Commission on Cancer Accreditation

VCU Massey Comprehensive Cancer Center is accredited by the American College of Surgeons’ Commission on Cancer (Coc) for its high standards in cancer care. The CoC evaluates cancer care programs on their commitment to provide comprehensive, high-quality and multidisciplinary patient-centered care.

Massey’s CoC accreditation benefits patients and the community by affirming the following:

• Patients and family members are involved in care decisions
• Massey is dedicating resources to provide quality treatment and supportive care services to cancer patients
• Patients have access to important components of treatment recommended by the Health and Medicine Division (formerly the Institute of Medicine), National Cancer Comprehensive Network and American Society of Clinical Oncology
• A multidisciplinary oncology team is involved in the planning and coordination of Massey’s cancer care
• Patients are informed about clinical research studies and trial options
• Massey works in collaboration with the community to provide cancer prevention and cancer screening events
• Massey’s standards of care are verified by a reputable national organization
• Massey’s quality cancer care is available close to home

Public reporting of outcomes

As part of the Commission on Cancer accreditation process, Massey ensures that diagnostic evaluation and treatment provided to patients is compliant with evidence-based national treatment guidelines. As required by CoC standards, each year Massey reports on its outcomes to the public regarding one or more of the COC standards. The following are three quality reports.

2019 Study of Quality

A retrospective review of 2017-2018 patients was done to identify what proportion of newly diagnosed glioblastoma patients undergo contrast-enhanced MRI scan of the brain within 48 hours of craniotomy for tumor resection.

For patients with brain tumors who have undergone surgical resection, the standard of care is to obtain a contrast-enhanced MRI scan of the brain within 48 hours after craniotomy to assess the amount of residual tumor. MRI scans performed beyond 48 hours cannot distinguish between residual tumor and the development of post-surgical change. Knowing the amount of residual tumor has a direct impact upon prognosis (more tumor equals worse prognosis), hence the rationale for obtaining scans as early as possible post-op.

The number of newly diagnosed patients with glioblastoma and craniotomy (denominator) were found on a fiscal year 2017 through fiscal year 2018 basis. Of those patients, the total number receiving MRI within 48 hours of the craniotomy (numerator) were also calculated and the resulting percentage compared to the baseline value.

Included in the study were analytic patients of all ages who had removal of a brain lesion (CPT code 61510) and an MRI of the brain with and without contrast selected.  Excluded were patients who only had a biopsy. Based on the selection criteria, the final denominator was 34 patients.

A review of FY2017-2018 newly diagnosed patients with glioblastoma and craniotomy revealed 100 percent of them – 15/15 in fiscal year 2017 and 19/19 in fiscal year 2018 – received an MRI within 48 hours of the craniotomy.

Because we have achieved and maintained the standard of care, there is no need to implement a strategy for improvement. We should and will continue current practice.

The results of this study were shared at the VCU Massey Comprehensive Cancer Center Brain Tumor Board on May 9, 2019.

2017 Monitoring Compliance with Evidence-Based Guidelines

Objective

To assess whether patients are treated according to evidence-based national guidelines

Measurement

2016 leukemia and lymphoma analytic cases, AML patients who received first-line treatment of 7+3 as an inpatient.

Methodology

1. Retrospective patient review of the Cancer Registry abstract records
2. Include abstracted records for all patients with a diagnosis of Acute Myeloid Leukemia, Acute Monocytic Leukemia, and Acute Promyelocytic Leukemia.
3. A physician review of the report from the Cancer Registry was completed.

Results

• A total of 65 cases were reviewed.
• Forty-two patients met NCCN recommendations and received 7+3 as induction chemotherapy.
• A total of 18 cases did not meet criteria for high-dose induction chemotherapy:
  • Nine cases did not qualify for high-dose chemotherapy due to age and/or comorbidities.
    • Eight of these cases received azacitidine.
    • One case received decitabine.
  • Four of the cases were enrolled in SGN33A-005 clinical trial for newly diagnosed AML elderly patients who did not qualify for high-dose chemotherapy.
  • Four of the cases were Acute Promyelocytic Leukemia and received standard induction treatment for APL according to NCCN Guidelines.
  • One case received FLAG induction chemotherapy because their AML was secondary to previous chemotherapy.

