American College of Surgeons Commission on

Cancer Quality Care Core Measures

The Pearlman Cancer Center consistently exceeds compliance rates as set forth by the American College of Surgeons Commission on Cancer. We are committed to providing the best cancer care available in South Georgia and North Florida.

Standard 4.4 – Accountability Measures: Each calendar year, the expected Estimated Performance Rates (EPR) is met for each accountability measure as defined by the Commission on Cancer indicated by the CoC quality reporting tool, Cancer Program Practice Profile Reports (CP3R).

Site

Measure

CoC EPR

SGMC EPR

Breast

BCSRT – Radiation therapy is administered within 1 year (365 days) of diagnosis for women under the age of 70 receiving breast conservation surgery for breast cancer.


90%

96%

HT – Tamoxifen or third generation aromatase inhibitor is recommended or administered within 1 year (365 days) of diagnosis for women with AJCC T1c or Stage IB-III hormone receptor positive breast cancer.


90%

98%

MASTRT – Radiation therapy is recommended or administered following any mastectomy within 1 year (365 days) of diagnosis of breast cancer for women with ≥4 positive regional lymph nodes

90%

95%


Standard 4.5 – Quality Improvement Measures:
Each calendar year, the expected Estimated Performance Rates (EPR) is met for each quality improvement measures as defined by the Commission on Cancer indicated by the CoC quality reporting tool, Cancer Program Practice Profile Reports (CP3R).

Site

Measure

CoC EPR

SGMC EPR

Breast

nBx – Image or palpation-guided needle biopsy to the primary site is performed to establish diagnosis of breast cancer.

80%

95%

Colon

12RLN – At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer.

85%

98%

Lung

LCT – Systemic chemotherapy is administered within 4 months to day preoperatively or day of surgery to 6 months postoperatively, or it is recommended for surgically resected cases with pathologic lymph node-positive (pN1) and (pN2) nonsmall cell lung cancer.


85%

85%

LNoSurg – Surgery is not the first course of treatment for cN2, M0 lung cases

85%

87%

Rectum

RECRTCT – Preoperative chemo and radiation are administered for clinical AJCC T3N0, T4N0, or Stage III; or postoperative chemo and radiation are administered within 180 days of diagnosis for clinical AJCC T1-2N0 with pathologic AJCC T3N0, T4N0, or Stage III; or treatment is recommended; for patients under the age of 80 receiving resection for rectal cancer.

85%

94%