Commission on Cancer

View all recommendations from this society

Released September 4, 2013

Don’t perform major abdominal surgery or thoracic surgery without a pathway or standard protocol for postoperative pain control and pneumonia prevention.

  • Uncontrolled pain and pneumonia after major abdominal and thoracic surgery are factors that lead to other serious complications and prolonged hospitalization.
  • Coordinated care efforts and established care pathways to control pain and prevent pneumonia reduce the frequency of complications and reduce length of hospital stay and should be in place.
  • Fewer pulmonary complications occur when adequate analgesia is provided making postoperative pain protocol and pulmonary plan as essential elements of care.
    • Facilities that conduct flow analyses in patients with lung cancer have improved quality care.
  • Institutions or hospitals in collaboration with the surgeons and other medical staff should develop these pathways, standard protocol or procedures and assure their implementation.
    • Improvement efforts need to address documentation and standardization of process of care.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American College of Surgeons concluded in its review of this opportunity that it was optimal to submit a separate list of interventions related to cancer from the American College of Surgeons Commission on Cancer. The Commission on Cancer appointed a multidisciplinary task force that met in person in September, 2012 and subsequently by conference call and electronic communications.

Recommendations for candidate interventions were solicited from panel members and other leaders from the Commission on Cancer. These panel members were provided a written charge to identify measures that would support the Commission’s standards for accreditation in use in more than 1,500 cancer programs across the U.S. In addition, panel members were provided with a full description of the Choosing Wisely®campaign and the interventions previously recommended by other organizations both for cancer and all other disorders.

Following initial submission of the candidate interventions, the panel discussed each intervention specifically evaluating the significance of the intervention, the potential scope of variation in care affected by the intervention, and the potential numbers of persons affected by this. The group also discussed the impact on short-term and long-term cost to be gained by implementation of each intervention. The panel voted on each intervention to select the final list of recommended interventions. The panel members then reviewed and refined the wording of each intervention and completed the bulleted supporting documentation and literature citations. The final list of interventions was then approved by the panel and submitted to the leadership of the American College of Surgeons for final approval. The Commission on Cancer’s disclosure and conflict of interest policy can be found at www.facs.org.

Commission on Cancer Panel Members

  • Stephen Edge, MD, FACS, Chair, Roswell Park Cancer Institute, Buffalo, NY
  • David Bentrem, MD, FACS, Northwestern Memorial Hospital, Chicago, IL
  • Daniel Kollmorgen, MD, FACS, University of Iowa, Des Moines, IA
  • Daniel McKellar, MD, FACS, Wayne Healthcare, Greenville, OH
  • Christopher Pezzi, MD, FACS, Abington Memorial Hospital, Abington, PA
  • Lee Wilke, MD, FACS, University of Wisconsin Health System, Madison, WI
  • David Winchester, MD, FACS, Medical Director, Cancer Programs, American College of Surgeons

Sources

Thompson DA, Makary MA, Dorman T, Pronovost PJ. Clinical and economic outcomes of hospital acquired pneumonia in intra-abdominal surgery patients. Ann Surg. 2006 Apr;243(4):547-52.

Katlic MR, Facktor MA, Berry SA, McKinley KE, Bothe A, Jr., Steele GD, Jr. ProvenCare lung cancer: a multi-institutional improvement collaborative. CA Cancer J Clin. Nov-Dec;61(6):382-96.

Cassivi SD, Allen MS, Vanderwaerdt GD, Ewoldt LL, Cordes ME, Wigle DA, Nichols FC, Pairolero PC, Deschamps C. Patient-centered quality indicators for pulmonary resection. Ann Thorac Surg. 2008 Sep;86(3):927-32.

Quality of colorectal cancer care in the VA 2003-2006: national and VISN results of Office of Quality and Performance special study. Washington: Veteran Health Affairs 2009. 10 p.

Delaney CP, Zutshi M, Senagore AJ, Remzi FH, Hammel J, Fazio VW. Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection. Dis Colon Rectum. 2003 Jul;46(7):851-9.

Senagore AJ, Delaney CP, Mekhail N, Dugan A, Fazio VW. Randomized clinical trial comparing epidural anesthesia and patient-controlled analgesia after laparoscopic segmental colectomy. Br J Surg. 2003 Oct;90(10):1195-9.

Lewis KS, Whipple JK, Michael KA, Quebbeman EJ. Effect of analgesic treatment on the physiological consequences of acute pain. Am J Hosp Pharm. 1994 Jun 15;51(12):1539-54