The CoC Source - June 29, 2012
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SAVE THE DATE: CoC Fall Meetings at Clinical Congress

The Commission on Cancer (CoC) 2012 Fall Meetings will be held in conjunction with the American College of Surgeons Clinical Congress on Sunday, September 30-Monday, October 1, 2012. This year's meeting will be held in Chicago, IL. Sunday’s CoC meetings take place at the Hilton Chicago Hotel and Monday’s Cancer Liaison Physician Breakfast meeting will be held at the Hyatt Regency McCormick Place. CoC Members, State Chairs, and Cancer Liaison Physicians should have received their invitation this week, which includes the complete meeting schedule. If you have questions, or if you did not receive your invitation, please contact Andréa Scrementi at

The CoC-sponsored Education Sessions during Clinical Congress are as follows:            

    PS111 - Managing the Axilla in Breast Cancer
    Monday, October 1, 2012     11:30 am-1:00 pm
    Presenter: David J. Winchester, MD, FACS

    PS125 - The Impact of Neoadjuvant Chemotherapy on the Locoregional Management of Early Stage Breast Cancer
    Monday, October 1, 2012     4:15 - 5:45 pm
    Moderator: Elin R. Sigurdson, MD, FACS

    PS303 - Quality Programs for Breast Surgeons: What Do I Need to Know?
    Wednesday, October 3, 2012    8:00-9:30 am
    Presenter: Cary S. Kaufman, MD, FACS

    PS328 - Progress and Current Controversies in the Management of Melanoma
    Wednesday, October 3, 2012     4:15-5:45 pm
    Presenter: Daniel Coit, MD, FACS and Danny Takanishi, Jr., MD, FACS

    PS401 - Evolution in Outcomes of the Endoscopic and Surgical Management of Esophageal Cancer
    Thursday, October 4, 2012     8:00-9:30 am
    Presenter: Steven Hochwald, MD, FACS

    NL10 - Commission on Cancer Oncology Lecture: 50 Years of Bowel Cancer Surgery - Tales of the Unexpected
    Wednesday, October 3, 2012     12:45-1:45 pm
    Presenter: R. J. Heald, OBE, MChir, FRCS

    To learn more about these sessions, or to register for Clinical Congress, please visit



    American College of Surgeons Commission on Cancer Surgical Oncology Scholar-in-Residence Program

    The American College of Surgeons (ACoS) CoC is offering a two-year fellowship in surgical oncology outcomes and health services research beginning July 1, 2013.  The ACoS CoC has one position available every two years for a surgical resident who has completed two or three years of clinical training in the U.S. or Canada. The fellow will work within the Cancer Programs Department of the ACoS to conduct clinical research and further the research agenda of the CoC’s National Cancer Data Base (NCDB) whose goal is to improve the quality of care for the cancer patient. The application deadline is August 15, 2012.

    Details about the program can be found on the CoC website at

    Program questions and completed applications with supporting documentation should be directed to Connie Bura at

    2013 Initial Survey Notification

    This communication serves as official notification from the American College of Surgeons (ACS) CoC for accredited cancer programs due for survey in 2013.

    If your program is scheduled to be surveyed during 2013, you will receive a detailed e-mail notification next week. If you do not receive this, a generic version will also be posted on the CoC website at It is important to look for this e-mail because of the changes to CoC Datalinks and the release of the Eligibility Requirement section of the new Survey Application Record (SAR).

    We appreciate your facility's continued commitment to high quality cancer care and participation in the CoC Accreditation program.

    Except for abstracting timeliness and CAP standards, which excludes 2010 and the first three months of 2011, the 2013 survey will include cancer program activity for the years 2010, 2011, and 2012.

    Cancer Program Standards 2009, Revised Edition, ( will be used to assess 2010 and 2011 cancer program activity.
    Cancer Program Standards 2012: Ensuring Patient-Centered Care
    ( will be used to assess 2012 cancer program activity.

    As of July 9, 2012, the Facility and Staff Contact Information and the Eligibility Requirement sections of the SAR will be available for completion in CoC Datalinks at  The availability date has changed due to additional enhancements being made to the CoC Datalinks system.  We apologize for this delay.

    Because this is a brand new system, the cancer registrar or designated staff must update or add contact information for ALL facility cancer program staff in the Manage Contacts section and update facility information in the Manage Facility section of the CoC Datalinks Activity Menu for your facility. We are now requesting contact information for several additional cancer program staff.

    The Eligibility Requirements section needs to be completed with 2012 activity and documentation by September 30, 2012. Many of the sections contain resource and services information displayed in the CoC Hospital Locator. Completion of ALL eligibility requirements is required before your program can move forward with survey in 2013. Failure to complete this section may result in a delay of your survey scheduling or in suspension of your program’s accreditation. You will be notified in a separate e-mail, on or around December 1, 2012, of the assigned surveyor's name. The surveyors contact email will be available in the SAR and a link to the surveyor profile will be available on the CoC Datalinks activity menu.

