In 2011, the American College of Surgeons Commission on Cancer announced several new patient-centered standards that were designed to ensure that key elements of quality cancer care are provided to every person with cancer treated at an accredited facility.
Among the newly required standards are implementation of a patient navigation process, screening patients for psychosocial distress, development of patient survivorship care plans, offering a palliative care program, and providing genetic services. Programs seeking accreditation are visited every 3 years by a physician surveyor who ensures that it is in compliance. This can be a daunting task for cancer centers, but the implementation can be even more of a challenge for physician offices.
At the Association for Community Cancer Centers 40th Annual National Meeting, Valeriy Moysaenko, MD, FACS, a physician surveyor with the American Cancer Society (ACS) presented practical tips for physicians’ offices to understand and comply with the new CoC standards.
Multidisciplinary, comprehensive cancer care requires a wide variety of services that may not always be available to the average physician office including the typical medical services, such as surgery, pathology, and radiology, in addition to things like having a quality improvement coordinator, a community outreach coordinator, administrators, and more.
“We can assume that physician offices are going to implement these in the easiest way possible, and that is to be expected,” Moysaenko said.
Therefore, Moysaenko provided a few practical tips regarding each of the five new patient-centered requirements.
Standard 2.3 – Risk Assessment and Genetic Counseling
The new standard says that all programs are required to provide cancer risk assessment as well as genetic counseling and testing, on-site or by referral by a qualified genetics professional.
Moysaenko said that a physician office will need to develop an effective screening tool, and a referral pattern to share information with the cancer program so that the cancer program can monitor effectiveness of the genetic screening and counseling.
An example of a genetic screening tool would be an intake document that asks if a cancer patient was diagnosed at an early age, if they have several generations of family members with the cancer, if they have multiple primary cancers, would ask about specific ancestry, if there is a genetic mutation previously identified in the family, if they have 10 or more colon polyps, or if they have a rare tumor.
“It can be as simple as that without consuming a lot of resources,” said Moysaenko.
Standard 2.4 – Palliative Care Services
This standard requires that palliative care services are available to patients either on-site or by referral. Palliative care addresses a patient’s or a patient’s family’s emotional, physical, practical, and spiritual issues. In addition, a palliative care team requires a lot of resources including a physician, nurse, social worker, mental health clinician, and a chaplain or spiritual counselor that is culturally confident.
Practices need an effective screening tool that addresses all of these components and that when associated metrics trigger it, a referral is obtained. Again, information on referrals must then be shared with the cancer program.
Moysaenko said that one great example of a potential palliative screening tool is the NCCN Distress Thermometer, which evaluates practical, emotional, spiritual, and physical problems.