The American College of Surgeons Commission on Cancer (CoC) is a consortium of professional organizations dedicated to improving survival and quality of life for patients with cancer through standard setting, prevention, research, education, and the monitoring of comprehensive quality care.
According to Frederick L. Greene, MD, FACS, past chair of the CoC and self-proclaimed “unabashed supporter for oncology patient navigators and nurse navigators,” accreditation with the CoC is, at its core, about team building.
“The Commission on Cancer is the mechanism that we use for impacting cancer care,” he explained at the AONN+ 12th Annual Navigation & Survivorship Conference in November 2021. “And it really impacts patient navigation, specifically palliative care survivorship.”
Benefits of CoC Accreditation
Fifty-nine organizations (including AONN+) make up the CoC, but over 1500 CoC-accredited cancer programs comprising about 24% of hospitals treat between 70% and 75% of all patients with cancer in the United States.
“So those of you who work in CoC-accredited institutions, I salute you,” he said. “Although you’re in the minority of cancer institutions in the US, you’re in the majority when it comes to taking care of cancer in this country.”
CoC accreditation offers tangible benefits, like their manual—Optimal Resources for Cancer Care—which offers guidance on the organization and infrastructure of a cancer program, as well as data to assess patterns of care and outcomes. However, according to Dr Greene, the intangible benefits, such as team building, leadership, and programmatic development—are just as important.
Other benefits of CoC accreditation include hospital and benchmark data on cancer outcomes, participation in cancer standards development, recognition as an accredited cancer program, and coordinated compliance with state-required cancer registries and data collection.
“AONN+ is vital in team building; that’s what this organization is based on,” he said. “They have also helped us so much with our standards development.”
Tangible Benefits: CoC Standards
The CoC Standards focus on structure, process, and outcomes and aim to address the full continuum of cancer—from prevention to survivorship and end-of-life care—while addressing both survival and quality of life.
“In 2016, I was very privileged to lead the work group that first brought in our patient-centered standards of psychosocial distress, navigation, and survivorship,” said Dr Greene.
He urges navigators to use the robust and valuable resources that the CoC offers, such as the National Cancer Database (which includes data points such as patient characteristics, cancer staging and tumor histological characteristics, type of first-course treatment administered, and outcomes information), and participant user files, which offer site-specific data sets (colon, breast, prostate, etc) from patient care research.
“These resources offer a wonderful opportunity for our nurse navigators to conduct research in these areas,” he said.
The CoC Standards were most recently updated in 2020. These evidence-based standards are meant to support and enhance efforts to improve patient care and are designed to be clearly interpretable by cancer programs for the benefit of patients. Additionally, they’re meant to be objectively verifiable by experienced site reviewers during site visits.
The 2020 CoC Standards includes 9 chapters, a notable change from the 5 chapters included in the 2016 Standards. Dr Greene went on to highlight some specific changes that are particularly relevant to AONN+, including updates to oncology nursing credentials and survivorship programs, and addressing barriers to care.
Important Updates: Standard 4.8: Survivorship Programs
According to the updated CoC Standards, the cancer committee at an institution should oversee the development and implementation of a survivorship program directed at meeting the needs of patients who are treated with curative intent.
“Remember that CoC Standards have to be involved with the cancer committees at your organizations,” he noted. “So we want nurse navigators to have close relationships with all members of the cancer committee, because all of our standards impact what the cancer committee does.”
The updated standards place less emphasis on survivorship care plans (SCPs) than previously and more on the importance of a team approach to survivorship led by a survivorship coordinator, he reported.
According to the 2020 Standards, a survivorship coordinator should be appointed to a survivorship program (per the requirements in Standard 2.1: Cancer Committee) and should assemble a survivorship program team of physicians, nurses, social workers, nutritionists, physical therapists, and other allied health professionals.
Responsibilities of the survivorship program team include determining a list of services and programs (offered on-site or by referral) that address the needs of cancer survivors, and formally documenting a minimum of 3 services offered each year at their institution (eg, nutritional, psychiatric, or rehabilitation services).
Each year, the survivorship program coordinator reports to the cancer committee regarding the activities of the survivorship program, including an estimate of the number of patients who participated in the 3 identified services. Dr Greene urges nurse navigators to also get involved and help with the process of reporting these metrics back to the cancer committee.
“Members of the survivorship program have to decide if they’re meeting the needs of their patients,” he said. “And if they’re not meeting the needs, what do they need to do in order to improve each of these selected survivorship programs in their hospitals?”
To demonstrate that the program is being monitored and evaluated, the standards state that the program coordinator identifies the resources needed to improve the services, if barriers were encountered.
While the CoC recommends and encourages that patients receive an SCP, this is no longer a required component of this standard. However, delivery of SCPs may be utilized as one of the services offered to survivors to meet the requirements of this standard; if this service is chosen, the program will have to define the population in receipt of these care plans.
Real Results
According to Dr Greene, using these standards can lead to real change. For example, Standard 8.1 pertains to barriers to care, and he has witnessed real results in identifying and addressing those barriers.
“We thought financial toxicity was a very important barrier, so 2 years ago we created a financial toxicity tumor board,” he said. “Every month, we have a tumor board meeting talking about specific patients and their financial toxicity, and I think it’s saved our patients millions of dollars over the last 2 years.”
The CoC has also developed patient education materials, such as an ostomy home skills kit and a central lines home skills kit. These are designed to help with reducing complications of care, improving patient participation and outcomes, supporting the transition to home, and increasing patient satisfaction.
“For those of you who are involved in the CoC program, these valuable resources are available in your institutions, just by contacting the American College of Surgeons,” Dr Greene noted.
All CoC-accredited institutions also have education and training resources available to them, offered in the form of online education (ie, CAncer Forum LIVE sessions), workshops, and other resources.
“These are wonderful opportunities to learn more about the specific standards, and what the CoC does,” he said.
Dr Greene concluded by quoting Peter Drucker: “All organizations need to know that virtually no program or activity will perform effectively for a long time without modification and redesign. Eventually every activity becomes obsolete....”
Just as staging systems must be updated in oncology, the same applies for the CoC Standards, he noted.
“Nobody likes change, but if we didn’t change our manual from time to time, we wouldn’t be current,” he added. “We’d be irrelevant.”
