The CoC: Ensuring quality cancer care and a commitment to advocacy for cancer research and prevention

The American College of Surgeons (ACS) established the multidisciplinary Commission on Cancer (CoC) in 1922 as part of its ongoing commitment to excellence in quality of surgical care. The CoC has sought to fulfill its goal of ensuring the delivery of comprehensive, high-quality cancer care by setting standards, conducting compliance surveys, collecting standardized data from its accredited programs to better measure quality, using data to monitor treatment patterns and outcomes to enhance clinical surveillance activities, and developing effective educational interventions to improve care delivery and outcomes.

Today, the CoC works in tandem with other ACS Cancer Programs—the American Joint Committee on Cancer, Clinical Research Program, National Accreditation Program for Breast Centers, National Accreditation Program for Rectal Cancer, and National Cancer Database—to provide tools, resources, and data that enable cancer programs to deliver comprehensive, high-quality, multidisciplinary, evidence-based, patient-centered care. The CoC remains a consortium of professional organizations, convened by the ACS, dedicated to improving the survival and quality of life for cancer patients through standard-setting, prevention, research, education, and ensuring comprehensive quality care. The CoC has more than 100 members—surgeons and affiliate health care professionals who represent the ACS and 58 other national organizations. Together, these individuals direct and coordinate the activities of the CoC through various committees.

Established in 2013, the CoC Advocacy Committee is responsible for identifying, evaluating, and recommending positions on legislative and regulatory issues that come before the state and federal government and have the potential to affect the needs or interests of CoC-accredited cancer programs and cancer patients. Priorities focus on issues that are related to the mission of the CoC or its standards for accreditation. The ACS CoC Advocacy Committee develops its list of priority areas on an annual basis and meets regularly throughout the year to review legislation, plan advocacy activities, and discuss ongoing developments.

ACS CoC advocacy at the federal level

The ACS CoC is dedicated to improving the survival and quality of life for cancer patients through advocacy on Capitol Hill for legislative solutions that support cancer prevention and research. The ACS CoC encourages members of Congress to maintain a bipartisan commitment to cancer legislation, with the overall goal of improving cancer care. Specific pieces of legislation that the CoC supports are as follows.

Palliative Care and Hospice Education and Training Act

The ACS CoC asserts that educating patients and providers on the benefits of palliative care has the potential to significantly improve the quality of life for patients and their families who are experiencing times of serious and complex chronic conditions. However, not all palliative care programs have the interdisciplinary teams necessary to provide comprehensive, high-quality care (see related story, page 13).

The ACS CoC supports the Palliative Care and Hospice Education and Training Act (PCHETA), H.R. 647/S. 2080, introduced by Reps. Eliot Engel (D-NY), Tom Reed (R-NY), Yvette Clarke (D-NY), Buddy Carter (R-GA), Frank Pallone (D-NJ), and Greg Walden (R-OR), and Sens. Tammy Baldwin (D-WI), and Shelley Moore Capito (R-WV). This legislation would improve the training of health professionals in palliative care by creating palliative care and hospice education centers to provide short-term intensive courses focused on palliative care; establishing traineeships for individuals preparing for advanced degrees in nursing; and providing education to social workers and physician assistants who focus their studies in palliative care. Additionally, PCHETA would expand palliative care research to strengthen clinical practice and improve care delivery for patients with serious or life-threatening illnesses.

Removing Barriers to Colorectal Cancer Screening Act

According to the National Cancer Institute (NCI), colorectal cancer is the second leading cause of cancer-related death in the U.S. This statistic is especially troubling because colorectal cancer is largely preventable if patients have access to effective screening methods. At present, Medicare waives coinsurance and deductibles for preventative colonoscopies; however, when a polyp is discovered and removed, the procedure is reclassified as therapeutic for the purposes of Medicare billing, and patients are therefore required to pay coinsurance charges. Not only is this cost-sharing obligation confusing to patients, it also results in the unintended consequence of creating a financial barrier to the most effective method of colorectal cancer prevention.

The ACS CoC is committed to cancer prevention and urges swift passage of the Removing Barriers to Colorectal Cancer Screening Act, H.R. 1570/S. 66, introduced by Reps. Donald M. Payne (D-NJ), Rodney Davis (R-IL), Donald McEachin (D-VA), and David McKinley (R-WV), and Sens. Sherrod Brown (D-OH), Roger Wicker (R-MS), Ben Cardin (D-MD), and Susan Collins (D-ME). This bipartisan legislation—which has more than 280 cosponsors in the House and 50 in the Senate—would help to ensure that the threat of unanticipated costs does not deter patients from undergoing the preventative screening by waiving Medicare’s cost-sharing requirement for preventative colonoscopies, even if a polyp or tissue is removed. By removing this financial barrier, Congress would help increase screening rates and reduce the incidence of colorectal cancer.

Cancer Appropriations requests

The ACS CoC has been a strong advocate in the fight to secure additional cancer research and prevention funding. Past congressional support for federally funded cancer research has been the foundation for progress made in the battle against this disease. The ACS CoC strongly supports the goal of maintaining and enhancing funding of these programs in order to build upon the momentum gained throughout the last few years.

