2020 CoC operative standards: Where are we now?

An increasing body of evidence demonstrates that adherence to specific operative techniques during cancer surgery directly improves key patient outcomes, including survival and quality of life. The 2020 Commission on Cancer (CoC) accreditation standards, Optimal Resources for Cancer Care, includes six new operative standards. Standards 5.3 through 5.8 were developed from review of the critical elements of operative procedures described in the Operative Standards for Cancer Surgery Volumes I & II (OSCS). The OSCS manuals provide concrete recommendations on the technical conduct of surgical procedures based on the best-available evidence. Incorporation of the OSCS recommendations as CoC accreditation standards is an important step toward improving oncologic outcomes for patients undergoing cancer surgery.

What are the CoC operative standards?

Surgeons and pathologists in CoC-accredited facilities soon will be required to adhere to and document compliance with Standards 5.3–5.8 described in the 2020 CoC standards for accreditation, Optimal Resources for Cancer Care (see Table 1 for proposed updated measures of compliance, pending CoC leadership approval). These new standards establish evidence-based best practices for operations conducted for breast cancer, colon cancer, lung cancer, melanoma, and rectal cancer.

Standards 5.7 and 5.8

Standards 5.7 and 5.8 require pathology reports to include specific elements in synoptic format; these elements also are required by the College of American Pathologists (CAP). Standards 5.7 and 5.8 will be implemented in CoC-accredited cancer programs beginning January 2021. Site visits conducted in 2022 will evaluate 2021 documentation to determine whether 70 percent of reviewed pathology reports for eligible patients meet the requirement for Standards 5.7 and 5.8 (see Figure 1). Surgeons must understand the requirements of these standards so that the appropriate specimens are retrieved for pathology review and documentation.

Standards 5.3–5.6

Standards 5.3, 5.4, 5.5, and 5.6 require operative reports to document specific elements and responses in a synoptic format. These will be required for implementation in CoC-accredited cancer programs in a phased approach beginning in 2022 and will be assessed first for compliance during site visits conducted in 2023 (see Figure 2). The full implementation plan, including dates and required compliance rates, can be found on the CoC website.

For Standards 5.3-5.6, surgeons at CoC-accredited cancer programs must achieve a compliance rate of 70 percent for these standards by January 2023; survey results show it will take anywhere from three to 15 months to achieve this level of compliance among surgeons conducting oncologic procedures for breast cancer, colon cancer, and melanoma. CoC-accredited cancer programs should begin to educate their teams on the standards, integrate synoptic elements into the operative report and electronic health records (EHRs), manage uptake by surgeons, and ensure registrars can find the necessary information in the medical record.

What is the College doing to help?

The Cancer Surgery Standards Program (CSSP) is a new program of the American College of Surgeons Cancer Programs dedicated to improving the quality of surgical care provided to people with cancer. The CSSP has developed synoptic operative reports that can be integrated into the EHRs of CoC-accredited cancer programs. Synoptic operative reports created by the CSSP will include specific designation of synoptic operative report templates for breast cancer, colon cancer, and melanoma will be available in early 2021, and additional disease sites are in development. Staff and surgeons at CoC-accredited cancer programs participating in focus groups conducted in 2019 indicated their preference for a complete and comprehensive synoptic operative report to serve as the operative report of record. Therefore, the comprehensive data elements required for CoC accreditation, provide a crosswalk to American Joint Committee on Cancer staging elements and National Cancer Database (NCDB) codes, include the option of providing narrative text, and will be designed to meet hospital and billing requirements.

The CSSP has been in discussions with the major EHR companies and third-party vendors since early 2020. The goal of the discussions has been to work with the EHR companies to ensure that synoptic operative reports can fit into the clinical workflow and be available as soon as possible for CoC-accredited cancer programs to start using the tools in routine practice. Sites are welcome to reach out to their EHR vendor to make sure plans are under way to use synoptic reports and to learn of timelines for their incorporation. The CSSP has encouraged EHR 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 percent compliance by January 2023. 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.

Incorporation of the OSCS recommendations as CoC accreditation standards is a step toward improving oncologic outcomes by reducing the variation in the way cancer operations are performed and documented across the U.S. In addition to synoptic operative reports, the CSSP is developing educational materials for surgeons and registrars on these standards. Resources in development include webinars, tip sheets, toolkits, and short videos that can be shared during multidisciplinary tumor boards. Presentations at national meetings will highlight the importance of these standards. The CSSP is dedicated to educating surgeons on these procedures and to providing resources to support implementation and compliance with these new standards.