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Centers of Excellence Network

COE Designations

The COE designations are built on evidence and incorporate clinical guidelines, best practice standards, and published data.

Designation criteria

The COE program is organized by designations informed by evidence and critical components of care known to improve health outcomes, quality of life, and lung cancer survival. A facility must first earn one of the foundational designations, Lung Cancer Screening or Cancer Care, to become a Center of Excellence. Once that has been achieved, a facility may apply for any number of additional designations.

Lung Cancer Screening

Implements a structured low-dose CT screening program that adheres to NCCN, USPSTF, or CMS criteria and uses a standardized process to manage patient follow-through.

Qualifying criteria:

  • Screen according to CMS, NCCN, USPSTF criteria; if your program screens patients outside these established criteria, please share your process for identifying patients’ screening appropriateness and which additional risk factors are considered for screening eligiblity.
  • A patient-centered discussion (about the benefits and harms) occurs before or at the time of low dose CT screening–for every baseline screening at a minimum.
  • Adherence to standards based on best-published practices for controlling screening quality, radiation dose and diagnostic procedures as outlined by American College of Radiology (ACR) Practice Parameters.
  • Utilize structured reporting and standardized follow-up and management decisions based on current, established screening classification systems and management algorithms.*
    *This designation criteria follows recommendations by LungRADS, NCCN Clinical Guidelines, and IELCAP.
  • Consult with or refer to a lung cancer multidisciplinary* and cancer care team for the management of any concerning findings (thoracic or extra-thoracic) in the screening process.
    *Multidisciplinary is defined as and must include at least three lung cancer disciplines from among the following: thoracic surgery, pulmonology, interventional pulmonology, interventional radiology, chest radiology, medical oncology, radiation oncology, pathology, advanced practice providers, navigator; if by referral, must explain the patient care referral pathway.
  • Integrate a standardized process within the screening workflow for patient and referring provider/care team communication on screening results and management plan.
  • Ask about current smoking status and advise to quit. Provide or refer for cessation services.*
    *This designation criteria follows recommendations by USPSTF and CMS.
  • Utilize a process for tracking, measuring, and reconciliation of annual and interval follow-up adherence in screening.
  • Collect and review internal clinical outcomes in a quality improvement process.

Best practice recommendations:

  • Submission of LDCT screening data to a multi-site registry (e.g., ACR LCSR, IELCAP, or other).
  • Monitor for lung cancer stage shift impact from screen-detected lung cancers.

 

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Cancer Care

Demonstrates access to standard cancer services within medical, radiation, and surgical oncology and pathology.

Qualifying criteria:

  • A patient-centered discussion about the potential benefits and harms of lung cancer treatment occurs at each point of the patient’s cancer care journey.
  • Biomarker Testing: Access to and compliance with guideline-directed testing for molecular and immune biomarkers with NGS technology in all patients with guideline-eligible tumors (when clinically appropriate).
    Using NGS results, consistently identify actionable mutations and eligiblity for guideline-directed targeted therapies or immunotherapies.
    *This designation criteria follows recommendations by NCCN, ASCO, and CAP.
  • Medical Oncology: Compliance with practice standards for the diagnostic workup, staging, and medical oncology (disease specific) treatment of all lung cancer types based on evidence, expert consensus, and practice guidelines for cancer care and treatment.*
    *This designation criteria follows recommendations by Stage Classification for Lung Cancer, ACCP, NCCN, ASCO, ESMO, and SITC.
  • Radiation Oncology: Compliance with practice standards for the diagnostic workup, staging, and radiation treatment of all lung cancer types based on evidence, expert consensus, and practice guidelines for cancer care and treatment.*
    *This designation criteria follows recommendations by TNM Stage Classification for Lung Cancer, ASTRO, NCCN, and ESTRO.
  • Thoracic Oncology: Compliance with practice standards for the diagnostic workup, staging, and surgical treatment of all lung cancer types based on evidence, expert consensus, and practice guidelines for cancer care and treatment.*
    *This designation criteria follows recommendations by AATS, ACCP, ESMO, NCCN, SSO, STS, and TNM Stage Classification for Lung Cancer.
  • Pathology: Comply with practice standards based on evidence, expert consensus, and practice guidelines for pathologic evaluation of malignancies.*
    *This designation criteria follows recommendations by CAP, AMP, ASCO, and NCCN.
  • Actively engage or have access to multidisciplinary expert input by way of tumor board or other team-based mechanism, including virtual.
  • Commitment and care delivery mechanisms are in place that standardizes consistent communication with patients and their active care providers about test results, diagnostic workup, and management plan.
  • Contribute to aggregated collection of relevant data and report to a cancer registry.
    (hospital, central or state, or special purpose registry, NPCR, NCI, SEER)
  • Ask about current smoking status and, as appropriate, advise to quit. Provide or refer for cessation services.*
    *This designation criteria follows recommendations by USPSTF and CMS.

