Tips to Comply With New Commission on Cancer Standards

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.

Standard 3.1 – Patient Navigation Process

The three new “3.x” standards can be particularly intensive standards to implement, Moysaenko said. Programs are not required to be in full compliance until 2015, but all programs should be acting on them because to get them up to full operational compliance will take time and resources.

To meet the Patient Navigation Process standard all physician offices will be required to demonstrate that they have the ability and resources to assist cancer patients, family, and caregivers in moving or navigating through the gaps and barriers to quality cancer care throughout their cancer journey.

That process will require offices to assess their community to identify prevalent healthcare disparities and barriers in order to address them. Physician offices should assimilate and identified barriers on their intake documents or during the course of the history or physical examination so that the patient gets the appropriate supportive care through referral. Again, the information of how this is done in the physician office needs to be shared with the cancer program. 

Standard 3.2 – Psychosocial Distress Screening

The psychosocial distress screening standard requires physician offices to demonstrate that they screen patients diagnosed with cancer and identify the issues that can negatively impact treatment and outcome. The screening should identify physical, psychosocial, social, spiritual, and financial support needs.

According to Moysaenko this is similar to the palliative care requirement; however, palliative care should be available on site or by referral, whereas, the psychosocial distress screening process should be developed, implemented, integrated, and monitored by 2015.

The office needs to decide at what point the screening is being accomplished. The tools need to be quick, effective, and validated. A referral needs to be done so that a patient’s distress is managed and there needs to be documentation and a free flow of information between the physician office and the cancer program.

Standard 3.3 Survivorship Care Plan

Finally, the survivorship care plan will provide a summary of treatment and a follow-up plan to all patients completing cancer treatments. These plans need to include a record of provided care, disease characteristics, a follow-up plan, and clear and effective counseling to the patient.

Templates of possible care plans are available from ASCO, IOM, LIVESTRONG and the ACS. Physician offices should select a template. In most cases the reports and counseling will be completed by the patient navigators.