    The SAR is used by the cancer program to document compliance with the CoC’s standards since the last survey. The old SAR should already be completed with cancer program activity and documentation for 2010 and 2011 and is read-only. The new SAR, which becomes available in October 2012, is to be completed with information describing 2012 cancer program activity along with posting of required documentation. Note: Content from the old SAR will NOT be copied over to the new SAR.

    Survey extensions or postponements are discouraged, but if this becomes necessary, the program should review the Survey Extension Policy, on the CoC website at The form to request an extension must be submitted to no later than August 6, 2012. Requests for extension received after that date will not be accommodated.

    The 2013 survey fee is $7,500 for individual cancer programs or $7,500 plus $3,750 for those facilities that are part of a network. An invoice for the survey fee is e-mailed to the registrar at the facility at least one month before the survey takes place. Payment of the fee is due within 30 days after the invoice is issued.

    Several tools and resources to prepare for survey are available through the CoC Online Education Portal or the Best Practices Repository accessible from the CoC website at

    Questions concerning SAR and survey scheduling should be forwarded with your facility name and FIN to

    Please contact if you require assistance with your User ID and Password.

    Standards-related questions and interpretations should be posted to the CAnswer Forum at

     We look forward to working with you as you prepare for your accreditation survey.

    Thank you.

    American College of Surgeons
    Commission on Cancer

    CAnswer Forum Monthly Highlight: Public Profile Features

    Our goal for these articles is to make the CAnswer Forum user aware of the many helpful functions of the system. This month we are highlighting Setting and Profile Features.

    Every member has a publicly viewable profile page. This page includes information provided by the member, either during the registration process or later via the User Control Panel. There are a number of ways to view a member’s profile. Whenever you see a member’s name, clicking on it will take you to view his or her profile page. The Member List allows you to browse all registered members and quickly click through to their public profiles. When logged in, you can also view your public profile by logging into the forums and clicking on your username shown in the header at the top of the page.

    The public profile lists information about the member under the “About Me” tab and  also includes statistical information, including the number of posts they have made and the date they registered for the CAnswer Forum. This information is shown under the “Statistics” tab. Other information includes a list of Friends, a profile picture (if set by the member), and a list of members who have recently visited the profile page.

    Visitor messages are publicly viewable messages posted on member profile pages. To post a message, click on “Visitor Messages” and use the form at the top of the section. You will only be able to use certain formatting in these messages as described underneath the edit box. This message will be viewable by all visitors to this profile. To communicate privately with a member, send a private message instead.

    Next time you visit the CAnswer Forum check out the Member list, click on a user name, then “About Me,” and get to know your fellow Forum users. Who knows, you may find people you know. You can send them a message or just say hello.

    Take the time to investigate and use one or more of these Quick Links the next time you access the CAnswer Forum.

    Cancer Program Standards 2012 Best Practices Repository—What’s New This Month?

    This month we introduce two new best practices submitted to the CoC Best Practices Repository. These documents have been reviewed and approved by the Standards Advisory Group for Excellence (SAGE),

    The first best practice is an Assessment and Evaluation of Treatment Planning to support standard 4.6. This document was provided by Washington Adventist Hospital in Takoma Park, MD. Each year, a physician member of the cancer committee performs a study to assess whether patients within the program are evaluated and treated according to evidence-based national treatment guidelines. The study must determine that the diagnostic evaluation is adequate and the treatment plan is concordant with a recognized guideline. The source of this study was a single treatment modality (radiation) for a specific cancer site (prostate). The study looked at AJCC staging, prognostic factors, treatment recommendation, and the treatment delivered. The assessment concluded in all patients reviewed, all treatment recommendations were found to be concordant with the National Comprehensive Cancer Network guidelines.

    The second best practice is a cancer services report entitled Transforming Research and Statistics into Patient Care, provided by Charleston Area Medical Center in Charleston, WV. This report supports standard 1.12. Each year the cancer committee develops and disseminates a report of patient or program outcomes to the public. This report includes outcome information and is published on the facility’s website for public view.

    We hope our constituents find these examples helpful as they work to comply with the new 2012 standards. To view these documents and other newly posted documents, access the Best Practices Repository at

    We would like to thank our constituents, member organizations, and staff for contributing resources, tools, and best practices to the repository. We would like to encourage all accredited programs to share their best practices.  Please submit best practices for consideration to

    Highlighting the 2012 Standards – Chapter 4: Patient Outcomes, Standards 4.6–4.8

    Standard 4.6 Assessment of Evaluation and Treatment Planning
    This standard ensures that evaluation and treatment conforms to evidence-based national treatment guidelines using AJCC or other appropriate staging, including appropriate prognostic indicators. Each year, a physician member of the cancer committee performs a study to examine the evaluation and treatment of patients and ensure that it is compliant with evidence-based national guidelines. The study must determine that the diagnostic evaluation is adequate and the treatment plan is concordant with a recognized guideline. If problems are identified with the diagnostic evaluation or treatment planning process, this could serve as a performance improvement source (for Standard 4.5).

