 Tumor Registrars Association of Maryland Educational Meeting

1.  Tumor Registrars Association of Maryland Educational Meeting Hagerstown, Maryland September 20, 2013

2. Gerald J. Béchamps, M.D., FACS Winchester, Virginia Review And Analysis Of The SAR

4. American College of Surgeons Commission on Cancer • Current Activities • Accreditation • Cancer liaison • Education • Member organizations and advocacy • Quality integration & national cancer data base

5. Accreditation • New standards well accepted in U.S. • Standards Advisory Group for Excellence (SAGE) to address issues • Best practices repository • Veterans affairs programs – (1/3)

6. Cancer Liaison Program • Enhance relationship and support of ACS • Enhance education of CLP’s • Focus groups to understand CLP needs • In-person training at state CLP meetings

7. Education • New CoC online education • Video vignettes • Annual Survey Savvy workshop • Best practices

8. Membership Organization Committee • Upswing in membership • New members • Hematology Oncology Pharmacy Association • National accreditation program for Breast Centers • American Society of Plastic Surgeons • Increasing communication and collaboration

9. New Advocacy Subcommittee • Identifying clear legislative priorities • Collaborating with member organizations • Coordinate with college advocacy office • Oct. 2013, legislative briefing

10. Quality Integration and NCDB • New measures in development for implementation in CP3R and RQRS • Breast, non-small cell lung and gastro-esophageal cancers • Other measures • Patent experience • Quality of life • Cost

11. Physician Credentials S1.1: “Diagnostic and treatment services are provided by or referred to the leadership and cancer program evaluation and management team physicians who are currently board certified, or the equivalent, in their general specialty, or are in the process of becoming board certified.”

12. Physician Credentials • Standard changed because: • It didn’t address physicians who will not be board-certified • No possibility for deficiency resolution

13. Physician Credentials • As of 1/1/2012, the cancer program leadership team member who serves in a required physician position on the cancer committee, are either board-certified, or in the process of becoming board-certified, or • Demonstrate ongoing cancer related education by annually earning twelve (12) cancer-related CME hours

14. Physician Credentials • A maximum of six (6) hours can be earned through activities within the facility, six (6) hours must be earned through activities that are external to the facility • All twelve (12) hours may be earned through activities that are external to the facility • This option will be used for deficiency resolution

15. Physician Credentials • Documentation may include one of the following: • Medical staff bylaws that address current board certification of physicians; • Roster of board certification status for physicians; • Documentation of 12 annual cancer-related CME hours for physicians who are not board-certified or board eligible

16. Cancer Committee Membership S1.2 “The membership of the cancer committee is multidisciplinary, representing physicians from the diagnostic and treatment specialties and non-physicians from administrative and supportive services. Coordinators who are responsible for specific areas of program activity are designated from the membership.”

17. Cancer Committee Membership The Standard for Coordinators include: • Cancer Conference Coordinator: Monitoring staging, evidence-based treatment guidelines and cancer conference activities. A CTR who is abstracting can fulfill this role. Reports at least annually to the cancer committee

18. Cancer Committee Membership 2.Quality Improvement Coordinator: Evaluates and focuses efforts on patient outcomes. Monitors the quality improvement program activity and reports the findings annually to the cancer committee. ACTR who is abstracting cannotbe selected for this role.

19. Cancer Committee Membership 3.Cancer Registrar Quality Coordinator: Monitors the quality of cancer registry data and reports the findings to the cancer committee at least annually. A CTR who is abstracting can be selected for this role. 4.Community Outreach Coordinator: Monitors outreach activity and reports findings to the cancer committee at least annually. A CTR who is abstracting cannot be selected for this role.

20. Cancer Committee Membership 5.Clinical Research Representative or Coordinator: Tracks patients enrolled in clinical trials or referred for enrollment in clinical trials at other facilities or physician offices. A Cancer Registrar who is abstracting cannotbe selected for this role. 6.Psychosocial Services Coordinator: An oncology social worker or other mental health professional trained in psychosocial aspects of cancer care assesses, improves, and expands services. A CTR who is abstracting cannotbe selected for this role.

21. Cancer Committee Membership • Additional Required members: Categories have additional required members, if services are provided on site • Each program assesses the need for additional cancer committee members based on the cancer patients served and their program offerings on site.

22. Cancer Committee Attendance S1.3 “Each required member attends at least 50% of the cancer committee meetings held during any given year.”

23. Cancer Committee Attendance • Minutes document the attendance at each meeting. Cancer Committee monitors the attendance and addresses low attendance • Teleconference calls are acceptable for compliance • Commendation: Each required member attends at least 75% of the cancer committee meetings held during any given year

24. Cancer Program Goals S1.5: “Each year, the cancer committee establishes, implements, and monitors at least 1 clinical and at least 1 programmatic goal for the endeavors related to cancer care. Each goal is evaluated at least twice annually. The evaluation is documented in cancer committee minutes.”

25. Cancer Program Goals • Annual goals: • Provide direction for strategic planning of cancer program activities • Serve as the basis for cancer program evaluation

26. Cancer Program Goals • Compliance • The cancer committee establishes goals appropriate to the program • Scope will vary depending on program size • Use of goal-setting tool (SMART) is recommended • Activities related to each goal must be implemented, monitored, evaluated and documented in cancer minutes at least twice annually

28. Cancer Program Goals • Goals: • Are not required to be completed each year • Not completed may be carried over into the next year • Should not be a restatement of a CoC standard • Are to be established at the beginning of each year and evaluated mid-year and at the end of same year

29. Cancer Registry Quality Control Plan S1.6: “The cancer committee establishes and implements a plan to annually evaluate the quality of cancer registry data and activity. The plan includes procedures to monitor and evaluate each component.”