The House of Representatives passed a “minibus” appropriations package June 19 to fund government programs, including increased funding for the National Institutes of Health (NIH), NCI, and Centers for Disease Control and Prevention (CDC). To continue the progress that has led to medical breakthroughs for treatment and therapies for millions of cancer patients, the ACS CoC urges the U.S. Senate to pass an appropriations bill that shows a commitment to cancer research funding as follows:

• Increase NIH funding by $2.5 billion, for a total of $41.6 billion, including $6.5 billion for the NCI
• Provide at least $555 million for the CDC’s Cancer Prevention and Control programs, including $70 million for the National Program of Cancer Registries

Breast Cancer Research Stamp Reauthorization Act

The ACS CoC supports the Breast Cancer Research Stamp Reauthorization Act of 2019, H.R. 2689/S. 1438, which would reauthorize the Breast Cancer Research Stamp for an additional eight years. Since its release in 1998, more than 1 billion of these stamps have been sold in the U.S., raising more than $87.8 million for cutting-edge breast cancer research.

Legislative successes

The Childhood Cancer Survivorship, Treatment, Access, and Research Act, P.L. 115-180, was signed into law in 2018 after years of advocacy. The ACS CoC and the cancer community at large played a critical role in achieving this important legislation, which will help to advance pediatric cancer research and child-focused cancer treatments, while also improving childhood cancer surveillance and providing resources for survivors of childhood cancer.

Cancer legislation at the state level

The ACS tracked more than 1,800 bills in the state legislatures in 2019, of which just 226 were cancer-related public health policy bills, with particular attention given to the issues of raising the legal age for purchasing tobacco to 21 years old (“tobacco 21”), tanning bed restrictions, student use of sunscreen in public schools, and access to breast tomosynthesis three-dimensional (3-D) mammography.

Tobacco 21 laws made significant advancements in 2019, passing in 12 states: Arkansas, Connecticut, Delaware, Illinois, Maryland, New York, Ohio, Texas, Utah, Vermont, Virginia, and Washington State, tripling the total number of states to 18. California, Hawaii, Maine, Massachusetts, New Jersey, and Oregon had passed this legislation previously. The laws in Maryland and Texas, however, exempt members of the U.S. military 18 years or older, while Arkansas and Utah will phase in the age restrictions over the next three years. Louisiana, New Mexico, and South Carolina introduced legislation that failed to pass. The Louisiana ACS CoC and Louisiana Chapter of the ACS supported their state’s legislation.

The ACS CoC has long supported restricting access to tanning beds by minors younger than 18 years of age. Bills containing this restriction passed in Maine and Maryland, whereas Tennessee enacted a law that allows minors between the ages of 14 and 18 years old to use tanning bed with parental permission. With the addition of Maine and Maryland, a total of 19 states and the District of Columbia have enacted the full ACS CoC supported restrictions: California, Delaware, Hawaii, Illinois, Kansas, Louisiana, Massachusetts, Minnesota, Nevada, New Hampshire, New York, North Carolina, Oregon, Rhode Island, Texas, Vermont, and Washington. At press time, a bill in New Jersey, A. 5409, was pending in the State Assembly. Legislation in Arizona, Indiana, Missouri, Montana, and Nebraska failed to pass.

Another skin protection issue that the ACS CoC supports calls for clarifying regulations regarding student possession and use of sunscreen products at school and school-sponsored events. These bills, which ensure that children and teens can protect themselves from harmful ultraviolet exposure outdoors, advanced in Arkansas, Connecticut, Illinois, Maine, Minnesota, and Nevada, with the Department of Education in Nebraska issuing rules clarifying state regulations for student use of sunscreen products. These states join Alabama, Arizona, California, Colorado, Florida, Indiana, Louisiana, Maryland, Michigan, New York, Ohio, Oklahoma, Oregon, Pennsylvania, Texas, Utah, and Washington. Legislation is still pending in Massachusetts S. 284, S. 261, H. 545; New Jersey S. 1803; Rhode Island S.B. 116; and the District of Columbia. Legislation failed to pass in Virginia. The ACS CoC is a member of the SUNucate coalition, joining others in supporting passage of the legislation.

At the request of the New Hampshire ACS CoC and Chapter of the ACS, the College sent a letter to the New Hampshire Senate in support of a bill to correct the legislative intent of the state’s law on insurance coverage for breast tomosynthesis 3-D mammography. Insurance companies had found a workaround to deny coverage for the screening for patients, necessitating passage of the new law. Other bills to expand coverage for 3D mammography were introduced but did not pass in Hawaii, Iowa, and Maine. Arkansas, Colorado, Connecticut, Illinois, Kansas, Louisiana, Maryland, Missouri, New Hampshire, New Jersey, New York, Oklahoma, Pennsylvania, Texas, Vermont, and Washington have laws requiring insurance coverage. Massachusetts, Minnesota, and Rhode Island each have active legislation pending.

2020 and beyond

The CoC already has begun planning its advocacy priorities in 2020. The ACS CoC Advocacy Committee will host an educational briefing on Capitol Hill in the spring of 2020 to further educate Congress about cancer issues and ACS Cancer Programs. Additionally, members of the Advocacy Committee will meet with members and staff to advocate directly for cancer research funding and other federal legislative priorities.

New this year, CoC State Chairs will have additional assistance to further engage and advance the CoC’s state legislative advocacy priorities. A new state advocacy tool kit was presented to ACS CoC State Chairs at Clinical Congress, highlighting activities and resources to work with the ACS State Affairs staff and CoC partner organizations, including the American Cancer Society. Because states often influence how the federal government tackles a problem, the active involvement of State Chairs in advocacy will help to achieve meaningful progress for cancer patients and the adoption of policies that lead to better research, prevention, and outcomes.

For information on other cancer-specific state legislation, contact Christopher Johnson, State Affairs Associate, at cjohnson@facs.org. For questions or additional information about the ACS CoC’s federal legislative priorities, contact Amelia Suermann, ACS Congressional Lobbyist, at asuermann@facs.org.