The Commission on Cancer (CoC) requires accredited programs to treat cancer patients according to nationally accepted measures endorsed by the CoC. The measures are included in the Rapid Cancer Reporting System (RCRS) tool for monitoring and reporting purposes. Standard 7.1 states that each calendar year the expected performance rate should be met for each of the quality measures, reviewed by the Cancer Committee and documented in the meeting minutes.
In 2022 the CoC announced the release of four new quality measures for the 2022 calendar year. Measure specifications are available to accredited programs in the RCRS library.
Measures are defined as follows:
Gastric (GCTRT) – Quality Measure
Criteria: this measure will include patients with esophageal or gastroesophageal junction (GE) carcinoma and are 18-79 years of age.
Rationale: Research has shown improvement in overall survival in patients who receive peri-operative chemotherapy or surgery followed by chemotherapy with various chemotherapeutic agents including specific number of cycles or regimens with MAGIC ECF, FFCD, CF, CROSS CRT, or FLOT therapies.
Rectum (RCRM) – Surveillance Measure
Criteria: The circumferential resection margin (CRM) must be >1 mm at resection to be considered negative. CRM is defined in the College of American Pathologists (CAP) synoptic report and should indicate the perpendicular distance from the tumor to the inked, non-serosalized resection margin.
Rationale: Circumferential resection margin, or CRM, status is an important indicator of post operative rectal cancer outcomes and is used for multidisciplinary treatment planning. Treatment of rectal cancer with neoadjuvant chemoradiation and total mesorectal excision (TME) has become the standard of care and dramatically reduced local recurrence rates from 50% to 5-10%. One of the most important prognostic factors associated with recurrence is the status of the circumferential margin. The presence of tumor cells <=1 millimeter from the CRM is a known risk factor associated with treatment failure.
Head and Neck (HadjRT) - Surveillance Measure
Criteria: elapsed time from surgery to initiation of post operative radiation therapy is < 6 weeks for patients with squamous cell carcinoma of the head and neck.
Rationale: there is an extensive discussion of the rationale for this measure in the RCRS quality measure specification document. But post operative XRT has shown great potential and:
- Is associated with known oncologic outcomes,
- Bridges known gaps in quality of care in the selected patient population,
- Data end points used for analysis are easily collected from the EMR,
- Result can be used to drive quality improvements in the future health care delivery process, and
- Has potential to improve the equity of care in racial and socioeconomic groups of patients with squamous cell carcinoma of the head and neck.
Melanoma (MadjRx) – Surveillance Measure
Criteria: administration of adjuvant therapy within 6 months post operatively in patients with Stage IIIB-D surgically resected melanoma.
Rationale: melanoma patients who are eligible for and receive adjuvant systemic therapy with ipilimumab have an 11% improvement in the 5-year survival rate. Therapy with other agents have not achieved similar results to date.
The three surveillance measures (RCRM, HadjRT and MadjRx) should be monitored by the Cancer Committee in the 2022 calendar year but will not be included in site surveys for compliance with Standard 7.1 until a later date.
Cancer Registrars, Cancer Liaison Physicians (CLPs), Cancer Committee Chairs, and cancer program administrators may download the full measure specifications and an updated User’s Guide from the RCRS Library online portal.
For additional information on the CoC and other topics, check out more from MRA here.
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