The Commission on Cancer, a consortium of professional organizations that sets the Standards for quality care in cancer, recently released its 2020 Standards for Optimal Resources for Cancer Care. These Standards, updated every four years, serve as the criteria for CoC accreditation of clinical oncology programs. There are currently over 1500 CoC accredited oncology programs in the United States and Puerto Rico. The Standards serve as a guidepost for these accredited institutions, those seeking accreditation, and for organizations seeking to benchmark their services for individuals with cancer.
Pack Health focuses on the navigation and psychosocial aspects of the cancer journey. Additionally, we work closely with clinical partners to achieve a higher standard of care for members with a cancer diagnosis. Below, we highlight a few key updates to the guidelines. These updates help to inform cancer care best practices within and beyond clinic doors.
What’s new: These updates relate to clinical practice and include 6 new Standards in 2020, each of which relates to surgical requirements for tumor margins and/or lymph node removal related to breast, melanoma, colorectal and lung tumors.
Why it’s important: These recommendations support complete removal or tumor and related lymph nodes, provide increased assurance of clean margins, and may have implications for recurrence and overall survival. These standards primarily impact surgical personnel involved in tumor and lymph node resection and the pathologists responsible for evaluating these tissue samples. However, there are also important considerations for patient education.
Implications for practice: In the peri-operative setting education for patients should focus on planned tissue removal and what to expect post-operatively. Patient-reported outcomes can support timely identification, assessment, and intervention in the post-operative period when physical and psychosocial effects may intensify. This is particularly important in the home setting between the time of discharge and the first follow-up visit, a period that may benefit from at-home symptom monitoring and support. Exploring interventions that can assist patients with both symptom monitoring and post-operative adjustment may support more efficient recovery and psychosocial adjustment.
What’s new: An area of significant change for service delivery involves changes to requirements related to survivorship services. Previously this Standard relied on the provision of survivorship care plans (SCPs) as an outcome measure for successful compliance. This required at least 50% of eligible patients to receive an SCP by December 31st, 2018. Now Standard 4.8 (page 48) focuses on the development of a survivorship program, including a coordinator and committee that oversee and make decisions on specific aspects of survivorship program services. These may include but are not limited to survivorship care plans, treatment summaries, screening for new or recurrent cancers, support groups and services, and formalized referrals to specialists (e.g. cardiologists and sexual health specialists)
Why it’s important: Studies suggest that while SCPs are an important tool in the delivery of comprehensive survivorship care, their implementation can be inconsistent and outcomes do not always demonstrate measurable improvement in clinical and patient-reported outcomes. Logistical and resource barriers may limit the consistent completion of and follow-up related to SCPs. The new Standard provides greater flexibility in how each clinical setting operationalizes the provision of care to cancer survivors.
Implications for practice: While SCPs remain an important part of care for survivors, opportunities exist to explore other avenues through which to support survivors within and beyond the clinical care setting. Exploring how novel survivorship support, such as digital health coaching, can be used to support survivors may lessen the burden on healthcare systems while expanding survivor access to support in the community setting.
What’s new: A focus on oncology-specific certification or continuing education for nurses delivering oncology care is emphasized in Standard 4.2 (page 23).
Why it’s important: Studies suggest some correlation between specialty certification and patient outcomes, including infection rates and falls. Related to oncology-specific certification, a recent study suggests oncology certification is correlated with significantly higher scores on knowledge assessments related to pain. Requiring either certification or the completion of continuing education in oncology may result in a more knowledgeable nursing workforce related to the provision of oncology care.
Implications for practice: Ensuring access to continuing education and resources for the successful completion of certification will be an important focus in the achievement of this Standard. However, the resulting implications for clinical practice range from a well-educated and empowered nursing workforce to the improvement of patient outcomes, satisfaction, and oncology care experience. Symptom Management is one of the largest content focus areas across all oncology certification tests, accounting for approximately 25% of the content focus. Understanding how to identify, assess and manage side effects in a timely manner is both fundamental to optimizing patient outcomes. Additionally, it contributes to successful performance on the certification exams now recommended as part of Standard 4.2.
Updates to the Commission on Cancer Standards reflect evolving, evidence-based approaches to clinical care delivery, survivorship programming, and training of staff. These updates reflect only a few of the overarching 9 categories and 38 individual standards in the document. However. they provide insights into new and novel approach areas and partnerships. These may serve to enhance both the practice of oncology providers and the experience and outcomes of individuals with cancer. Pack Health is excited to partner with many of the industry and professional organization leaders in oncology care to enhance the holistic wellness of individuals during cancer treatment and beyond.
Kelly Brassil, PhD, RN
Director of Medical Affairs