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

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Questions about Virtual Site Visits? Join the September 24 Webinar

The leadership and staff of the American College of Surgeons (ACS) Commission on Cancer, National Accreditation Program for Breast Centers (NAPBC), and the National Accreditation Program for Rectal Cancer (NAPRC) remain committed to the health and safety of our participating accredited program staff, health care professionals, physicians, and patients as we continue to deal with the impact of the COVID-19 pandemic.

Currently our CoC, NAPBC, and NAPRC site reviewers have been given the go ahead to resume scheduling for the remaining 2020 site visits and should be reaching out to those programs that need to reschedule beginning this September/October through June 30, 2021. We’ve asked our site reviewers to confirm dates with all programs that were initially due in 2020 by November 1, 2020.

The American College of Surgeons has created virtual site visit plans for each accreditation and verification program, including the CoC, NAPBC, and NAPRC. The virtual plans we have developed will retain the key components of the in-person visit and offer the same level of quality to assess compliance with the accreditation standards, provide education and consultation, and offer strategies to help programs enhance the quality of their cancer care delivery.

A total of 10 cancer accreditation programs (four CoC, four NAPBC, and two NAPRC) have agreed to serve as pilot sites to test the virtual site visit plans. These pilot site visits are scheduled through October 1, 2020. All of our site reviewers have been trained on the virtual site visit plans and are encouraged to communicate the virtual site visit as an option when talking with their assigned programs about rescheduling. However, where feasible and based on state COVID-19 regulations, in-person visits are allowed and can take place if both the program and site reviewer agree.

We are hosting a webinar on virtual site visits for accredited programs on Thursday, September 24 at 12:00 noon Central Time. Registration is now open for CoC, NAPRC, and NAPBC Virtual Site Visits: What Programs Need to Know, where we will review the components of the virtual site visit plans for each ACS Cancer Program, share results from the pilot site visits, and discuss how the virtual plan option can be utilized by interested programs during the pandemic.

Lastly, we want to remind programs that we have developed COVID-19 Accreditation Trackers for each program to assist with documenting the impact of COVID-19 on compliance with the CoC, NAPBC, and NAPRC accreditation standards. Although 2020 standards compliance is not being reviewed as part of the rescheduled 2020 site visits, the tracker could be used as the basis for a conversation with the site reviewer about the overall impact of the pandemic on the program. The COVID-19 Accreditation Trackers are located in the respective program portals.

We encourage you to regularly visit our accreditation program websites for program updates and resources. We value your continued participation in our accreditation programs and welcome your feedback, questions, and concerns. Please contact us anytime at

CoC Clarifies Registry Accrual for Standard 9.1

The intent of the Commission on Cancer’s Standard 9.1: Clinical Research Accrual is to increase accruals to and availability of clinical research because of its critical role in advancing knowledge in cancer medicine. Accruals to a clinical research study or clinical trial are eligible for Standard 9.1 if the study/trial:

  • Is cancer related
  • Is approved by an internal or external Institutional Review Board (IRB)
  • Has informed, written patient/subject consent (unless consent is waived by the IRB)

Patient registries, including COVID-19 registries, with an underlying cancer research focus may be appropriate for accrual for CoC Standard 9.1 in some cases. However, as of January 1, 2020, a registry that collects information with no guarantee that it will be used in cancer research or lead to clinical scenarios that evaluate one form of care versus another do not qualify as an accrual for CoC Standard 9.1. For example, just submitting patient information to the following registries does not qualify for accrual under Standard 9.1:

  • Lung Cancer CT Database (ACR)
  • National Mammography Database
  • Society of Thoracic Surgeons (STS) on lung and esophageal resections
  • American College of Surgeons COVID-19 Registry
  • American Society of Clinical Oncology (ASCO) COVID-19 Registry
  • American Society of Breast Surgeons (ASBrS) COVID-19 Registry
  • COVID-19 and Cancer Consortium
  • COVIDSurg-Cancer
  • ASH RC COVID-19 Registry for Hematologic Malignancy

A cancer-related registry that includes patient consent and submission of a tissue or biospecimen would qualify as an accrual under Standard 9.1. For example, the NCI COVID-19 in Cancer Patients Study (N-CCaPS).