    The annual study includes all of the following components:

    1.    Sources for the study include one of the following:

    • A site-specific sample

    • Involves all cases from that site, to a maximum of 300 cases
    • Is based on an identified need, concern, or problem
    • Is based on uncommon cases such as cases not generally presented at cancer conferences
    • 10 percent random review of the annual analytic case load, maximum of 300 cases for facility
    • Review of a single treatment for a specific cancer site.

    2.    A determination that the first course of therapy is concordant with an evidence-based national treatment guideline and/or prognostic indicators, when available.

    3.    A reporting format that permits analysis and provides an opportunity to recommend performance improvements

    Results of the annual study are presented to the cancer committee and documented in the cancer committee minutes. The cancer committee should use the findings to make improvements in patient care. The completion of this study does not fulfill the requirement for Standard 4.7.

    Standard 4.7: Studies of Quality

    Annual evaluation of the care of cancer patients provides a baseline to measure quality and an opportunity to correct or enhance care and quality outcomes. Quality improvement (QI) is a multidisciplinary effort and must include support and representation from all clinical, administrative, and patient perspectives. The QI coordinator, under the direction of the cancer committee, focuses on evaluation areas of cancer care. Study topics are selected by the cancer committee and the QI coordinator.

    The study focuses on areas with problematic quality-related issues relevant to the program and local cancer patient population. Studies are designed to evaluate the entire spectrum of cancer care. The spectrum of cancer includes issues related to

    • Structure
    • Process
    • Outcomes

    Studies are designed to involve physicians and allied health professionals. QI tools to address these issues include, but are not limited to, the following:

    • Checklist
    • Fishbone diagram
    • Flowchart
    • Pareto chart
    • Run chart

    The first step in completing the QI process is completing a study of quality. Standard 4.8 provides information for the second step in the QI process. The second step focuses on implementation of a correction or improvement in performance that is based on a finding from a study of quality.

    For each study, the QI coordinator and the cancer committee are responsible for the following:

    • Setting the study topic that identifies problematic quality-related issues
    • Defining criteria for evaluation, including data needed to evaluate the study topic or answer the quality-related question
    • Conducting the QI study according to the identified measures
    • Preparing a summary of the findings
    • Comparing data results with national benchmarks
    • Designing and initiating action plans based on the evaluation of the data
    • Establishing follow-up steps to monitor the actions implemented
    • Monitoring the effectiveness of the study action plans and all cancer-related QI activities at the program

    Methods used to monitor quality studies are set by the QI coordinator and the cancer committee, documented in cancer committee minutes, and shared with the medical staff and administration. Note the following:

    •    Data monitoring may be used once to examine (study) a quality topic but not continued annually.
    •    Activities that duplicate study topics and criteria without analysis of the findings do not fulfill this standard.
    •    Ongoing monitoring activities do not fulfill this standard.
    •    A study required by outside organizations related to oncology is acceptable if it follows the study criteria that are outlined in the standard.
    •    Review of data presented in the CoC quality reporting tools does not fulfill the requirement for this standard

    Standard 4.8: Quality Improvements

    QIs are the actions taken, processes implemented, or services created to improve patient care. Each year the QI coordinator, under the direction of the cancer committee, implements two patient care improvements. One improvement is based on the results of a completed study that measures cancer patient quality of care and outcomes. One improvement can be identified from another source or completed study. Improvements are documented in the cancer committee minutes and shared with medical staff and administration.

    Implementation of improvements demonstrates a program’s continuous commitment to provide high-quality cancer care. Sources for improvements include, but are not limited to, the following:

    •    Actions based on analysis of a study of quality
    •    Actions to address undesirable performance
    •    Changes to improve acceptable performance

    The QI coordinator monitors, reports, and recommends activities related to the QI program, reports regularly to the cancer committee, and recommends corrective action if any area falls below acceptable norms or when undesirable performance is identified. The results and recommendations are documented in cancer committee minutes that are shared with the medical staff and administration.

    Next month—Chapter 5: Data Quality 5.1–5.7

    The full series of articles on the new standards is accessible at

    Need Help with Preparing Your Cancer Committee Report?

    Need Help with Preparing Your Cancer Committee Report?
    Now that Standard 4.3 requiring Cancer Liaison Physicians (CLPs) to report on their cancer program’s performance four times per year is in place, there are many questions asking about what should be included in those reports. To help CLPs prepare their reports, Phil Roland, MD FACS,  Chair, Commission on Cancer (CoC) Committee on Cancer Liaison, developed a resource that includes some sample queries using the National Cancer Data Base (NCDB) tools. The CLP NCDB Examples document is posted on the Cancer Liaison Physician Information Board at

    The samples include review of the Cancer Program Practice Profile Report (CP3R) quality measures and addressing any measures with low performance rates, generating a report of “Stage at Presentation” in patients with a diagnosis of colon cancer using the NCDB Hospital Comparison Benchmark Report, generating site-specific survival using the NCDB Survival Report, and evaluating the inflow and outflow of patients with prostate cancer in your cancer program. These sample queries can be used as the basis for additional queries using the NCDB tools. For example, you can follow the steps for the “Stage at Presentation” query for patients with breast cancer and include additional variables, such as age or ethnicity.

