United under the theme, “Where Cancer Care Comes Together,” more than 300 surgeons, healthcare team members, and administrative professionals gathered in person for the first time since 2019 at this year’s ACS Cancer Conference to reflect on the meaning of cancer care as the country emerges from the pandemic.
Held at the Hilton Atlanta, March 1–4, the conference provided attendees with updates from all ACS Cancer Programs, including the Commission on Cancer (CoC), National Accreditation Program for Breast Centers (NAPBC), National Accreditation Program for Rectal Cancer (NAPRC), National Cancer Database, Cancer Research Program (CRP), Cancer Surgery Standards Program, and the American Joint Committee on Cancer (AJCC).
Throughout the conference, speakers and panelists put a spotlight on teamwork, empathy, and understanding the complexities of the patient journey—from diagnosis to survivorship.
“Our theme this year, ‘Where Cancer Care Comes Together,’ reflects the changing shift in cancer care that we’ve seen emerge in the past decade. Our goal was to take American College of Surgeons’ standards, which are traditionally reflected in a printed document, and breathe life into them,” said Heidi Nelson, MD, FACS, Medical Director of the ACS Cancer Programs. “We wanted to allow participants to learn from one another and see firsthand how standards can be implemented to improve cancer care across the continuum.”
New Patient-Centric Standards for Breast Cancer
The first day of the conference focused on the new NAPBC standards, which were officially released in late February. The new standards represent a paradigm shift to put the patient’s journey at the center of the framework.
The conference opened with the passionate voices of Katharine A. Yao, MD, FACS, director of the breast surgical program at NorthShore University HealthSystem in Evanston, IL, and Chair of the NAPBC, and Jill R. Dietz, MD, MHCM, FACS, Vice-Chair of the NAPBC, who presented on the significance of rewriting the standards from the patient perspective.
“The new standards are a way to refresh,” Dr. Dietz said. “It’s a way for both centers and site reviewers to refocus on the patient. Instead of providing instructions for each discipline and care team, we switched the focus to the patient and what they need at each point of their journey.”
Many of the significant changes in the new standards are reflected in Chapter 5: Patient Care: Expectations and Protocols.
“Each patient has different needs, and we need to be thinking about that,” Dr. Dietz added. “We hope that these standards help centers provide high-value patient care that is feasible, educational, and not punitive.”
To illustrate the unique challenges a patient faces before, during, and after cancer treatment, Jane L. Meisel, MD, an NAPBC board member and associate professor of hematology and medical oncology at Emory University School of Medicine in Atlanta, GA, sat down with Jennifer Fay Kawwass, MD, a reproductive endocrinologist at Emory.
Dr. Kawwass was diagnosed with breast cancer last fall after her first screening mammogram at age 40 detected an abnormality; a biopsy later confirmed cancer. In her talk with Dr. Meisel, she articulated the many challenges she faced as a physician-turned-patient, even as a medical professional with experience guiding patients through the uncertainty of fertility treatments.
For Dr. Kawwass, finding care team members who were willing to have open conversations about balancing treatment options and quality of life helped her navigate uncertainty. Small decisions that may not matter from a medical perspective, such as using cooling caps (also known as scalp hypothermia) to reduce hair loss from chemotherapy, played a significant role in her recovery, too.
“This time last year I was in chemotherapy, and I have hair on my head because I did the cold cap. It took a lot of time and energy, but it made such a huge difference in my ability to be able to think of the cancer as something that I overcame,” she said.
Keynote Address: What Does It Mean to Be Part of a Cancer Team?
In the conference keynote address, Arif H. Kamal, MD, MBA, MHS, FACP, FAAHPM, FASCO, an oncologist and chief patient officer at the American Cancer Society, reflected on how multiple disciplines can come together to care for patients across the continuum of care, from prevention through survivorship care.
We live in a time of tremendous progress, with advances in cancer treatments occurring faster than most people can keep up, he noted. At one point in his research at Duke University in Durham, NC, Dr. Kamal counted more than 300 new critical cancer drugs or treatments that occurred in the last decade, meaning that physicians would have to keep up with about 30 innovations per year.
“It is fantastic that we now have new treatments compared to 5 or 10 years ago, but at the same time, it increases the complexity of the delivery of care. Because new innovation doesn’t mean that a new treatment is easier to give, easier to access, or easier to understand,” he said.
That tightrope—the ability to balance hope, innovation, and uncertainty—is where teamwork can come into play. In particular, caregivers and family members have unique voices that should be elevated in conversations about cancer care.
“The concept of hope is not something we as clinicians can take away from people. We have the power to be reminders that hope itself is a dynamic construct. Hope changes over time,” he said. “I’ve been at the bedsides of patients who are actively dying with hours or days left, and in that moment, there is still hope. The hope to be symptom-free, the hope to mend fences, reduce conflict, or be together with family.”
Promoting DEI in Cancer Care
Despite the rapid revolution of cancer treatments available in the past 2 decades, the availability of these new treatments is not always equitably distributed among populations. The pandemic magnified many of these disparities, which exist across geographic regions and races in regard to both cancer incidence and mortality rates.
“Many of the challenges that we face have historical roots. I believe it’s vital in medicine to understand these issues so we can really take a look at access, trust, and physical differences in care as well,” said Susan Hedlund, MSW, LCSW, OSW-C, an oncology social worker and assistant professor of medicine at Oregon Health & Science University in Portland.
Hedlund noted that specific to cancer care, contributing factors that exacerbate disparities in healthcare include:
- Social determinants of health, which are nonmedical factors that influence health outcomes, including income, education, and access to housing, food, and basic amenities
- Disparities in insurance coverage and access to care
- Variable quality of care
- Implicit bias and patient- and system-level factors
For example, patients who reside in ZIP codes with lower socioeconomic status have lower rates of cancer screening and are more often diagnosed with cancer at a later stage.