Please submit questions to the CAnswer Forum or to

Synoptic Operative Reporting Tools Moving Forward

We are pleased to report that we are making steady progress on the production of synoptic operative reports (SORs), and we anticipate that these tools will be ready for dissemination and implementation by January 2021. The content of the reports has been well vetted by diverse focus groups, the vendor for designing and building the digital tools has been selected, the kick-off phase has been completed, and pilot sites have been selected.

Thinking ahead and preparing for the broad dissemination of the tool, we need to identify sites that plan to use the tool. We also need sites to identify their surgeon super user and IT contacts. The surgeon super user would be the local surgeon who champions the introduction and implementation of the tool at the local hospital. He or she will be the first to learn about the tool and will be expected to help colleagues become familiar with the features as well as help make the tool work in their local Electronic Medical Record (EMR). We will also need sites to identify IT contacts at their hospitals who work with the local version of the EMR for customization as needed.

Hospital Registrars at Commission on Cancer-accredited facilities have already been sent a survey to collect information on how their facilities plan to achieve compliance with the synoptic operative reporting requirements of the CoC standards. Those at facilities that plan to use our tool have also been asked to provide contact information for their surgeon super user and IT contact, if already available.

We are also pleased to report that thanks to the invaluable feedback from focus groups, these reports will not only fulfill the synoptic operative reporting requirements for the four CoC 2020 standards (5.3 through 5.6), but also will be comprehensive and flexible enough to fulfill all surgical reporting needs. Although the focus of these SORs is on capturing cancer-specific information, the reports also include universal surgical data elements and information required for the generation of billing codes as well as fulfilling other information functions. The vendor is working closely with users to make the SORs easy to understand and complete.

We look forward to sharing additional updates in the coming months. Visit our website for information about implementation of the CoC operative standards and the Cancer Surgery Standards Program. Questions should be sent to

Pediatric Programs Exempt from Standards 8.2 and 8.3

The Commission on Cancer has recently determined that CoC-accredited programs with the “Pediatric Cancer Program” category designation are exempt from Standard 8.2: Cancer Prevention Event and Standard 8.3: Cancer Screening Event. Pediatric cancer programs will not be required to demonstrate compliance with either Standard 8.2 or Standard 8.3 in 2020 and beyond. Optimal Resources for Cancer Care (2020 Standards) will be updated to reflect this change.

Questions? Please e-mail

NAPRC Section of CoC Datalinks to Close August 31, 2020

The National Accreditation Program for Rectal Cancer section of Commission on Cancer Datalinks will be retired on August 31, 2020, and programs will no longer have access to it.

The NAPRC online portal has moved to a new platform. A helpful user guide is available to assist with navigating the new portal for accredited and applicant NAPRC programs. Instructions for action items related to migrating into the new portal were e-mailed directly to rectal cancer program contacts and are linked on the home page of the NAPRC section of CoC Datalinks.

No documentation uploaded into the NAPRC section of CoC Datalinks will be transferred to the NAPRC Quality Portal. If a program wishes to save any documentation uploaded in the NAPRC section of CoC Datalinks, it must download copies before August 31, 2020.

Exception: If a program has undergone a NAPRC site visit and is resolving deficiencies, it will continue to utilize CoC Datalinks to manage NAPRC accreditation until deficiencies are resolved. Next steps on transitioning into the new NAPRC Quality Portal will be provided when accreditation is awarded.

Questions? Please e-mail

Deadline Extended: ACS CRP Mediastinal Lymph Node Stations ID Survey

The American College of Surgeons Cancer Research Program (ACS CRP) is conducting a survey on the identification of mediastinal lymph node stations as a follow-up to the publication of the Operative Standards for Cancer Surgery manuals. As lung cancer staging and prognosis rely on appropriate lymph node assessment, we would like to identify how best to teach accurate mediastinal lymph node staging. We are interested in gathering responses from general thoracic surgeons, cardiothoracic surgeons, and general surgeons who perform thoracic surgery, and we would appreciate if you could share this survey with these individuals.