    During the year, the Cancer Liaison Program will develop other practical examples and brief webinars to assist CLPs with the reporting requirements of Standard 4.3. Questions about the standard, the NCDB tools, or other topics can be sent to

    July 1, 2012 Expiring Terms for Cancer Liaison Physicians

    CLPs serve a three-year term and are eligible to serve an unlimited number of terms based on performance and evaluation data collected at the time of survey. The terms of more than 207 CLPs will expire in July 2012 and each cancer committee must determine whether the current CLP is appropriately serving in this role or if another candidate would better suit the position. 

    In June, the CoC e-mailed letters to the programs with a CLP whose term is expiring. The letters included details on how a facility can either reappoint the CLP to another three-year term or recommend a replacement.

    If you reappoint your CLP, please use this time to update and confirm your CLP’s contact information in the CoC database at



    Cancer Liaison Physician Webinar Series

    Another resource for helping CLPs with the Standard 4.3 reporting requirements is the webinar series available on the CoC Online Education Portal at Webinar topics include

    •    Orientation to the Cancer Liaison Physician Role: Focus on Improving the Quality of Cancer Care (13 minutes)
    •    Becoming an American Cancer Society Liaison (8 minutes)

    •    How to Navigate the National Cancer Data Base Tools: A Primer (12 minutes)

    •    Putting the National Cancer Data Base Tools to Work (17 minutes)

    •    Analyzing and Reporting Your Cancer Program's Quality Data (11 minutes)

    The series is free of charge.  Before accessing the Webinars, new users to the Education Portal will have to create an account by clicking on “Create an Account” in the last blue tab on the left and follow the instructions. Complete instructions are posted on the Cancer Liaison Physician Information Board at

    The educational series should be completed as soon as possible. Any questions can be directed to

    Congratulations, New State Chairs

    Congratulations to these new and reappointed State Chairs:
    Dr. Rudy Lackner, University of Nebraska Medical Center, Omaha, NE (new)
    Dr. Norman Estes, University of Illinois, Peoria, IL (reappointment)

    Save the Date!

    The Cancer Liaison Physician Breakfast Meeting will take place on Monday, October 1, 2012, from 6:30–8:00 am at the Hyatt Regency McCormick Place in Chicago. Meeting topics will focus on the CoC quality standards, including a discussion of the role of the CLP in meeting these standards and a demonstration of how to interpret your program’s compliance using NCDB data. The meeting will be recorded and the podcast will be available free of charge in the CoC Education Portal. Invitations to the CoC meetings were disseminated to all CLPs earlier this week. Questions about the meeting and registration should be directed to Andréa Scrementi at





    Completion of the Annual CLP Activity Report

    Each year CLPs are required to complete an Activity Report, documenting their cancer program contributions. This report is incorporated into the Survey Application Record (SAR) for the accredited cancer program.  This report is required for completion by the CLP at the time of survey as well as annually between surveys.  The annual completion takes place during the CoC’s Annual Update process scheduled between July 1 and September 30th.  On July 9th we will be releasing the new Eligibility Requirements section for accredited cancer program completion.  This serves as the Annual Update for this year.  The 2012 CLP Activity Report will not be included as part of the Annual Update, rather, it will be included as part of the new 2012 SAR scheduled for release in October.  Therefore, all CLPs will be required to complete the new 2012 CLP Activity Report during the last quarter of this year documenting their 2012 activity.  A reminder will be sent in the fall.  Please submit any questions to  Thank you.

    One-Quarter of Accredited Facilities Participating in RQRS

    In the past nine months since voluntary Rapid Quality Reporting System (RQRS) enrollment was released, participation has been increasing rapidly! Nearly 25 percent of all accredited facilities currently participate in this real time, clinical quality tool. Because this system operates in real clinical time, participating programs may track cases within the timeframe recommended for adjuvant therapy. 

    To increase the utility of this clinical quality tool, the RQRS is equipped with system Case Alerts, which change color from white to red as a case nears the end of the treatment window without reported adjuvant therapy.  Once adjuvant therapy has been received or the treatment window has expired, all cases submitted to RQRS can be viewed within the Case List to be monitored for accuracy.

    For more information on the RQRS system, please visit the RQRS webpage at

    June Publications by NCDB Staff

    An article on recording sentinel lymph node biopsies, a poster on the currency of follow-up when the National Cancer Data Base (NCDB) changed the submission cycle, and a poster published in June on differences in treatment status for the Rapid Quality Reporting System cases are highlighted as follows:

    An article entitled “Scoping It Out: A Change in Sentinel Lymph Node Surgery Coding Practice,” by Jerri Linn Phillips and Andrew Stewart appeared in the Spring 2012 edition of the Journal of Registry Management (, pp. 29-34). The American College of Surgeons Commission on Cancer clinicians investigated what appeared to be overuse of axillary lymph node dissection rather than sentinel lymph node biopsies, for node-negative breast cancer patients. Working with their registrars, they established that the problem lay not in the coding of these procedures, but in the instructions themselves. The article outlines three separate problem areas:

    1. Inappropriate use of the pathology report to code Scope of Regional Lymph Node Surgery
    2. Difficulty distinguishing between nodes removed as part of a sentinel lymph node biopsy and as part of a completion axillary lymph node dissection
    3. Failure to code multiple surgical procedures cumulatively

    The article describes the development of the current instructions that have already been implemented for use beginning with 2012 diagnoses by all registry standard setters, for which the surgical report is used as the coding source.  Additional notes specific to breast cancer are also presented.

