The centennial of the Commission on Cancer (CoC) founding provides an opportunity to recognize the accomplishments of this organization, the contributions of so many volunteers, physicians, and nonphysicians, and the work of the CoC staff members. This milestone also provides an opportunity to review the impact of the CoC and its standards on patient care and examine how it has influenced the more than 1,500 accredited programs that voluntarily choose to adopt these standards and participate in accreditation site visits.
Those of us who serve on the CoC are less likely to be unbiased observers. For the past three decades, I have served on the cancer committees of four different health systems, as a CoC State Chair, on the CoC (including the Executive Committee), and as a site visitor. I have twice participated in the revision of the standards. As I tell programs during the site visit, no one donates that much time unless they have “drunk the Kool-Aid.” Many of my colleagues on the 100th anniversary committee have made similar or greater commitments.
We, therefore, thought this moment in history was an opportune time to query our 1,500-plus accredited programs anonymously about the impact of the standards and the site visit process on their institutions. This article not only provides a retrospective picture of the CoC’s impact, but also outlines opportunities to continue evolving the standards and accreditation process.
A total of 460 centers responded to the survey, comprising approximately one-quarter of accredited sites. The largest proportion, almost 64 percent, represented community programs; roughly two-thirds were comprehensive community care programs, and the rest were community cancer care programs. Sixteen percent were academic comprehensive cancer programs, and 10 percent were integrated network programs. National Cancer Institute-designated programs represented 4 percent of the respondents (see Figure 1). More than a third of the responding sites—173—have been accredited for more than a quarter century while another 45 percent have been accredited for 10 to 25 years (see Figure 2).
Question 1: What is your CoC cancer program category?
Question 2: Estimate the number of years your program has been accredited by the CoC
Importance of CoC accreditation
Most of the programs identified two primary values of CoC accreditation: the process challenges their program to provide optimal cancer care (350 centers or 76 percent) and provides a structure and methodology for continuous improvement in cancer care (335 centers or 73 percent). “Being accredited pushes us to constantly stay current and monitor patients’ outcomes, enhancing our patient care,” one respondent said, and another stated, “The standards give me a way to hold myself and my team accountable for providing the best experience possible for our patients.” These comments exemplify the benefits of participating in the accreditation process. Comments such as the “CoC accreditation provides a structure for us to enhance interdisciplinary care that we otherwise may not have pursued,” and “It has provided a roadmap from which we function…” underscore the value that many programs receive from adhering to these standards.
Program leaders also noted the direct impact of accreditation on cancer care delivery (40 percent); the benefit of enhanced organization and coordination of the cancer program (35 percent) as a result of program participation; and the ability to access the National Cancer Database and its quality tools (31 percent) (see Figure 3). Only 83 sites identified marketing as an area of importance.
Question 3: Why is the CoC accreditation important to your facility? (top three reasons)
Impact of the standards on patient care
Nine out of 10 (88.91 percent) programs stated that accreditation improves the quality of patient care (see Figure 4). The comments suggest that interdisciplinary collaboration, in both clinical care and operations, is the primary driver for program participation. Respondent comments included the following observations: “CoC accreditation…promotes intentional collaboration. By bringing the interdisciplinary team together, we naturally identify opportunities for improvement and engage the right people in that work,” and “The collaboration across specialties in tumor boards…ensures the best possible treatment plan for the patient.”
Question 4: How does accreditation impact patient care at your facility?(top three reasons)
The next two most frequently cited benefits were related to resources, with 77 percent of programs reporting that the requirements in the standards support obtaining resources for patient-centered services and 50 percent noting that the standards assist them in providing prevention and screening activities. Several programs commented that the accreditation process “forces administration to do the right thing.”
Areas of opportunity identified included alignment of the standards with enhancement of the patient experience and safety, with a surprisingly low 43 percent selecting the former and only 28 percent opting for the latter. Despite these responses, comments such as “standards promote safer cancer patient care practices,” standards “help mitigate distress during this difficult journey,” and the accreditation process “is a valuable framework for patient safety,” suggest that some programs are seeing these benefits and that the standards are directionally correct.
The two dominant concerns expressed in the survey comments centered on the relatively recent increases in the cost of accreditation and the time and effort necessary for implementation of several of the standards to complete the annual work for compliance. While the former was a frequent observation, it appeared most often with the corollary comment that the value of the process remains strong.
This relatively robust survey representing one-quarter of CoC-accredited programs affirms the value of the standards and the site visit/accreditation process. Programs state a desire for an external process to drive continuous improvement, multidisciplinary clinical care, and interdisciplinary programmatic engagement in order to evolve their services and improve outcomes. The accreditation process appears to be successful in aiding institutions in this regard, as well as in providing an impetus for resource allocation to patient-centered, prevention, and early detection services. Future iterations of the standards must maintain this alignment.
Hopefully, surveys such as this one will continue to provide the commission with valuable feedback. The 2020 revision of the CoC accreditation standards allowed for the greatest degree of engagement with our programs to date. Just as the accreditation process requires institutions to annually review the outcomes of their cancer care efforts, so should we regularly assess whether the standards are having the impact intended.