While deaths from cancer have dropped dramatically in the past 3 decades—by approximately one-third—cancer remains the second leading cause of death in the US, behind only heart disease, and an estimated 1 in 3 Americans will be diagnosed with cancer in their lifetime.1,2
New cancer treatments are emerging at an increasingly rapid pace, but access to these treatments remains highly variable, and large gaps exist in understanding the complex needs of patients with cancer, who must often manage treatment-related complications years after their treatments end, as well as the distinct needs of their family members and caregivers.
Focused on understanding and addressing such complexities in cancer care—and on helping Commission on Cancer (CoC)-accredited sites provide quality care—this year’s ACS Cancer Conference brought together nearly 500 surgeons, allied healthcare providers, program directors, oncology data specialists, and accreditation specialists to discuss the latest in cancer care and research. Registration increased by more than 30% compared with 2023.
Kicking off with a sold-out preconference workshop focused on quality improvement (QI), attendees heard from more than 50 moderators and panelists who provided updates on local and national QI projects and led thematic discussions on incorporating health equity into cancer care and raising surgeons’ voices in advocacy at the state and national levels.
“The goal of this year’s ACS Cancer Conference is to provide comprehensive, practical information about new standards, data collection, site visits, staging, and accreditation all in one setting,” said Laurie J. Kirstein, MD, FACS, a breast surgical oncologist from Memorial Sloan Kettering Cancer Center in New York, New York, and the 2024 ACS Cancer Conference Chair. “We’re trying to do all of this in one forum so that when you leave here, you can take this information, go back to your program, and take care of everything you need to for the rest of the year.”
Improving Quality at the Local and National Levels
QI often can seem like a daunting concept, but never has it been more important than in cancer care, where access to treatment can depend on multiple factors, including where patients receive their care and if they’re able to make the myriad appointments that come with a cancer diagnosis.
“Everybody in the hospital needs to be thinking about quality, and if you’re going to do that, you can’t have barriers for people to get involved,” advised Daniel J. Boffa, MD, MBA, FACS, director of clinical affairs for the Thoracic Surgery Program at Yale Medicine in New Haven, Connecticut, and Chair of the CoC Quality Assurance and Data Committee.
Dr. Boffa moderated several sessions on quality where panelists highlighted the importance of engaging teams from the ground up. Describing best practice examples, presenters walked attendees through frameworks that worked in their local environments:
Show Value in Change, Don’t Just Tell People to Be More Careful
"Telling people to be more careful is one of the weakest reduction strategies when it comes to human beings in complex environments, because all humans make errors,” said Christine Garcia, MD, MPH, an assistant professor of medicine and director of quality and patient safety at Weill Cornell Medicine in New York, New York. Dr. Garcia described an initiative to reduce medication waste at an oncology infusion area in her hospital system, emphasizing that understanding the process from end to end and simplifying or automating processes when possible were key steps to helping her team develop a new practice clearance process to reduce medication waste.
Leverage Opportunities to Participate in National QI efforts
Several national QI projects led by the CoC and National Accreditation Program for Breast Centers (NAPBC) are also at the forefront of breaking down barriers to cancer care. One initiative—Patient Reported Observations on Medical Procedure Timeliness (PROMPT) for Breast Patients—is assessing various timeliness aspects of breast cancer, including time to treatment and patients’ perceptions of timely care.
Shelby Murphy, BSN, RN, CPHQ, a clinical quality consultant at Presbyterian Cancer Care in Albuquerque, New Mexico, noted that participating in PROMPT helped her hospital system better understand the barriers that many women may face to screening, which is especially important given that New Mexico has one of the lowest up-to-date screening mammography rates in the nation.3
To encourage screening, her team spearheaded a QI initiative focused on telephoning eligible patients who were not up to date on their screening mammograms to provide education. “With a high number of patients who need a screening mammogram, access to timely appointments is vital to ensuring adequate care for these patients,” she said.
Keynote Address: Improving Cancer Care for All
Offering a scoping national perspective on emerging cancer treatments and prevention efforts, James Gulley, MD, PhD, FACP, clinical director of the National Cancer Institute, described the need to improve cancer care throughout the continuum—opportunities to decrease cancer death exist through prevention, early detection, and better therapies.
Innovations such as vaccines, multicancer detection assays, and cell therapy are examples of emerging technologies that are rapidly changing how cancer is both prevented and treated. More progress, however, needs to be made to ensure equitable access to these treatments, he noted.
Dr. Gulley stressed that while overall survival rates of cancer have improved in recent decades, significant gaps remain in cancer care. The goal of the reignited Cancer Moonshot is to both reduce the US cancer death rate by 50% in the next 25 years (by 2047) and improve the lives of people and their families living with and surviving cancer. To achieve these goals, cancer death rates must decline faster, from the current rate of decline of approximately 2.3% per year to 2.7% per year.
Throughout his keynote, Dr. Gulley emphasized that preventive efforts through screening and vaccination, as well as improving access to emerging treatments, are equally important in cancer care. For example, increasing the global uptake of the human papillomavirus (HPV) vaccine can have profound implications for preventing cervical cancer and other cancers associated with HPV.
Screening for lung cancer—the nation’s most lethal cancer—with a low-dose CT scan is remarkably effective at early detection of the disease but needs to reach far more people to have a greater impact, including at-risk Black and Hispanic patients; and while telehealth can improve healthcare access and quality, large-scale research in diverse clinical settings is needed to optimize its use in cancer care.