    Jerri Linn Phillips and Andrew Stewart presented a poster, “How the NCDB Data Collection Cycle Affects Survival Calculations,” at the North American Association of Central Cancer Registries (NAACCR) 2012 Annual Conference held in Portland, OR. The poster is available at

    Until 2011, NCDB collected reports on a five-year cycle, such that information added to hospital registries after a Call for Data may not have been reported for as long as five years after the event took place. The follow-up currency effects of that data collection cycle are illustrated, along with comparisons to the currency of follow-up after the 2011 Call for Data. The 2011 Call for Data was the first of the new cycle in which all updated cases are submitted annually.  NCDB staff reported the following conclusions:

    • The change in submission cycle vastly improved NCDB’s access to annual follow-up results.
    • Follow-up for the most recent year collected lags behind due to hospital and NCDB processes.
    • NCDB will recalculate survival rates for the same years using the same cut-off date to establish the stability of the calculated survival results using the 2012 submissions.

    Erica McNamara and colleagues presented a poster titled “Beyond the Performance Rate: Understanding Differences in Treatment Status Using the Rapid Quality Reporting System (RQRS)” at the American Society of Clinical Oncology‘s 2012 Annual Meeting in Chicago, IL (J Clin Oncol 30, 2012 suppl; abstr 6088) at

    RQRS assesses compliance with six quality measures; four reported measures require adjuvant therapy to be administered within a specific number of days or to have a documented reason for non-administration. The purpose of this study is to evaluate changes and differences in the proportion of cases that consider but do not receive adjuvant therapy. They reported the following conclusions:

    • Considered but not administered (CNA) therapy accounts for 4–8 percent of measure-eligible patients and did not increase over the study period.
    • Patient refusal is the most common reason for CNA therapy.
    • Including CNA patients in performance rate calculations ensures patient choice and contraindications are represented in high-quality cancer care.

    New Webinar Now Available: CoC Standard 3.1 Patient Navigation Process

    Visit the Online Education Portal to register and view the latest on-demand webinar, “Cancer Program Standards 2012 Continuum of Care Services: Standard 3.1 Patient Navigation Process”, presented by Virginia Vaitones, MSW, OSW-C, from PenBay Medical Center, Rockport, ME.

    This program is intended for cancer program team members responsible for implementing the CoC standards, patient navigation programs, and processes within their cancer program, and establishing new patient navigation.

    This presentation will provide participants from CoC-accredited cancer programs or those seeking accreditation with information about the definition, requirements, documentation, and compliance expectations for Standard 3.1 Patient Navigation Process. In addition, the presentation will provide a general primer on patient navigation concepts including resources and strategies for conducting a needs assessment to identify health care disparities and barriers, including aspects concerning development and evaluation of patient navigation processes and programs. 

    Learning objectives
    1. Understand the rationale, requirements, and compliance expectations for the CoC Standard 3.1 Patient Navigation Process.
    2. Illustrate the key concepts of patient navigation, including available resources and training programs.
    3. Review the process for conducting a needs assessment.
    4. Describe concepts for cancer program planning, implementation, and evaluation of patient navigation processes and programs.

    To register for the webinar, visit

    Are You Caught Up On The Latest New Standards Education?

    Stay up-to-date on the latest CoC standards education and view one of the 13 recently launched webinars on the CoC Online Education Portal. These webinars were created to support all cancer program staff in understanding and implementing the 2012 patient centered standards.

    Some of the most popular webinars include:

    • Cancer Program Standards 2012 Continuum of Care Services: Focus on Survivorship Care Plans
    • Studies of Quality and Quality Improvements
    • Cancer Program Standards 2012 Continuum of Care Services: Focus on Psychosocial Distress Screening, Tools and Resources
    • Quality of Patient Care: New CoC Standards

    For more information and to register visit the CoC Online Education Portal.

    AJCC News

    AJCC Cancer Staging Atlas, 2nd Edition Available for Pre-Order

    Significantly expanded and expertly and beautifully illustrated, the AJCC Cancer Staging Atlas, 2nd Edition, offers more than 600 illustrations created exclusively for this new edition and is fully updated to reflect the concepts discussed in the 7th Edition of both the AJCC Cancer Staging Manual and its companion Handbook. This Atlas illustrates the TNM classifications of all cancer sites and types included in the 7th Edition of the Manual and visually conceptualizes the TNM classifications and stage groupings.

    Specifically designed for simplicity and precision, the drawings have been verified through multidisciplinary review to ensure accuracy and relevancy for clinical use. Every illustration provides detailed anatomical depictions to clarify critical structures and to allow the reader to instantly visualize the progressive extent of malignant disease. In addition, nodal maps are included for each site, appropriate labeling has been incorporated to identify significant anatomic structures, and each illustration is accompanied by an explanatory legend.

