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February 2020 Updates: Cancer Protocols, Biomarker Reporting Templates, electronic Cancer Checklists (eCC), and a new Autopsy Protocol

Reporting protocols designed by pathologists for pathologists are among the most valuable CAP member benefits. Templates that record pathologic findings in uniform ways can drive substantial improvements in the quality of care that patients receive. They can also build the credibility and influence of the specialty within the wider health care system.

The February 2020 release of the updated Cancer Protocols, Biomarker Reporting Templates, and electronic Cancer Checklists (eCCs) also included an all-new Reporting Protocol for the Examination of Gross Autopsy of Adult Decedents.

These tools cast a wide net, enabling rapid, clear, and precise laboratory information sharing across the continuum of care. The CAP library of services, partnerships, and educational offerings is growing geometrically to keep pace with increased incidence of cancer and rapidly emerging targeted therapies for diagnosis and management.

Members (volunteer subject matter experts who are community pathologists, academic pathologists, and subspecialists) and staff manage the Cancer Protocols and eCCs. Cancer Committee Chair Joseph D. Khoury, MD, FCAP, says the advent of personalized medicine and targeted therapies has underscored the collective responsibility of pathologists for creating and maintaining succinct, robust cancer data at the clinical and biological levels. As the pace picks up and discoveries multiply, cancer reporting will need to be ever more portable and complete, Dr. Khoury says, to protect the quality of patient care.

Pathologists and staff collaborate on the protocols with a growing cadre of partners whose expertise continually sharpens their value. Members of the CAP House of Delegates, who also review the templates, create another layer of credibility, bringing the insights of pathologists in every practice setting.

The current release features updates to 47 CAP Cancer Protocols and 86 eCC templates. The updates incorporate new standards from such collaborators as the World Health Organization (WHO), International Federation of Gynecology and Obstetrics, American Society of Clinical Oncologists (ASCO), American Joint Committee on Cancer, and American College of Surgeons Commission on Cancer, as well as edits based on feedback from end users. Substantive changes in this release include those prompted by an ASCO/CAP update to the guideline on estrogen and progesterone receptor testing in breast cancer related to low-positive estrogen receptor status. The 2019 WHO histologic type updates that affect protocols for breast and gastrointestinal tumors prompted additional significant edits.

A growing number of pathologists subscribe to the companion eCCs, which are formatted for incorporation into pathologists’ laboratory information system (LIS) workflow, in addition to facilitating structured data capture. The Pathology Electronic Reporting (PERT) Committee, chaired by Mary E. Edgerton, MD, PhD, FCAP, oversees and manages eCC development and implementation. PERT members work closely with the Cancer Committee to create eCCs that meet content-specific requirements while ensuring that both pathologists and downstream users can readily apply them. The CAP works closely with vendors to ensure that the eCCs interface smoothly with LIS software.

As Dr. Edgerton puts it, the eCCs are tailored to mirror the pathologist’s methodology while meeting downstream patient-management needs of surgeons and oncologists. The pathologist has an intake process, she says; the surgeon has an out-take process. An eCC should enable ease of use on both ends while enabling real-time, accurate record-keeping.

Finally, a few words about the new adult autopsy protocol. Former Autopsy Committee Chair Jody E. Hooper, MD, FCAP, explains that the climb got steeper when they surveyed pathology training programs and learned that every institution had its own approach. That sealed the case for developing a rigorous autopsy reporting template suited to hospital use. The autopsy is a powerful learning tool, Dr. Hooper says, and the learning is not necessarily about encountering something unexpected but also about delineating a disease and understanding what it does.

“If I do an autopsy of a cancer patient,” Dr. Hooper says, “I am looking to determine what kinds of infections they had, the effect of their treatment, why they died today as opposed to next week” — concerns directly tied to the care of future patients. “Having a template for grossing does not mean the death of description,” Dr. Hooper adds, “It means bringing the immediacy back. And this is a tool that’s going to evolve.”

In coordination with the Autopsy Committee, the PERT Committee is also evaluating an electronic version of the adult autopsy protocol that would function like the eCCs within the LIS workflow. Further interest in this work can be discussed with the committee staff at cancerprotocols@cap.org.

Access the new Autopsy Protocol; Cancer Protocols and Biomarker Reporting Templates; and electronic Cancer Checklists