“If we can focus on prevention and early detection strategies and better treatment for patients with metastatic disease, and we also focus on the efficiency of the system using tools such as AI, we can improve clinical care for patients as well as clinical outcomes for patients and maybe decrease the rate of death,” he said.
Elevating Cancer Care through Advocacy and Community Engagement
Improving cancer care also involves effectively engaging communities and promoting change through effective legislation.
In a session on advocacy efforts to improve cancer care, panelists highlighted the value medical expertise brings to shaping legislation aimed at improving cancer care. While the federal legislative process doesn’t always work smoothly, there are opportunities to engage at each stage of the process.
“When you show up to talk to a legislator, you bring with you, much like your lived experiences, a very diverse picture that legislators need to understand,” said Timothy W. Mullett, MD, MBA, FACS, medical director of the Markey Cancer Center Network with the University of Kentucky Healthcare in Lexington, and CoC Chair.
Dr. Mullett has been involved with several local and national efforts focused on improving cancer care and access to lung cancer screening. “I think it’s imperative that our perspective as surgeons not be diluted. Many legislators will remember that there was someone in their office who has experience, is passionate, and has evidence that supports the direction you want to go in.”
Advocacy also takes patience and understanding of the needs of the local community. In a session on incorporating health equity into caring for cancer patients, panelists described effective ways to build trust and break down existing barriers in cancer care.
Shayla Scarlett, MBA, MPA, DipACLM, assistant director of community outreach, engagement, and equity at George Washington Cancer Center in Washington, DC, described six pillars to address health equity: ensure accountability, mitigate bias, diversify leadership, develop workforce pipelines, purchase and invest locally, and address social needs.
Scarlett highlighted several projects, including Strengthening Community Reach and Equity by Engaging Neighborhoods (SCREEN), which focuses on increasing breast cancer screening and reducing cancer risk by directly engaging local communities in the greater DC area. The project is helping train community members to become neighborhood health ambassadors and provides community education and digital health support directly to at-risk populations, including Black and Hispanic women, who face barriers to mammogram screening and breast cancer care.
“Complex programs require ample time to fully implement,” Scarlett said, noting that the SCREEN project was originally slated to be an 18-month project, but the team quickly realized that things take longer to lift off the ground. “In addition, community collaboration in every aspect of program design and implementation is important.”
New Pediatric Accreditation Standards and Other Projects on the Horizon
Several sessions of the conference also highlighted new directions for the CoC and Cancer Research Program, as well as ongoing research initiatives.
Currently, only about 1% of CoC centers are accredited as a pediatric cancer program. Recognizing that children are one of the most vulnerable patient populations to experience cancer, the CoC revised its standards for pediatric specialty accreditation to encourage broader participation. Recent modifications also allow for a facility to be identified as both a CoC facility and pediatric cancer program.
“Children are not just small adults, especially for cancer care. They require very specific, nuanced care,” said Richard Glick, MD, FACS, director of pediatric surgical oncology at Cohen Children’s Medical Center in Queens, New York, and a member of the CoC Advocacy Committee.
Dr. Glick said that while less than 1% of cancer diagnoses per year are in children, cancer is a leading cause of death in children older than 5 years, and incidence has been slowly increasing. For every child who dies of cancer, 70 life years are lost compared with 14 life years lost in adults. In addition, children often face distinct malignancies, and most solid malignancies in children are treated with multimodalities, including surgery, chemotherapy, and radiation, that may impact their future health. New standards for pediatric accreditation are designed to be more relevant and comprehensive to the unique needs of children with cancer, including addressing survivorship issues, rehabilitation services, and other measures.
Several other emerging initiatives focused on making quality cancer care more accessible include:
- New National Accreditation Program for Rectal Cancer standards updated to address all current treatment modalities for rectal cancer
- Upcoming release of American Joint Committee on Cancer (AJCC) Staging Online
- Health Equity Toolbox designed to provide education and resources for CoC-accredited programs to assist them in addressing financial toxicity and health literacy issues within their programs
- Changes to the Rapid Cancer Reporting System of the National Cancer Database that will allow cancer programs to receive more timely reports
- Several Cancer Research Program projects, including further refinement of a cancer survival calculator to serve as a comprehensive prognostic tool and understanding the scope of survivorship services offered at CoC sites
Reflecting on future directions, Ronald J. Weigel, MD, PhD, MBA, FACS, Medical Director of the ACS Cancer Programs, expressed gratitude to everyone on the front lines of seeking change in cancer care.
“I want to stress that so much of what we do is dependent upon you. I appreciate the fact that you devote so much of your time and effort to outstanding patient care for those who are having to deal with a cancer diagnosis,” he said. “They and the ACS appreciate all the commitment that you have made to taking care of cancer patients.”
Additional key insights and lessons learned from the conference, as well as new opportunities for clinical practice and what to expect this year and beyond from the ACS Cancer Programs were discussed by Drs. Weigel, Boffa, Kirstein, and Mullett in a recent episode of The House of Surgery podcast series. Visit the House of Surgery for more information.
Mark Your Calendars
Next year’s ACS Cancer Conference will be held in Phoenix, Arizona, March 12–15.
