The ACS has been a leader in advancing quality patient care for more than a century. The ACS Cancer Programs have advanced quality cancer care for patients throughout the US. These programs include the Commission on Cancer (CoC), National Accreditation Program for Breast Centers (NAPBC), National Accreditation Program for Rectal Cancer (NAPRC), National Cancer Data Base (NCDB), American Joint Committee on Cancer (AJCC), Cancer Surgery Standards Program (CSSP), and Cancer Research Program (CRP).
Ronald J. Weigel, MD, PhD, MBA, FACS, became Medical Director of the ACS Cancer Programs in 2023, and together with a team of dedicated surgeons, other physicians, and staff, the following advances have been made.
CoC
The CoC was established in 1920 and continues to be a national leader in the advancement of cancer care for patients in the US. There are currently approximately 1,400 CoC-accredited hospitals, all of which submit clinical data to the NCDB, which includes more than 74% of all cancer cases in the US.
Recently published data have demonstrated that CoC accreditation improves the quality of cancer care as measured by a greater adoption of guideline concordant care and reduced mortality.1-4 Studies examining CoC accreditation in rural hospitals in Iowa have demonstrated that becoming CoC accredited improves cancer care to patients in this setting, whereas hospitals that remain nonaccredited do not advance the quality of cancer care.5
One study performed in a rural setting in Iowa was designed to facilitate rural hospitals becoming CoC-accredited facilities. However, it has become clear that many rural hospitals lack the resources to attain CoC accreditation. With this in mind, we have begun an initiative to develop a Rural CoC Accreditation Program, which will use a set of standards that are more appropriate for patients receiving care in a rural setting. Recognizing that patients in rural regions are often underserved, the goal of the Rural CoC Accreditation Program will be to advance the quality of cancer care for patients in rural areas.
Another initiative will be to extend CoC accreditation to hospitals outside of the US. A process is being initiated to expand CoC accreditation to hospitals in Canada and plans are in place to explore the potential of expanding CoC accreditation in the UK.
NAPBC
The NAPBC provides the structure and necessary resources to provide high-quality care to patients with breast cancer. The 2024 standards became effective earlier this year. New to the 2024 standards is an expansion of patient educational resources and initiatives related to breast survivorship.
The new standards also include a risk assessment in the screening process and referral for genetic testing when appropriate. The NAPBC standards provide a comprehensive roadmap for the care of breast cancer patients from the point of screening and prevention through the diagnosis, treatment, and survivorship.
NAPRC
The NAPRC is one of our newest accreditation programs and provides a comprehensive set of standards for the quality care of patients with rectal cancer. New NAPRC standards will be provided later this year.
Given the success of the NAPRC program, the ACS is developing an umbrella program for high-risk cancer care under the CoC structure to develop accreditation programs in other complex cancers, including colon, pancreas, hepatobiliary, esophageal, and lung, that will be modeled based on the success of the NAPRC.
NCDB
The NCDB is transitioning away from an annual call for data to monthly data submissions to deliver more real-time and actionable data and provide reports back to CoC-participating hospitals. Newly designed benchmarking, site by stage, and completeness reports take advantage of this move to concurrent data abstraction.
The use of new reporting technologies such as Tableau and the eventual incorporation of 30 quality measures will add value to the program. In addition to the NCDB’s role in generating an annual report and studies showing the value of CoC accreditation, the NCDB is collaborating with the AJCC and CRP to develop a cancer survival calculator incorporating machine learning to provide a comprehensive prognostic online tool to provide patients with survival estimates in real time. Calculators for each cancer type will be developed, providing more individualized survival estimates that take into account patient factors and treatment factors, as well as standard staging factors and other tumor factors.
AJCC
AJCC Staging Online, launched in June 2024, provides real-time easy access to the AJCC staging system (see June Bulletin). AJCC Staging Online provides updated staging information based on the Version 9 Cancer Staging Protocols. Detailed information concerning the 2024 issue of the AJCC Cancer Staging Manual, 8th Edition, also is available online. This information will be updated continuously to provide the most comprehensive and up-to-date staging system through a seamless navigation format ensuring that information can be quickly available to oncologists.
CSSP
The CSSP provides critical educational materials related to the technical conduct of cancer operations and sets standards for surgical care. The Operative Standards Toolkit provides resources for implementation of the CoC operative standards and optimal resources for hospitals to comply with CoC Standards 5.3 to 5.8.
These standards include technical and documentation requirements for procedures, including sentinel lymph node biopsy for breast cancer, axillary lymph node dissection for breast cancer, wide local excision for primary cutaneous melanoma, colon resection, total mesorectal excision for rectal cancer, and pulmonary resection. Several of these standards have now been incorporated into the CoC standards. Additional work is underway to formally include the CSSP recommendations in the National Comprehensive Cancer Network guidelines for cancer care and include CSSP Cancer Surgery Protocols as a benefit of CoC participation.
CRP
The CRP performs research that determines how to drive quality cancer care for all the ACS Cancer Programs. One of the key ACS resources used is the NCDB, which is the most comprehensive cancer database available in the US. Later this year, we will be publishing an annual report developed through the CRP which will describe the state of cancer care in the US.
Further efforts are underway to incorporate cost and additional financial data into the quality programs with an attempt to advance the value of cancer care considering both quality and cost of care. The CRP continues to seek additional funding sources to support innovative approaches to advancing quality surgical care. As one example, the CRP was awarded a recent grant from the National Cancer Institute to evaluate the impact of the current slate of CoC operative standards on short-term cancer outcomes and to evaluate implementation outcomes.
Cancer Quality Improvement Initiatives
The newest area of ACS Cancer Programs—nationwide cancer quality improvement (QI) initiatives for CoC, NAPBC, and NAPRC participating sites—was launched in 2021. Past projects have focused on return to screening during the COVID-19 pandemic (in conjunction with the American Cancer Society), “Just Ask,” which focused on smoking cessation, and “Beyond Ask,” designed to offer smoking cessation assistance.
In the NAPBC, the Patient-Reported Observations on Medical Procedure Timeliness (“PROMPT”) for Breast Patients study, a 2-year quality collaborative, was completed in January 2024. Current cancer QI projects include Breaking Barriers, aimed at reducing missed radiation therapy appointments, and Lung NODES, which seeks to help CoC programs improve compliance with CoC Standard 5.8 on nodal harvest during lung resection. Overall participation in national QI projects remains high, and new projects are being vetted.
ACS Cancer Programs leaders, staff, and volunteers are excited for what the future holds for these programs and how it can continue to collaborate with other ACS divisions and member organizations to improve the care for patients with cancer.
The annual ACS Cancer Conference is March 12–15, 2025, in Phoenix, Arizona. For more information about the ACS Cancer Programs, contact Dr. Weigel at rweigel@facs.org or Amy Sachs at asachs@facs.org.
