ACS' Commission on Cancer releases new standards to directly address patient concerns

Sep 2 2011

A patient-centered approach is at the forefront of new accreditation standards for hospital cancer programs released today by the Commission on Cancer (CoC) of the American College of Surgeons (ACS). "The changing landscape of cancer patient care motivated us to develop new standards to directly address patient concerns," said Stephen Edge, MD, FACS, Chair of the Commission on Cancer. "These standards enhance the focus of care so that it is much more than a defined structure of clinical treatment."

The new CoC standards ensure that key elements of quality cancer care are provided to every person with cancer treated in a CoC-accredited facility throughout their diagnosis and treatment process, as well as psychosocial support, care for cancer-related pain, palliative care, and hospice care.

Four national cancer patient support/advocacy organizations worked closely with the CoC to develop the new patient-centered standards to better enable cancer patients to work with their interdisciplinary cancer treatment team and become partners in their own care. Family members are also welcome participants in the process.

These advocacy group contributions are reflected in three key areas of patient-centered treatment and include:

•A patient navigation process to address health care disparities and barriers to care.
•Screening patients for psychosocial distress.
•A survivorship care plan that documents care received and seeks to improve cancer survivors' quality of life.

The four patient support/advocacy organizations that are members of the CoC and provided key input into the development of these standards are: the American Cancer Society, the Cancer Support Community, the National Coalition for Cancer Survivorship, and LIVESTRONG. These groups also contributed input on how patient-centered standards could be implemented into the framework of CoC-accredited cancer programs.

Additionally, new patient-centered standards have been developed that require accredited programs to offer patients palliative care (either on site or by referral) and genetic services (either on site or by referral by a qualified genetics professional).

The CoC standards require a coordination of care among many medical disciplines including physicians ranging from primary care providers to specialists in all oncology disciplines. Clinical and allied-health professionals including nursing, social work, genetics, nutrition, rehabilitation, and others also help to ensure that patient needs are addressed. This complex system of care can be a challenge for many cancer patients and their families, prompting the CoC to work with the American Cancer Society to develop a patient navigation process standard. Specifically, the CoC will require that its accredited cancer programs perform an assessment of their community and develop programs to address barriers to access and cancer care.

"Integrating this extra layer of support alongside curative treatment is essential to reduce suffering and improve quality of life for cancer patients and their loved ones," said Otis W. Brawley, MD, chief medical officer, American Cancer Society. "Cancer patients who seek care at CoC-accredited facilities will benefit from interdisciplinary teams who focus on relieving symptoms, pain, and stress, and can help coordinate communication among the patients, their families, and their medical team."

Another component of the "extra layer of support" Dr. Brawley mentions is the patient's psychosocial well-being. The new CoC standard that requires all patients be screened for distress was developed in consultation with the Cancer Support Community (CSC), a group that "has long been a champion of distress screening at critical stages along a person's cancer journey," explains Kim Thiboldeaux, CSC president and CEO. "We are particularly pleased with the Commission's adoption of a standard requiring that all cancer patients be screened for distress," she said. "We will support implementation of this new standard by continuing to make a wide array of support services available through our network of more than 50 professionally led community-based centers as well as online, so that no one has to face cancer alone."

Fortunately, early screening and improved local therapy and systemic treatments are producing more cancer survivors. The decline in cancer mortality rates for many types of the disease--while cause for optimism--promoted the CoC to seek input on the development of a cancer survivorship standard to address quality-of-life issues for the growing ranks of cancer survivors. "The integration of these new standards at all Commission on Cancer facilities is an important step towards addressing the needs of survivors, a population that is growing now that more people are living with cancer," said Doug Ulman, LIVESTRONG president and
CEO. "We are proud to be part of this national effort."

"We commend the Commission for adoption of the new standard calling for cancer survivors to receive a comprehensive care summary and survivorship care plan upon completion of their cancer treatment," said Ellen L. Stovall, Senior Health Policy Advisor, National Coalition for Cancer Survivorship. "Incorporation of this new standard into the Commission's accreditation process is an important milestone in implementation of a key recommendation of the Institute of Medicine's 2005 consensus report From Cancer Patient to Cancer Survivor: Lost in Transition," explained Ms. Stovall who also served as Vice-Chair, IOM Committee
on Cancer Survivorship: Improving Care and Quality of Life.

Promoting the highest level of quality cancer care has always been the foundation for Commission on Cancer standards, and the new 2012 standards contain new quality requirements. Of particular note is a new standard that requires CoC programs to reach specific performance levels on measuring quality for treating patients with breast, colon, and rectal cancers. These "quality measures" are defined by the Commission on Cancer and endorsed by the National Quality Forum. The CoC, through its National Cancer Data Base (NCDB), has the only system available in the United States to apply these quality measures and feed data back to its programs to evaluate how they are performing. This system in turn allows them to develop a cancer care program that renders care along a continuum of continuous quality improvement.

"The 2012 CoC standards challenge cancer programs to enhance the care they provide by addressing patient-centered needs and measuring the quality of the care they deliver against national standards. Both areas are critical components of quality cancer care," explained Daniel P. McKellar, MD, FACS, who chairs the CoC's Accreditation Committee.

The Commission on Cancer revises its standards every five to seven years. While the new patient-centered approach is now a required part of the standards, "we recognize that cancer programs may not immediately have all of these elements in place, and are allowing them to be phased in," said Dr. Edge. "However, we do expect phase-in efforts to move along quickly, and CoC programs will derive great benefit from the support of the four leading national cancer advocacy groups that have been such valuable contributors to our efforts in promoting patient-centered cancer care."