario, for example, we might expect that the National Cancer Database (NCDB) would first validate the new cancer practices by confirming the findings. From there, the American Joint Committee on Cancer (AJCC) would make adjustments to staging in order to reflect the relative impact that the new practice would have on cancer prognosis. Once AJCC staging changes are made, downstream changes need to be made in the STORE Manual, synoptic operative reports, and affected standards and quality measures. A similar process occurs when a cancer practice is no longer considered appropriate and needs to be removed from the content of STORE and/or AJCC materials, and likewise when new cancer types emerge, such as HIV- and HPV-related cancers, the staging and standards often have to be adjusted. Acknowledging the interdependencies of definitions, classifications, and codes across programs affords us the opportunity to coordinate the changes that are required across the programs and allows us to make the changes well in advance of the time when accredited programs need to implement them. It is our hope that coordinating the content from across the programs and communicating early will help everyone—from vendors to accredited programs—plan for how they will adapt to the changes as each new year approaches.

With that in mind, you will notice in the content below an article devoted to communicating updates from all of the Cancer Programs that can be expected to take effect next year. The collated information helps summarize, in one place, what accredited programs can expect to implement in 2022, including: (1) compliance expectations for Commission on Cancer (CoC) standards; (2) National Accreditation Program for Breast Centers (NAPBC) standards revisions; (3) NCDB reporting tool and quality measure upgrades; (4) STORE Manual coding changes; (5) implementation of the Quality Portal (QPort), the new online system for managing accreditation program activities; and (6) AJCC’s release of the new cancer surveillance staging updates in the form of the Dynamic Link Library (DLL) and Application Programming Interface (API) for vendor and electronic medical records. Further details on each item will be forthcoming in the next several weeks leading up to 2022 implementation. Stay tuned.

What’s New for Cancer Programs in 2022

The ACS Cancer Programs team has been hard at work developing resources to support you and your accredited programs. We wanted to provide advance notice of some of the things to expect beginning in 2022. More details on each of these items will be shared over the coming months, but here is a basic overview of what’s to come. Please send your comments to


The QPort was developed as a standard online system for managing all ACS accreditation/verification program activities, including the CoC, the NAPBC, and the National Accreditation Program for Rectal Cancer (NAPRC). QPort will be released to CoC programs this fall and will include the new CoC Pre-Review Questionnaire (PRQ) for programs due for a site visit in 2022. The PRQ is the application programs will use to document standards compliance with the 2020 standards. The PRQ replaces the Survey Application Record (SAR).

CoC Standards

For CoC site visits being conducted in 2022, accredited programs will be expected to demonstrate a 70 percent compliance rate for CoC Operative Standards 5.7 and 5.8 (Total Mesorectal Excision and Pulmonary Resection) for 2021 cases. Programs will need to show documentation of their final plan for how they will achieve compliance with Standards 5.3, 5.4, 5.5, and 5.6 (Sentinel Node Biopsy for Breast Cancer, Axillary Lymph Node Dissection for Breast Cancer, Wide Local Excision for Primary Cutaneous Melanoma, and Colon Resection) during 2023 site visits. The Cancer Surgery Standards Program (CSSP) continues to release resources to support implementation of the operative standards. In addition, a further adjustment to the follow-up timeline in Standard 6.5 (Follow-Up of Patients) will be communicated for implementation in 2022 to further reduce the follow-up burden for programs. Although we plan to revise and release new quality measures in the Rapid Cancer Reporting System (RCRS) in 2022, we anticipate that the current nine required for accreditation will remain the same for compliance in 2022 for Standard 7.1 (Accountability and Quality Improvement Measures).

STORE Manual

The v2022 STORE Manual, effective with diagnosis year 2022, has been posted to the NCDB Call for Data website. The 2022 Summary of Changes identifies coding clarifications, updates to cases eligible for reporting, word changes, and new data items for collection.


The NCDB will soon be updating and releasing the following reporting tools with 2019 data: Hospital Comparison Benchmark Reports, Survival Reports, Cancer Quality Improvement Program (CQIP) Reports, and the Site by Stage Distribution Report. We also will be releasing a new video on how to use the NCDB reporting tools along with a new video series for Cancer Liaison Physicians on how to use the NCDB tools to assess program performance and prepare reports for the cancer committee.


The NAPBC is finalizing work on the new standards for accreditation and will be preparing to collect constituent feedback on the draft in the coming months prior to finalizing and determining the implementation timeline. More details to come.


The Cancer Surveillance DLL is being released in August 2021 to cancer registry vendors, so they will have the updates they need to support cancer staging data collection beginning in 2022. Cancer program registry staff are encouraged to contact their vendors to ask for these updates to their software at the earliest possible time to support 2022 abstracting.