Follow-up

On a yearly basis, continue to review cases via the Cancer Registry for consistency with evidence-based national guidelines and provide a report to the multidisciplinary Oncology Care Committee.

2017 Screening Program

Lung cancer is by far the leading cause of cancer death among both men and women; about 1 out of 4 cancer deaths are from lung cancer. Each year, more people die of lung cancer than of colon, breast and prostate cancers combined. The American Cancer Society’s estimates for lung cancer in the United States for 2017 are about 222,500 new cases of lung (116,990 in men and 105,510 in women) and about 155,870 deaths from lung cancer (84,590 in men and 71,280 in women). Prior to the availability of a lung cancer screening test, lung cancers were detected at a late stage, often resulting in poor outcomes. The VCU Massey Comprehensive Cancer Center 2016 Community Needs Assessment identified Chesterfield County as averaging 102 lung cancer diagnoses per year and Hanover County as averaging 97 lung cancer diagnoses per year. The National Cancer Institute’s landmark National Lung Screening Trial demonstrated a significant reduction in risk of death from lung cancer in high-risk patients through annual screening with low-dose computed tomography (LDCT). Early detection with low-dose CT (LDCT) saves lives. It is endorsed by approximately 40 major medical societies and organizations, including the National Comprehensive Cancer Network, American Cancer Society, American Lung Association, American Society of Clinical Oncology and the Lung Cancer Alliance.

In 2016 the VCU Health System Lung Cancer Screening Program was revamped to include a multidisciplinary model. This model went live February 15, 2017. During an appointment in the Lung Cancer Screening (LCS) Clinic, patients receive their LDCT scan. They meet with a specialized, highly trained LCS nurse navigator. The nurse navigator explains all aspects of the LCS process to the patient and is available to review results with the ordering physician and schedule any necessary follow-up tests or specialists consultations with specialists based on the lung scan findings and/or other significant incidental findings. The patient’s LDCT is read by an American College of Radiology board-certified and fellowship-trained thoracic radiologist. The scans are interpreted and reported immediately to the staff pulmonologist and then shared with the patient during their clinic visit.

Age range and ethnicity of individuals screened, February 15, 2017 – June 15, 2017

Screening assessment findings, February 15, 2017 – June 15, 2017

*Not a good representation as some of these are 3-6 months

**Follow-up with other specialties such as cardiology, pulmonary, renal, etc.

Aspects to enhance in the program

• Provide expanded and integrated smoking cessation program options:
  • Having the patient review their lung scan with the pulmonologist and nurse navigator during their clinic visit is an ideal “teaching moment” to discuss the need for smoking cessation. The smoking cessation program literature suggests a number of program options and counseling techniques to enhance smoking cessation success rates. The LCS Program is exploring additional program offerings to help patients quit smoking and strengthen the overall success of the LCS Program.
• Expanding the medical provider referral base:
  • As an increasing number of primary care physicians are making lung cancer screening available to their high-risk patients, another area for program improvement is to enhance LCS Program awareness to other health care providers. During the course of their everyday practice, other medical providers (OBGYNs, internal medicine and dental practitioners) will care for patients who may be at risk for lung cancer and should be made aware that early detection saves lives.

Recommendations for future program considerations

• As the Lung Cancer Screening Program enhances its local reputation as a “Center of Excellence” and gains firmer traction within the local medical community, there are opportunities to expand the program to the more rural, economically disadvantaged areas within the state via greater collaboration with rural health care facilities and the potential for a mobile CT scanner (“Lung Bus”). Such community-focused efforts will ensure that the LCS Program addresses the population disparities (racial, economic and ethnic) across Virginia and offers high-quality lung cancer screening services and lung cancer care to all Virginians.

References

American Cancer Society (2017) Retrieved from https://www.cancer.org/cancer/non-small-cell-lung-cancer/about/key-statistics.html

Landmark National Lung Screening Trial: National Institute of Health (2014). Retrieved from https://www.cancer.gov/types/lung/research/nlst

VCU Massey Comprehensive Cancer Center Community Needs Assessment (2016).