AJCC Initiatives

Education and Promotions Task Force

 

  

CA: A Cancer Journal for Clinicians Series

The AJCC has entered into an agreement to publish articles in the American Cancer Society's publication, CA: A Cancer Journal for Clinicians. CA publishes comprehensive review articles of a multi-disciplinary nature, which takes into account the journal's diverse readership of primary care physicians; medical, surgical, and radiation oncologists; nurses; and other health care and public health professionals. Articles published in CA provide up-to-date information on all aspects of cancer prevention, early detection, treatment of all forms, palliation, advocacy, quality of life, and more. Supplemental material associated with the CA articles not included in the print version of the journal is accessible online via the CA website.

CA's mission is to provide information to clinicians about best practices in cancer prevention, early detection, and treatment in an effort to support the American Cancer Society's goals of reducing cancer incidence and mortality rates and improving quality of life for people living with cancer. The journal also serves as a vehicle for continuing professional education.

The American Cancer Society designates certain articles in CA: A Cancer Journal for Clinicians as appropriate for a continuing medical education activity based on needs assessment data. An issue of CA may include one to three continuing medical education activities (courses) in the CME Quiz and Evaluation section of the journal.

Over the next 18 to 24 months the AJCC will be developing articles relative to the staging strategies and changes to the Cancer Staging Manual, 6th Edition. Each article will describe TNM staging for a particular cancer site or system and will include clinical examples that illustrate the staging process. The articles will emphasize the importance of accurate staging in clinical care, cancer research, and cancer surveillance, and include CME opportunities and patient pages. An editorial on TNM staging authored by Dr. Frederick Greene, along with an article on Evidence-Based Staging System for Cutaneous Melanoma, authored by Dr. Charles Balch, appeared in the May/June issue. The table below outlines the authors, articles and submission dates for the series.

CA: A Cancer Journal for Clinicians Series

Author Submission Schedule

Article
Author
Submission Date
TNM: Our Language of Cancer Frederick L. Greene, MD, FACS
Published May/June 2004 issue
An Evidence-Based Staging System for Cutaneous Melanoma Charles M. Balch, MD, FACS
Co-Authors: Seng-Jaw Soong, PhD;
Michael Atkins, MD;
Antonio C. Buzaid, MD;
Natale Cascinelli, MD;
Daniel Coit, MD;
Irving Fleming, MD;
Kelly McMasters, MD;
Jeffrey Gershenwald, MD;
Arthur Sober, MD;
Alan Houghton, Jr., MD;
John Kirkwood, MD;
Martin Mihm, MD;
Donald Morton, MD;
Douglas Reintgen, MD;
Merrick Ross, MD;
John A. Thompson, MD;
John F. Thompson, MD
Published May/June 2004 issue
The Staging of Colorectal Cancer: 2004 and Beyond Carolyn C. Compton, MD, PhD
Co-Author: Frederick L. Greene, MD, FACS
Published November/December 2004 issue
TNM Staging of Cancers of the Head and Neck: Striving for Uniformity Among Diversity Snehal G. Patel, MD, FRCS
Co-Author: Jatin P. Shah, MD, FACS
Published July/August 2005 issue
Staging Non-Hodgkin Lymphoma James O. Armitage, MD
Published November/December 2005 issue
Breast Staging S. Eva Singletary, MD, FACS
Co-Author: James L. Connolly, MD
July 29, 2005
Bone Staging Michael A. Simon, MD
Co-Authors: Robert K. Heck, Jr., MD;
Terrance D. Peabody, MD
February 3, 2006
Soft Tissue Staging Raphael E. Pollock, MD, FACS
Co-Author: Andrew Rosenberg, MD
February 3, 2006
Pancreatic and Biliary Staging Douglas B. Evans, MD, FACS
Co-Authors: James Crawford, MD
Volkan Adsay, MD
March 1, 2006
Prostate Staging Sam Chang MD
Co-Author: Mahul Amin, MD
May 5, 2006

AJCC Cancer Staging Atlas

The AJCC, in conjunction with its publisher, Springer-Verlag, is in the process of developing the AJCC Cancer Staging Atlas. The AJCC Cancer Staging Atlas will illustrate the Sixth Edition TNM staging with 450 black-and-white line drawings of key tumor, regional lymph node, and metastatic infiltration for more than 40 disease sites. All of the staging changes published in the AJCC's Sixth Edition will be illustrated, including the revised breast cancer staging system, the revised melanoma staging system, as well as changes to the staging of cancers in the colon, head and neck, kidney, liver and more. The illustrations will be created exclusively for the AJCC in collaboration with the Atlas Editorial Board whose membership includes: Drs. Frederick L. Greene, Carolyn C. Compton, Jatin P. Shah, Ian M. Thompson, David P. Winchester, and cancer registrar, April Fritz, CTR. Designed as a portable resource for surgeons, pathologists, oncologists, registrars, and trainees in these areas, the Atlas' clear, didactic illustrations paired with the appropriate TNM staging text will provide an essential visual tool for professionals engaged in the diagnosis and treatment of cancer patients

Staging Moments Program

The Staging Moments Program is moving along and is scheduled for release on the AJCC Web site this summer. This program will include brief, succinct case-based presentations for use as part of department weekly conferences (e.g., morbidity and mortality or tumor board). Slide sets will be provided that include site-specific cases, the staging system for that organ site, and the final stage for the case. The program will launch with three cases each for the following sites: breast, colorectal, melanoma, lung, cervix, and ovary. Users will be encouraged to utilize the program on a regular basis. Additional cases and additional sites will be added to the program overtime. The program will be posted on the AJCC Web site and promoted through the Commission on Cancer Flash and American College of Surgeons NewsScope email newsletters.

Monitoring and Improving TNM Staging Accuracy

The AJCC will formulate a task force to develop methods and tools to evaluate, monitor, and improve TNM staging accuracy by the managing physician. NCDB data submissions from CoC - approved cancer programs have shown inconsistencies between the T, N, and M categories and TNM stage groupings. This incorrect data is allowable to NCDB because there are no edits for this type of information to validate the TNM against the stage group, therefore, institutions are not aware of these inconsistencies. In addition, TNM staging requirements for CoC - approved cancer programs are very basic and do not include a standard for rating staging accuracy.

Initially the task force will be charged with reviewing NCDB submissions by hospital, specifically the T, N, M, categories and the stage grouping for the major sites. Key inaccuracies in physician TNM staging will be evaluated and classified as "AJCC instructional problems' or "physician and/or medical record type issues' (physician not using the chart to stage).

CoC cancer program surveyors will be evaluated to determine their knowledge of AJCC staging, and a tool or staging algorithm will be developed for use by the CoC to monitor and evaluate TNM staging accuracy. Implementation will require the need to evaluate the current level of CoC surveyor knowledge and understanding of TNM staging. If a need is identified, a meeting or web conference will be held to educate CoC surveyors about TNM staging for the major sites. This initial training is required before the CoC, in conjunction with the AJCC, can proceed to pilot this initiative and eventually incorporate it as a standard for cancer programs to measure staging accuracy. A second training program for surveyors would then be required to implement the accuracy initiative.

American College of Surgeons Commission on Cancer

The Commission on Cancer's Cancer Program Standards 2004 includes a requirement on TNM Staging. The Commission has modified the staging standard over the past year and has developed a tracking tool and sample best practices to help programs with staging compliance. The changes to the staging standard can be found on the Commission's Web site at http://www.facs.org/cancer/coc/standards.html, along with the tracking tool and best practices at http://www.facs.org/cancer/coc/resourcetools.html.

 

 

Revised February 14, 2006