    • Combines the AJCC Staging Atlas with a CD containing all images
    • Users can also import figures into presentations for cancer conferences, grand rounds, presentations, and journal articles/book chapters
    • Based on the 7th Edition staging system

    The AJCC Cancer Staging Atlas, 2nd Edition, is an official publication of the American Joint Committee on Cancer, the recognized international leader in state-of-the-art information on cancer staging. This Atlas has been created as a companion to the updated 7th edition of the AJCC Cancer Staging Manual, which continues to disseminate the importance of anatomical and pathological staging in the management of cancer. This state-of-the-art, invaluable 2nd edition includes a CD containing PowerPoint slides of all illustrations, additional color, and a user-friendly, easy-to-read layout. The AJCC Cancer Staging Atlas, 2nd Edition will serve as an indispensable reference for clinicians, registrars, students, trainees, and patients. Order your copy today at or directly at

    AJCC and UICC Webinar: Tumor Deposits in Colorectal Cancer

    The AJCC and the Union International for Cancer Control (UICC) collaborated to develop an educational presentation dedicated to tumor deposits in colorectal cancer. Tumor deposits were first introduced as a new concept for categorization in the AJCC Cancer Staging Manual, 7th edition, and the UICC TNM Classification of Malignant Tumors, 7th edition.

    The purpose of this presentation is to highlight the criteria for and provide guidance on the new N1c category. The presentation answers frequently asked questions on tumor deposits with a united voice from the AJCC and UICC.

    The free webinar can be viewed on the AJCC Online Education portal at

    Target Audience
    This program is primarily intended for physicians, especially pathologists, but is also open to cancer registrars.

    Learning Objectives
    1. Understanding of the definition of tumor deposits
    2. Guidance for pathologists on documenting TD
    3. Utilizing the new N1c category
    4. 7th edition Hindgut task force process for change

    Christian Wittekind, MD
    Professor of Pathology
    Chairman Institute of Pathology
    University of Leipzig, Germany

    Carolyn Compton, MD, PhD
    J. Milburn Jessup, MD
    Leslie H. Sobin, MD
    Mary Kay Washington, MD, PhD
    Christian Wittekind, MD

    For questions, please contact

    CS Educational Resources: Know What’s Available and Where to Find Them!

    Take advantage of the many Collaborative Stage (CS) educational resources available! Below is a brief overview of the various resources available and links to take you to the information.


    Five new videos were recently added to the AJCC YouTube Channel. These presentations focus on the often confusing topic of coding neoadjuvant therapy. Other available video resources include important topics such as 998 vs. 999 and Grade Path Value/ Grade Path System. When you view the videos on the AJCC YouTube Channel, be sure to take an extra minute to comment on the videos, leave suggestions for other topics, and share with friends and colleagues!

    CS Webinars
    There are seven CS webinars available at the AJCC Education portal for complimentary viewing to the entire registry community! These seven webinars were developed and presented by some of the leaders in the field. The webinars are available for viewing 24 hours a day, 7 days a week. Topics include:

    The CS webinars are free, but, creation of an account to view the webinars is necessary for new users. If you have previously viewed an AJCC or CoC webinar through the CommPartners Education Portal, you can begin viewing the presentations immediately by adding the CS webinars to your cart. For technical issues, such as login or account creation, contact Comm Partners directly at

    CS Website
    The CS website has all the critical information you need for CS coding—from the General Rules of the Coding Instruction (essential reading for any CS coder!) to the CoC and SEER Combined Required Site Specific Factors. There are many helpful documents on the CS website for registrars. Check out the recently added Education Presentations. This page includes the CS presentations from the 2012 and 2011 NCRA meeting for anyone to download. The page also contains PowerPoint slides, handouts, quiz, and answer sheet for the seven CS Webinars available on the AJCC Education Portal. All these materials have been made available so that all registrars have access to these important educational resources.

    CAnswer Forum

    Lastly, if you have a question that isn’t addressed by any of the educational resources, the CAnswer Forum is the best place to visit! Chances are if you have the question, someone else does, too. Be sure to search the CAnswer Forum for your question before posting a new one.

    The CS Education and Training Team encourage registrars to become familiar with these resources as more content will continue to be added in the future. The CS Education Team has strived to provide CS education in a variety of formats to cater to the various learning styles of the registry community.

    We hope that you will find these resources useful and, as always, we welcome your feedback at




    NAPBC News

    Lead Your Breast Program to Excellence: Learning from Those Who Developed the Standards
    November 16–17

    The National Accreditation Program for Breast Centers (NAPBC), in conjunction with the National Consortium of Breast Centers (NCBC), will host a dynamic two-day conference at the Renaissance Chicago O’Hare Suites in Chicago, IL, November 16–17. Nationally recognized leaders will discuss critical success factors for comprehensive breast centers.

