New cancer protocols are developed based on the incidence of the tumor type and on the availability of staging standards.
Phase 1: Identify Members for the Cancer Protocol Review Panels
The 12 Cancer Protocol Review Panels (CPRP) develop the CAP cancer protocols, with the chair of each panel serving as a CAP cancer committee member. Each panel contains approximately 10 members including at least one:
- Community pathologist
- Academic pathologist
- Pathologist member of Cancer Care Ontario (CCO)
- Member of the CAP Pathology Electronic Reporting (PERT) Committee
- Clinician (medical oncologist, surgeon, or radiation oncologist)
- Representative from standard recommending groups for malignant tumors, (eg, American Joint Committee on Cancer [AJCC] staging task forces, World Health Organization [WHO] working groups, American Society of Clinical Oncologists [ASCO] working groups)
Phase 2: Review Evidence and Create Draft Protocol
The CPRP Chair identifies potential review panel members and confers with chair of Cancer Committee to generate a list of individuals to invite to serve on the panel. Potential review panel members are contacted before appointment to ascertain their interest in serving as panelists.
The primary authors and CPRP base decisions on published scientific literature with reasonable strength of evidence (National Health and Medical Research Council (NHMRC)). Some elements may be required in the absence of acceptable scientific evidence, if the element is required by consensus.
For example, the size of colorectal carcinoma is measured with little difficulty, traditionally reported, and useful for clinical correlation, even though colorectal cancer size does not correlate with prognosis or response to therapy.
When scientific evidence of acceptable strength is not available, CPRP consensus is required before the element will be required.
Phase 3: Scientific/Informatics Review
Cancer committee members, CPRP members, PERT members, CAP staff, and Electronic Cancer Checklist (eCC) review and comment on the draft. Primary authors incorporate revisions as appropriate.
Phase 4: Public Comment and Field Review
The finalized cancer protocols are posted online for public commentary for the duration of one month. The primary author will consider the feedback for edits to the final draft. The volunteer field testing panel of pathologists reviews the final draft for comment and consideration in revisions by the primary author.
Note: The field test review and public comment period only occur for new protocols or significant revisions, as deemed by the Cancer Committee.
Phase 5: Protocol Approval and Release
Read more about the cancer protocol revision process.