The survey contains seven questions and should take approximately five to 10 minutes to complete. Your responses are anonymous. You will be able to review the correct answers to the questions after submitting some demographic information. Links to additional educational reference materials are available on the last page, which we hope will be useful to your practice. The deadline for completing the survey has been extended to August 31, 2020.

Take the Mediastinal Lymph Node Survey

If you have any technical issues with the survey, please contact Linda Zheng at For questions about the study, please contact Chi-Fu Jeffrey Yang at

Changes Announced for the NCDB STORE Manual

A new version of National Cancer Database (NCDB) STORE Manual v2021 will be released for diagnosis years beginning with January 1, 2021. To prepare registrars for upcoming changes, we will be communicating highlighted changes in Cancer Programs News:

  • Changes for coding Phase I Radiation Treatment Modality [1506]

Change to current code 99, Radiation treatment modality unknown, Unknown if radiation treatment administered to:

98 Radiation treatment administered; modality unknown

99 Unknown if radiation treatment administered

  • Clarification for gastro-intestinal stromal tumors (GIST)

In STORE 2018, the rule for GIST reportability has been clarified:

Gastro-intestinal stromal tumors (GIST) and thymomas are frequently non-malignant. However, they must be abstracted and assigned a Behavior Code of 3 if they are noted to have multiple foci, metastasis, or positive lymph nodes. GIST, NOS with a Behavior Code of 1 is not reportable; GIST, NOS with a Behavior Code of 3 is reportable, and the Date of Initial Diagnosis [390] is the earliest date the GIST is found malignant, noted to have multiple foci, metastasis of positive lymph nodes.

Submit 2020 Call for Data Closes August 31

The August 31, 2020 (11:59 pm CST), deadline for the 2020 Call for Data window for initial submissions and corrections is fast approaching. Please review the website for complete information online.

Reminder: 2020 ACS Quality and Safety Conference VIRTUAL Begins This Friday, August 21

2020 ACS Quality and Safety ConferenceThe 2020 American College of Surgeons Quality and Safety Conference is rescheduled for August 21–24, 2020, and sessions will be held each day from 8:00 am to 12:00 noon Central Daylight Time. The final program is available on the ACS website.

This event offers something for everyone, including the following:

  • Free access to 600+ total presentations, individual speaker talks, panel discussions, fireside chats, abstract research, and quality improvement presentations
  • Topics that cover quality, safety, and reliable surgical care, as well as global health, leadership and communication, diversity, equity and inclusion, and COVID-19
  • Interaction with experts in real-time through chat during the conference

Conference content will be accessible in an easy-to-navigate platform via a one-click login, and all sessions will remain accessible post-event.

Registration is open—complete yours today.

Cancer Programs Leaders Featured in ACS Bulletin Brief

In the August 4 issue of the American College of Surgeons Bulletin Brief, ACS Regent and National Accreditation Program for Rectal Cancer Chair Steven D. Wexner, MD, FACS, FRCSEng, FRCSEd, FRCSI(Hon), FRCSGlasg(Hon), interviewed several Cancer Programs leaders.

Cancer Surgery Standards Program Integration and Implementation Committee Chair Arden M. Morris, MD, MPH, FACS, professor and vice-chair of clinical research, department of surgery, Stanford University, CA, discussed her research in practice and policy change to improve health care, including on synoptic reports in surgery.

CoC Committee on Cancer Liaison Chair Peter Hopewood, MD, FACS, a general surgeon with Cape Cod Healthcare Cancer Programs, and Rosemary Crawford, BS, CTR, registrar, Lawrence and Memorial Hospital, discussed their experiences conducting the first virtual CoC site visit.

COVID-19 Breast Cancer Operation Delays Appear to be Non-Life-Threatening for Women with Early-Stage Disease

A new breast cancer study brings reassuring findings for women with early-stage breast cancer who were forced to delay their cancer operations because of the Coronavirus Disease 2019 (COVID-19) pandemic. A longer time from diagnosis to surgical treatment does not lower overall survival of women with early-stage breast cancer who underwent delayed operations before the pandemic, according to the study results, which are published as an “article in press” on the Journal of the American College of Surgeons website in advance of print.