The American College of Surgeons (ACS) Cancer Programs is proud to announce the launch of the Cancer Surgery Standards Program (CSSP). Led by Chair Matthew H.G. Katz, MD, FACS, and Vice-Chair Kelly K. Hunt, MD, FACS, the CSSP seeks to improve the quality of surgical care provided to persons with cancer through the development of technical standards and quality measures; the creation and dissemination of electronic tools to support implementation and adherence to these standards; and the education of surgeons, trainees, and staff.
The ACS has been committed to setting standards for more than 100 years and sponsors a multitude of initiatives focused on improving the quality of care. Surgical clinical research trials, including many conducted by the ACS through the American College of Surgeons Oncology Group, have generated data that demonstrate that the specific methods by which certain technical aspects of surgery are conducted have a direct impact on patient outcomes. In some cases, the results from these trials led to the widespread adoption of standardized surgical approaches and evidence-based best practices.
Background and origins of CSSP
The CSSP has its origin in the Cancer Care Standards Development Committee of the ACS Clinical Research Program (ACS CRP), which was established to evaluate the level of evidence that exists to support the development of standardized surgical approaches and to develop standards based on this evidence. The committee also was tasked with improving the quality of surgical data captured during the conduct of clinical trials. The collaboration between the ACS and the Alliance for Clinical Trials in Oncology, created in 2012 by Heidi Nelson, MD, FACS, past-Program Director of the ACS CRP, current Medical Director of ACS Cancer Programs, and co-author of this article, has produced two volumes of Operative Standards for Cancer Surgery, each of which describes evidence-based standards for the technical conduct of oncologic surgery. Two additional volumes currently are in production. These technical standards are now being implemented into surgical practice through collaboration with other ACS Cancer Programs.
The CSSP builds upon this history with a view toward standardizing operative documentation such that it accurately reflects oncologically critical standard components.
For nearly 100 years, the Commission on Cancer (CoC) has set standards to ensure patients received the best care possible through accreditation of cancer practices. Over the last decade, the CoC standards have shifted from facilities and equipment to processes, and now toward outcomes-based standards. In 2020, the CoC included six of the operative standards—two for breast cancer surgery, two for colorectal cancer surgery, and one each for lung cancer surgery and melanoma surgery—in the Optimal Resources for Cancer Care (2020 Standards). The evidence from the Operative Standards for Cancer Surgery manuals formed the basis for the six CoC operative standards, and adherence to these standards will be required for maintenance of CoC accreditation. Download the 2020 Standards.
Goals of the program
The CSSP builds upon this history with a view toward standardizing operative documentation such that it accurately reflects oncologically critical standard components. Increased collaboration across surgical teams using the common language of these standardized operative reports is an important goal for this new program.
In order to facilitate implementation of the operative standards in CoC-accredited sites, to improve the quality of surgical documentation, and to educate surgeons and surgical trainees, the CSSP is developing synoptic operative reporting templates and point-of-care electronic documentation tools. Furthermore, the program will create cancer surgery protocols to provide guidance on the collection of essential data elements for cancer surgery. Educational content will be created and disseminated to assist with implementation of these standards and tools at each accredited center.
Disease site-specific workgroups within the CSSP include a diverse group of experts in the surgical oncology community and representatives from the ACS Young Fellows Association, the Resident and Associate Society of the ACS, and surgical societies such as the American Society of Colon and Rectal Surgeons, the American Society of Breast Surgeons, and the Society of Surgical Oncology. Additionally, the CSSP will benefit from broad representation from, and coordination between, the other ACS Cancer Programs, including the CoC, ACS CRP, National Accreditation Program for Breast Centers, National Accreditation Program for Rectal Cancer, and American Joint Committee on Cancer.
Leaders of the ACS Cancer Programs have been gratified to have the approval of David B. Hoyt, MD, FACS, ACS Executive Director, and the Board of Regents to launch the CSSP. We look forward to providing our members with tools and resources to help improve the quality of surgical care for all persons with cancer.