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

What Registrars, Pathologists and Surgeons Need to Know about the CoC Operative Standards

Standards 5.3 through 5.8 of the 2020 Commission on Cancer (CoC) accreditation standards, Optimal Resources for Cancer Care, were developed from the evidence-based critical elements of procedures described in the Operative Standards for Cancer Surgery Volumes I & II (OSCS). The CoC recently released implementation details for the operative standards, including dates and compliance criteria.

Standards 5.7 and 5.8 require pathology reports to include specific elements in synoptic format and will be implemented in CoC accredited cancer programs beginning January 2021 (Figure 1). The Cancer Surgery Standards Program (CSSP) will host two webinars in December to help pathologists, registrars and surgeons understand the requirements of these standards so that the appropriate specimens are retrieved for pathology review and documentation. In each webinar, a multidisciplinary panel will discuss the purpose of the standard, best practices for achieving compliance, and the role of these evidence-based standards in improving outcomes for patients with cancer. The webinar on Standard 5.7 (Total Mesorectal Excision) will be held on Monday, December 7 at 3:00pm CT (registration required) and the webinar on Standard 5.8 (Pulmonary Resection) will be on Tuesday, December 15 at 3:00pm CT (registration required). Recordings will be posted online after the live events. More details for both webinars will be posted to the Cancer Programs Education and Events web page.

Figure 1. Requirements for Standards 5.7 and 5.8: Compliance and Site Reviews

Figure 1. Requirements for Standards 5.7 and 5.8: Compliance and Site Reviews

Standards 5.3-5.6 require operative reports to document specific elements and responses in a synoptic format. These will be implemented in CoC accredited cancer programs in a phased approach beginning in 2022 (Figure 2). The Cancer Surgery Standards Program (CSSP), a new program of the American College of Surgeons, has developed comprehensive synoptic operative reports for breast cancer, colon cancer and melanoma. The CSSP has been in discussions with the major Electronic Medical Record (EMR) companies and third-party vendors since early 2020 to ensure that these synoptic operative reports have been designed to efficiently fit within the clinical workflow.

The CSSP has encouraged EMR vendors to integrate capabilities for synoptic reporting as soon as possible to ensure surgeons at CoC accredited cancer programs can begin routine use early in order to achieve 70% compliance by January 2023. Recent survey results show it will take anywhere from 3-15 months for sites to achieve this level of compliance for these standards. Sites are encouraged to reach out to their EMR to confirm that plans are underway to include these synoptic operative reports for surgeons and to learn about the release timelines. Additional information on the availability of the CSSP synoptic operative reports will be released in early 2021. CoC accredited cancer programs are not required to use the synoptic operative reports developed by the CSSP and may elect to develop their own synoptic operative reports to meet CoC requirements.

Figure 2. Requirements for Standards 5.3-5.6: Compliance and Site Reviews

Figure 2. Requirements for Standards 5.3-5.6: Compliance and Site Reviews

In the coming months the CSSP will hold educational webinars and Tweet Chats on Standards 5.3-5.8 and welcomes pathologists, registrars and surgeons to participate. The CSSP is working directly with registrars and surgeons to develop a host of resources including short videos on each standard for presentation at multidisciplinary tumor boards, tip sheets and checklists on the critical elements, and a comprehensive toolkit.

To facilitate discussion on the operative standards, a brief (6-minute) introductory video on the operative standards and the rationale for their incorporation into the CoC accreditation standards is now available on the CSSP Resources webpage. We recommend that all Cancer Liaison Physicians (CLPs) and State Chairs distribute this video to surgeons at their CoC accredited cancer programs and encourage program staff to show the video during tumor boards.

Additional resources will be posted on the CSSP webpage and shared with staff at CoC accredited cancer programs when available. Stay tuned to Cancer Programs News for upcoming webinars and resources!