    Come learn how others “built” their multidisciplinary breast center from the ground up using nationally recognized programs. Learn from the experts who developed the standards. This two-day conference will include nationally recognized authorities discussing

    • National Quality Programs: The What, Why, and How of NAPBC, NQMBC, and BICOE
    • Developing a High-Quality Breast Program
    • Critical Success Factors for Developing Certification/Accreditation-Worthy Breast Programs
    • Benefits and Cost-Effectiveness of Breast Center Programs
    • Defining Benchmarks for Breast Centers of Excellence
    • Breast Diagnostic, Treatment, and Management Quality Metrics
    • Aggressive Screening Programs, Patient Navigation, Genetic Risk Assessment and Counseling, Survivorship, and Advocacy

    The ideal audience for this conference will be:

    • Hospital CEOs & COOs
    • Service Line Administrators
    • Breast Program Leaders (BPL) and other physicians involved with breast centers
    • Radiologists & Technologists involved with Breast Centers
    • Nurse Navigators, Quality Managers
    • Breast Imaging Supervisors
    • Genetic Counselors
    • Social Workers

    The American College of Surgeons designates this conference for a maximum of 16 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Mark your calendar TODAY. Seating for this conference will be limited and, because of the comprehensive nature of the agenda, will sell out quickly. If you would like to be placed on a priority registration list, please send an e-mail, with your contact information, to

    Registration will be open soon.

    2012 NAPBC Standards Manual NOW Available!

    The 2012 NAPBC Standards Manual is now available as a free download or a hard copy may be purchased for a nominal fee at Compliance with these standards will be required for centers applying for accreditation on or after June 1, 2012.

    NAPBC Exhibit Schedule

    The NAPBC is scheduled to exhibit at the following national meetings:
    Breast Cancer Coordinated Care
    July 19-21
    JW Marriott
    Washington, DC

    ASCO Breast
    September 13–15
    San Francisco Marriott
    Marque, CA

    Stop by the exhibit hall at any one of these meetings and pick up an NAPBC Information Kit or additional information about the program.

    ACS Clinical Research Program News

    Announcing the Surgical Standards Manual Project: A Call for Volunteers

    Kelly Hunt, MD; Leslie Kohman, MD; and Heidi Nelson, MD

    As surgeons involved in the daily care of cancer patients, we are all familiar with the American Joint Committee on Cancer (AJCC) Staging Manual and the College of American Pathologists (CAP) guidelines. The American College of Surgeons Clinical Research Program (ACS CRP) proposes that the time is right to develop a similar manual detailing surgical standards, complete with surgical checklists. The time is now because many, if not all, of the essential elements have been developed in the context of either clinical trials or as part of CoC standards for accreditation. Take for example the standardization practices developed for sentinel lymph node harvest in breast cancer and laparoscopic colectomy studies. The introduction of the sentinel lymph node surgery for breast cancer brought to the surgical community a well-defined procedural and training program to ensure high rates of accuracy. The introduction of laparoscopic surgery and other forms of less invasive oncologic surgery brought us surgical checklists and surgeon credentialing practices. Some standards within the CoC, such as the 12 lymph node count for colon cancer, have evolved to become national quality metrics. In essence, for those cancers covered by the National Cancer Institute (NCI) Cooperative Groups and the CoC, there have been substantial efforts to standardize surgical procedures and establish measurable metrics. The ACS CRP Cancer Care Standards Development (CCSD) Committee has accepted the challenge of collating all available surgical standards to launch the first edition of a surgical standards manual.

    It is difficult to predict with certainty what the final draft of such a manual will look like. It may resemble previously published surgical standards projects with checklists and summary recommendations. In an ideal world, such a manual would provide an assessment of the level of evidence in support of recommended standards and suggest areas in need of more research. The scope of the manual will be restricted to the intraoperative experience (i.e., from skin incision to skin closure). The standard will not attempt to duplicate the efforts of the NCCN guidelines because these guidelines already cover pre- and post-diagnostics and therapeutics. Current plans are to cover surgical procedures for the most common solid malignancies.

    The process for developing standards will be transparent and as inclusive as possible by seeking input from as many relevant societies, organizations and groups, and volunteers as possible. To manage the process, three diseases at a time will undergo review with a core team from the alliance and the CoC. Volunteers from relevant groups will be solicited, input will be welcome, and drafts will be vetted appropriately. If you or someone you know has an interest in participating in this process, please contact Dr. Kelly Hunt, Chair, CCSD Committee, at or Carla Amato-Martz, ACS CRP Program Manager, at

    The first public town hall on the surgical standards project will take place at the ACS Clinical Congress on October 3, 2012. Set aside this date and plan to attend to get more information about our progress and offer your input.

    NCRA News

    Order NCRA’s Premier Reference Guide for the Cancer Registry Today

    The National Cancer Registrars Association’s (NCRA) Cancer Registry Management: Principles and Practices for Hospitals and Central Registries is the only one-stop desk reference for cancer registry professionals. This comprehensive resource provides detailed information on the essential responsibilities of a cancer registrar and showcases new discoveries and improved technologies. It is designed to help cancer registrars quickly find important information on methodology and organization, and explains how to set up and maintain a cancer registry. Principles and Practices also includes a CD with a full-featured review of each chapter, providing practitioners a quick way to gauge understanding. It also includes appendices, a glossary of cancer registry terms, and a comprehensive index. Order this important reference guide directly from Kendall/Hunt Publishing Company by calling 800-228-0810 or visiting the website at (Use the term “NCRA” in your product search; NCRA members need to use the 1-800 number to receive the member-discounted price.)