Best practice recommendations:

  • Internal clinical outcomes review and quality improvement process
  • Thoracic Oncologist(s) are board certified thoracic or cardio-thoracic surgeons.

 

Apply now

Incidental Pulmonary Nodules

Provides a structured program that captures incidentally found lung nodules from imaging. Utilizes standardized processes for patient follow-up and reporting across the health system.

Qualifying criteria:

  • Structured nodule reporting in place for standardized follow-up and management decisions based on appropriate and established nodule classification systems and management guidelines.*
    *This designation criteria follows recommendations by Fleischner Criteria, LungRADS, ELCAP, and NCCN.
  • Consult with or refer to a lung cancer multidisciplinary* and cancer care team for the management of any concerning findings.
    *Multidisciplinary is defined as and must include at least 3 lung cancer disciplines from among the following: thoracic surgery, pulmonology, interventional pulmonology, interventional radiology, chest radiology, medical oncology, radiation oncology, pathology, advanced practice providers, navigator; if by referral, must explain the patient care referral pathway.
  • Commitment to a standardized process for communication with patients and their active care providers about test results and management plan.
  • Ask about current smoking status and advise to quit. Provide or refer for cessation services.*
    *This designation criteria follows recommendations by USPSTF.
  • Adherence to standards based on published best practices for controlling image quality, as low as reasonably achievable radiation dose, and diagnostic procedures as outlined by the American College of Radiology.
  • Tracking, measuring, and reconciliation process for interval follow-up adherence for incidentally detected lung nodules based on patient risk for lung cancer and surveillance guidelines.*
    *This designation criteria follows recommendations by Fleischner Criteria, LungRADS, ELCAP, and NCCN.
  • Internal clinical outcomes review and quality improvement process.

Best practice recommendations:

  • Institutional workflows that capture (at all entry points into the health system) and refer incidental pulmonary nodules for management.
  • Institutional tools are engaged to ensure all IPNs are identifed and managed.

 

This designation is coming soon.

Biomarker Testing

Ensures access to guideline-directed testing for molecular and immune biomarkers with next generation sequencing technology in all patients with guideline-eligible tumors to determine eligibility for targeted therapies or immunotherapies.

Qualifying criteria:

  • Access to guideline-directed testing for molecular and immune biomarkers with NGS technology in all patients with guideline eligible tumors (when clinically appropriate) to determine eligibility for targeted therapies or immunotherapies.
  • Biomarker and PD-L1 results are reviewed and discussed with patients once results are available. Discussion includes the clinical implications and therapeutic options based on these results.
  • Biomarker and PD-L1 results are reviewed and discussed with patients once results are available. Discussion includes the clinical implications and therapeutic options based on these results.
  • When appropriate, guideline directed PD-L1 and biomarker testing are integrated into treatment decisions before systemic therapy is initiated.
  • In the setting of disease progression on FDA approved therapy, updated PD-L1 and biomarker testing is utilized to identify next therapeutic option.
  • In the setting of disease progression, updated PD-L1 and biomarker testing is utilized to confirm need for clinical trial referral when FDA approved therapeutics are not an option.

Best practice recommendations:

  • Rapid on-site evaluation (ROSE), when available to increase diagnostic and molecular yield.
  • Utilization of liquid biopsy modalities in the setting of tissue insufficiency or unavailability and points of disease progression.

 

This designation is coming soon.