30. Cancer Registry Quality Control Plan • Rating the Standard: • Cancer committee establishes and implements a plan to evaluate the required areas • Each year the cancer committee performs the required quality control review as outlined in the plan • Each year review findings are reported to the cancer committee • Each year the findings are documented in minutes

31. Monitoring Conference Activity S1.7: “ The cancer conference coordinator monitors and evaluates the cancer conference activities and reports findings to the cancer committee at least annually.”

32. Monitoring Conference Activity • Rating the Standard, Part 1 • The cancer conference coordinator monitors and evaluates cancer conference activities, including: • Conference frequency • Multidisciplinary attendance • Total case presentation • Discussion of stage, prognostic indicators and treatment planning using evidence-based treatment guidelines • Clinical trial options • Adherence to conference policy

33. Monitoring Conference Activity • Rating the Standard, Part 2 • The cancer conference coordinator reports the findings of the cancer conference evaluation to cancer committee • Report is documented in cancer committee minutes

34. Monitoring Community Outreach S1.8: “The community outreach coordinator monitors the effectiveness of community outreach activities on an annual basis. The activities and findings are documented in a community outreach activity summary that is presented to the cancer committee annually”.

35. Community Outreach Coordinator Responsibilities • Contribute to the development of community outreach activities • Work with outreach organizations • Ensure activities meet community needs • Ensure activities follow accepted guidelines • Ensure positive findings are followed • Evaluate the effectiveness of referral • Create summary • Summary addresses all of these areas

36. Monitoring Community Outreach • Rating the Standard • Cancer committee monitors effectiveness of community outreach activities annually • Activities and findings are documented in community outreach activity summary • Summary is shared with cancer committee • Summary is documented in CC minutes

37. Question • The standard asks that the community outreach coordinator monitors the effectiveness of community outreach activities. How do you measure the effectiveness?

38. Answer • Effectiveness for a screening activity might be the rate of diagnosis made in the group screened or perhaps this is an increase in screening participation because of a new tool or new communication strategy • Effectiveness in a prevention activity could include the number of participants who stopped smoking or who began to change their lifestyle at the completion of the program

39. Did we miss the date?

40. Clinical Trial Accrual S1.9: “As appropriate to the cancer program category, the required percentage of patients is accrued to cancer-related clinical trials each year. The clinical trial coordinator or representative reports clinical trial participation to the cancer committee each year.” -Version 1.1 made no changes

41. Clinical Trial Accrual • Key Point – Phase in Time Period • Until 2015, cancer programs are expected to achieve the minimum and commendation accrual percentages set forth in Standard 5.2 as published in Cancer Programs Standards 2009, Revised Edition and based on the facility category as of 2011

42. Clinical Trial Accrual • Programs participating in cancer-related clinical research demonstrate that an independent peer review mechanism consistent with national standards is in place and used • Research projects must be approved by an internal or external institutional review board (IRB) • Patients participating in clinical trials must give their informed written consent, unless verbal consent has been specified by the IRB

43. Patient Eligibility • When does the patient count? • Seen at your program for diagnosis and/or treatment and placed on a cancer-related clinical trial through your program • Seen at your program for diagnosis and/or treatment and placed on a cancer-related clinical trial through the office of a staff physician • Seen at your program for diagnosis and/or treatment and placed on a cancer-related clinical trial through another program (referral) • Seen at your program for any reason and placed on a cancer prevention or cancer control clinical trial

44. Clinical Trial Accrual • Treatment-related clinical trial groups examples: • NCI-sponsored cooperative cancer clinical trial groups • Pharmaceutical company research • Locally developed, investigator-initiated, peer-reviewed research

45. Clinical Trial Accrual • Cancer prevention and cancer control research examples include: • Primary prevention of cancer • Early detection of cancer • Quality of life related to cancer (supportive care trials) • Economics of care related to cancer

46. Clinical Trial Accrual • Key to successful compliance • A research coordinator, data manager, or other clinical research professional available to assist with enrolling patients, monitoring patient accrual, and identifying and providing information and education about new cancer related clinical trials

47. Clinical Trial Accrual • Who can fill the clinical research representative or coordinator role? • Clinical trail principal investigator • Clinical trial data manager • Clinical trial research associate • Clinical research nurse • Appointed by the cancer committee • Member of the cancer committee • NOTE: A cancer registrar who is abstracting cannot be selected to fulfill this coordinator role

48. Percentage RequirementsAnnual Analytic Cases – Effective in 2015

49. Clinical Educational Activity S1.10: “Each year, the cancer committee offers at least 1 cancer-related educational activity, other than cancer conferences, to physicians, nurses, and other allied health professionals. The activity is focused on the use of AJCC or other appropriate staging in clinical practice, which includes the use of appropriate prognostic indicators and evidence-based national guidelines used in treatment planning.” -One activity required annually; additional activities encouraged -Focus on stage and prognostic indicators and evidence-based guidelines

50. What’s New in Version 1.1? • The cancer committee must monitor the success of and attendance at educational activities each year • To fulfill the educational requirement of the standard, a webinar is to be a minimum of one cumulative hour annually. The webinar is to be viewed as a group with a physician leader from the cancer committee designated to facilitate discussion