    NCRA Is Offering Free Viewing of the Annual Conference Session

    The 411 on Site-Specific Factors

    This 30-minute special presentation, titled “The 411 on Site-Specific Factors,” is now available for free viewing online for a limited time. Dr. Mary Kay Washington provides an overview of the scientific basis and clinical significance of selected site-specific factors, demonstrates how the pathologist evaluates selected site-specific factors, and provides guidance on extracting site-specific factors from the medical record. (CE credit is not available for this free presentation.) To view the session, go to

    NCRA Announces New Fall Webinar Series on Strategic Abstracting

    NCRA has designed a unique webinar series focused on providing better information for cancer control through strategic abstracting. The four-part series begins September 26 with Strategic Abstracting: General Coding and Data Relationships and continues through January. Details will be outlined in the next edition of the CoC Flash. Registration opens in late summer.


    Monthly Spotlight: Society of Surgical Oncology

    The Commission on Cancer regularly collaborates with more than 50 member organizations in its mission to provide quality cancer care. This month we introduce the Society of Surgical Oncology® (SSO).

    Founded in 1940 as the James Ewing Society, the SSO is the premier organization for surgeons and health care providers dedicated to advancing and promoting the science and treatment of cancer. The society’s focus on all solid-tumor disease sites is reflected in its Annual Cancer Symposium, monthly scientific journal (Annals of Surgical Oncology), educational initiatives, and committee structure.

    SSO’ mission is to improve patient care by advancing the science and practice of surgical oncology worldwide.

    President Monica Morrow, MD, chief, breast service, department of surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, shared some recent advances in the specialty and with the society, including the historic establishment of the new Certificate in Complex General Surgical Oncology, approved by the ACGME in March 2011. It is anticipated that the first exam for the certificate will be offered in 2013.

    The society is also building new programs and initiatives for the future of surgical oncology, including an expansion of its educational offerings. The newly developed SSO Fellows Institute, a didactic and hands-on skills training program for fellows-in-training, premiered in 2011 and was attended by more than 80 surgical and breast oncology fellows. The 2012 offering will be expanded to include a hepato-pancreato-biliary (HPB) track for HBP fellows.

    In light of changes in continuing medical education requirements, the 2012 SSO Annual Cancer Symposium debuted a pilot Maintenance of Certification (MOC) Part II offering that was well received. Additional MOC offerings are planned for 2013.

    Finally, to support its ongoing work and these new additions, the society is strengthening the James Ewing Foundation to become its sole fundraising arm. The foundation will work with the SSO and industry partners to solidify support for a variety of education and research programs.

    Event Information
    •    The 2013 SSO Annual Cancer Symposium, March 6–9, at the Gaylord National, National Harbor, MD
    •    2012 SSO Fellows Institute, November 14–16, at the Ethicon Endo-Surgery facilities in Cincinnati, OH

    Recent Publications and Products
    The SSO is proud of the continued publication and circulation growth of the Annals of Surgical Oncology. The journal boasts a current five-year Impact Factor of 4.412, which ranks it eighth in a field of 188 surgical journals.

    Another exciting development is the beginning of work on the Surgical Oncology Self-Assessment Program (SOSAP), similar in format to the SESAPTM program of the American College of Surgeons. The first edition of the SOSAP is scheduled to be released in Spring 2013 and will include both CME and MOC Part II credits.

    For more information on this organization, please visit our website at:

    New American Cancer Society Publication: Cancer Treatment & Survivorship Facts and Figures 2012-2013

    The number of Americans with a history of cancer, currently estimated to be 13.7 million, will grow to almost 18 million by 2022, according to a first-ever report by the American Cancer Society in collaboration with the National Cancer Institute (NCI). The report, Cancer Treatment & Survivorship Facts & Figures, 2012-2013 and accompanying journal article published in CA: A Cancer Journal for Clinicians, used data from the NCI-funded Surveillance, Epidemiology, and End Results (SEER) Program to generate brand new estimates of cancer survivor prevalence in the U.S.

    The report finds that even though cancer incidence rates are decreasing, the number of cancer survivors is growing due to the aging and growth of the population, as well as improving cancer survival rates.  The new Facts and Figures publication includes information on treatment, survival, and common concerns of survivors for 11 selected cancer types, and  includes sections on the effects of cancer and its treatment, palliative care, long term survivorship, and the benefits of healthy behaviors.

    “With this effort, we review the critical issues related to cancer treatment and survivorship,” said Elizabeth R. Ward, Ph.D., national vice president of Intramural Research and senior author of the report. “Many survivors, even among those who are cancer free, must cope with the long-term effects of treatment, as well as psychological concerns such as fear of recurrence. As more people survive cancer, it is vital that health care providers are aware of the special needs of cancer patients and caregivers.”

    For more information and resources for cancer survivors and caregivers, go to