Updates to the AJCC API will be released this fall to licensed vendors. Updates provide the electronic health records (EHR) vendors with the choice of either condensed or expanded stage tables for all disease sites, and it also will return a list of valid values for staging a disease site.

ACS Cancer Programs Releases Accreditation Fee Updates

ACS Cancer Programs annual accreditation fees have been adjusted for 2022. The new fee amounts will go into effect for subscriptions beginning or renewing on or after January 1, 2022. For detailed CoC, NAPRC, and NAPBC fee information and schedules, please review the 2022 fee chart, which is available in each program’s portal.

Learn More about Cancer Programs Sessions at Clinical Congress 2021

Since Clinical Congress is virtual this year, you can maximize your registration fee and participate in more sessions. ACS Cancer Programs is sponsoring several sessions, including the following on Wednesday, October 27:

Panel Session PS525: Operative Standards and Intraoperative Decision Making: Thyroid Cancer will take place from 10:00 to 10:55 am CT. The session will build on recent publications by the ACS Cancer Care Standards Development Committee on operative standards for thyroidectomy. Presenters will review the most recent updates in imaging and surgical approaches and discuss the current controversies in patient care, including observation versus lobectomy versus total thyroidectomy for early-stage thyroid cancer, as well as the indications and decision-making for lymphadenectomy. The session will be moderated by Tracy S. Wang, MD, FACS, and co-moderated by Amy Y. Chen, MD, MPH, FACS.

Catch the CoC Oncology Lecture at 1:00–1:55 pm CT. ACS Cancer Programs Medical Director Heidi Nelson, MD, FACS, will introduce lecturer Lisa A. Newman, MD, MPH, FACS, from Weill‐Cornell Medicine in New York.Dr. Newman is a surgical oncologist with a practice dedicated to breast cancer management. Her primary research has focused on race/ethnicity-related variation in breast cancer risk and outcome, the evaluation and management of high-risk patients, broadened applications for neoadjuvant chemotherapy, and special surgical techniques such as the skin-sparing mastectomy and lymphatic mapping/sentinel lymph node biopsy. Dr. Newman’s extensive research related to disparities in breast cancer risk and outcome has been published in numerous peer-reviewed medical journals and was featured in CNN’s documentary “Black in America 2.”

Finally, there is Panel Session PS563: Ten Hot Topics in Surgical Oncology from 2:00 to 2:55 pm CT. Moderated by John H. Stewart IV, MD, FACS, this panel addresses 10 of the most current and controversial issues in surgical oncology.

If you can’t participate in these sessions live, you can always watch them on demand at your convenience. For more information on cancer-related programming at this year’s Clinical Congress, please visit our web page. Stay tuned to this newsletter for more details on each of these sessions.

Never Too Late

Frederick L. Greene, MD, FACS

Frederick Greene, MD, FACSMy reverence for cancer registrars and appreciation for the role of cancer registries began well before I assumed the role of medical director of cancer data services at the Levine Cancer Institute seven years ago, well before I began my involvement with the AJCC Cancer Staging Manual 25 years ago, and well before I began my association with the Commission on Cancer 35 years ago! My infatuation with all aspects of cancer registries and the dedicated professionals who oversee them began when I was a medical student and a neophyte surgeon in training. One of the first journal articles that I ever published used registry data to review the advances made in the treatment of Wilm’s Tumor in the pediatric population. This was in 1969! I was also fortunate to work with cancer registrars and the Connecticut State Cancer Registry as a young surgical resident and American Cancer Society Fellow at Yale in 1972.

My point in relating this ancient history is that opportunities for young physicians to work with registrars and registries can lead to a lifelong understanding and appreciation for what you and your colleagues do on a daily basis. As I relate frequently to physician groups regarding cancer staging, the TNM system is our “language of cancer,” and when do we learn a language the easiest? When we are young! Similarly, the time to acquaint physicians with cancer registries is during medical school, residency, and fellowship experiences. This is a mission that has given me an immense amount of joy during my academic surgical career. This is a message that I have also attempted to relate to physician audiences over the years.

Although many clinicians dedicated to cancer care may not have had an opportunity for association with cancer registries early in their careers, all is not lost. At the Levine Cancer Institute in Charlotte, NC, we have developed a strategy of inviting clinicians to give a presentation at the monthly meetings of our entire registry staff. The purpose of this exercise, ostensibly, is to provide education for our registrars covering all disciplines of cancer care. The hidden agenda, however, is to educate these clinicians as to the information that is contained in the cancer abstract and the vast amount of important material that is available to them in their particular specialty. The overarching goal is that these individual physicians then become disciples and carry this information back to their particular specialty sections.

There are so many opportunities for physicians to become involved in registry activities at every level of their careers. Whether you and your registry are housed in an academic training institution or a community hospital, remember that it is never too late to introduce clinicians to the incredible world of the cancer registry.