Multidisciplinary Teams

Provides a patient-centric multidisciplinary team comprised of a cancer navigator, or coordinator, and a minimum of three lung cancer disciplines that meet at a regularly scheduled tumor board.

Qualifying criteria:

  • Routinely scheduled MDT or Tumor/Nodule Board meetings and ad hoc as needed.
  • MDT comprised of a minimum of three lung cancer disciplines (thoracic surgery, pulmonology, interventional pulmonology, interventional radiology, chest radiology, medical oncology, radiation oncology, pathology, advanced practice providers, navigator).
  • Patient-centered communication and coordination of information for expeditious clinical decision-making and care routinely occurs following MDT and/or Tumor/Nodule Board review.

Best practice recommendations:

  • Designated lung cancer navigator engaged in the clinical care continuum for all lung cancer screening and cancer patients.
  • Virtual MDT is available and will be accessed in the absence of local MDT resources.

 

This designation is coming soon.

Smoking Cessation

Consistently supplies evidence-based smoking cessation services and information across the lung cancer care continuum.

Qualifying criteria:

  • 5 A’s (Ask, Advise, Assess, Assist, Arrange) are consistently integrated across the cancer care continuum in initial and follow-up visits.
  • Evidence-based smoking cessation services are consistently integrated across the cancer care continuum in initial and follow-up visits.
  • When clinically indicated and appropriate, FDA-approved pharmacotherapy (OTC and prescription) options are offered and prescribed to patients.
  • Behavioral therapy modalities (individual counseling, motivational interviewing, group counseling, cognitive behavioral therapy) are offered and provided (in-person, telehealth, or telephonic) to patients as accepted.

Best practice recommendations:

  • Actively engage in use of text messaging, app and/or web-based activities, and/or print materials for cessation work.
  • Proactively address stigma and people-first communication to destigmatize lung cancer, build trust, and promote communication.

 
This designation is coming soon.

Survivorship

Facilitates survivorship care plans and resources to improve quality of life among all lung cancer patients.

Qualifying criteria:

  • Lung cancer patient care is a shared and coordinated effort by oncology, primary care, and subspecialty providers.*
    *This designation criteria follows recommendations by OCS, NCCN, and COC.
  • All lung cancer survivors should be assessed annually or more frequently to determine any needs and necessary interventions related to their cancer.*
    *This designation criteria follows recommendations by NCCN.
  • Survivorship Program exists to meet the needs of lung cancer patients with curative intent.*
    *This designation criteria follows recommendations by OCS, NCCN, and COC.
  • Screening for psychosocial and mental health needs of lung cancer survivors occurs regularly. Treatment and support are offered as needed.*
    *This designation criteria follows recommendations by OCS, NCCN, and COC.
  • Ask about current smoking status, and advise to quit, provide, or refer for cessation services.*
    *This designation criteria follows recommendations by USPSTF and CMS.
  • Healthy lifestyle and behaviors, and preventive health measures are offered and provided to all lung cancer survivors.*
    *This designation criteria follows recommendations by NCCN.

This designation is coming soon.

Patient Centric Research

Consistently navigates lung cancer patients to clinical trial opportunities when appropriate.

Qualifying criteria:

  • Internal policy and procedures and clinical pathways are in place to consistently access and query ClinicalTrials.gov or another commensurate tool on behalf of patients.
  • Prompt referral to clinical trials when a disease has progressed and updated PD-L1 and biomarker testing confirm FDA-approved therapeutics are not an option.

Best practice recommendations:

  • Submission of LDCT screening data to a multi-site registry (e.g., ACR LCSR, IELCAP, or other).
  • Cancer Care facility is engaged, equipped, and open to supporting patients in local clinical research trial enrollment.
  • Cancer Care facility has a dedicated research team to support patient participation in clinical trials.
  • Promote awareness of research participation impact among the patient population.

 This designation is coming soon.

Health Equity

Consistently navigates lung cancer patients to clinical trial opportunities when appropriate.

Demonstrates an approach that considers diversity, health equity and inclusion for all community members.

This designation is coming soon.

Community Engagement

Participates in community outreach to expand lung cancer awareness and education.

This designation is coming soon.