Many of these disparities can be addressed through existing CoC standards. As one example, survivorship services can be promoted to include patients from diverse populations who in the past have tended not to seek services due to barriers.
In addition, healthcare workers, including surgeons, can advance diversity, equity, and inclusion (DEI) initiatives by valuing all individuals and populations and providing resources according to need without judgment.
“Each of us has an opportunity to innovate in this space so that we can make all of our environments inclusive for everyone,” said Bonnie Simpson Mason, MD, FAAOS, Medical Director of the ACS Office of DEI. “Because when we feel like we belong, we can perform maximally, show up authentically, and in surgery, that means we have better patient outcomes. Our patients do better because we can deliver a better quality of care for all of our patients.”
Increased diversity also drives better clinical research. Rebecca A. Snyder, MD, MPH, FACS, an associate professor of surgical oncology at The University of Texas MD Anderson Cancer Center in Houston, described how diverse teams can come together to address cancer disparities and drive research in the clinical trial setting, where historically, Black and Hispanic patients are underrepresented.
She pointed to research that shows teams comprising mixed genders are more likely to publish higher-impact research, and physicians from minority backgrounds are more likely to include diverse populations in their clinical trial research, which is vital in the age of precision oncology.
“Diversity is really key in conducting high-quality, multidisciplinary clinical care,” Dr. Snyder said. “For us to come up with innovative solutions, we need representation from a variety of perspectives, both from patients and stakeholders in terms of identifying effective interventions.”
Driving Quality Surgical Care
Multiple sessions provided attendees with practical tips, resources, and best practices for participating in effective quality improvement projects, applying for accreditation, undergoing a site visit, and completing a synoptic operative report.
“The most important thing we can do is to ask: How can we do it better? How can we deliver better care to our patients, and how can we look at our processes and make sure we are doing a good job?” said Laurie J. Kirstein, MD, FACS, a breast surgical oncologist from Memorial Sloan Kettering Cancer Center in New York, NY, and the ACS Cancer Conference Chair.
Recommendations addressed in these sessions included:
Use templates, process maps, flowcharts, and online resources when available
For example, a visual flowchart may help summarize key steps to achieve accreditation and describe the value of the program.
“Oftentimes, you won’t get everyone to read all the standards because they’re quite long. For those who are good visual learners, the flowchart is a succinct way to describe key steps,” said Kimberly Yee, MD, FACS, a colorectal surgeon at White Plains Hospital in NY, who helped her team achieve NAPRC accreditation.
Employ strategic communication when introducing new standards or trying to improve a specific quality measure
“Framing is really important,” said Daniel J. Boffa, MD, FACS, director of clinical affairs for the Thoracic Surgery Program at Yale Medicine in New Haven, CT, and Chair of the CoC Quality Assurance and Data Committee. “You want to avoid presenting performance data in a way that is accusatory or makes people feel bad. Focus on the opportunity to take better care of patients and recognize improvement as a win. If you want people to be engaged and committed to quality improvement, getting better should feel good.”
Consider holding smaller meetings (4–6 people) where everyone has an opportunity to speak, he suggested, and focus on the shared goal of improving patient outcomes.
Ask for help building your team
“We really want to reinforce the idea of using a systematic, stepwise approach to quality improvement, not only nationally but locally. You’re not in this alone,” said Anthony D. Yang, MD, MS, FACS, a surgical oncologist with Indiana University Health in Indianapolis and Chair of the Core for Quality Improvement Methodology and Implementation in the ACS Cancer Programs.
Looking Ahead
On the last day of the conference, speakers highlighted new projects that will drive forth the mission of the ACS Cancer Programs and improve the quality and timeliness of cancer care. Some projects on the horizon include:
Cancer Survival Risk Calculator
The calculator will incorporate specific data, including type of surgery, age at diagnosis, tumor size, and time to treatment, to better provide patients with information on their prognoses.
“The overarching goal is to increase individualized care so that we can give patients a better understanding of their specific prognosis because right now, it’s usually based solely on overall stage and the expertise of the clinician,” said Lauren Janczewski, MD, a general surgery resident at Northwestern Medicine in Chicago, IL, and clinical scholar with the ACS Cancer Programs.
Survivorship Services Survey
The number of cancer survivors has increased rapidly in recent years. The Survivorship Services Survey, led by the CRP and CoC, is a short survey (<20 minutes) designed to characterize survivorship services currently available to cancer patients in the US, with the goal of better understanding their needs and improving how ACS Cancer Programs can help.
Collaborative research to evaluate quality standards
“We want to drive research that demonstrates the value of standards,” said Judy C. Boughey, MBBCh, FACS, a breast surgical oncologist from the Mayo Clinic in Rochester, MN, and Chair of the ACS CRP. “On the flipside, if we study a standard and show that it is not valuable, that’s also important information. We’re constantly looking at ourselves and making sure the work we do impacts patient care.”
In one of the last sessions, Timothy W. Mullett, MD, MBA, FACS, medical director of the Markey Cancer Center Research Network with the University of Kentucky Healthcare in Lexington, and Chair of the CoC, expressed great excitement for the collaborative future of the ACS Cancer Programs.
“We are moving at a rate I’ve never seen before, and you all are driving us with new information,” he said. “For the past few years, we’ve been hunkered down at our own institutions and forced into virtual meetings. I think this year, we are going to be catching our rhythm again.”
Listen to additional insights and highlights from the conference via the House of Surgery podcast (episode 8) at facs.org/houseofsurgery.
Mark Your Calendars
The 2024 ACS Cancer Conference will be held February 22–24, in Austin, TX.
