6.1 CoC Accreditation: Standards Structure, Program Categories & Accreditation Awards
Key Takeaways
The CoC 2020 Standards have nine chapters, from Institutional Administrative Commitment (Chapter 1) and Program Scope and Governance (Chapter 2) through Data Surveillance and Systems (Chapter 6) and Research (Chapter 9).
A Community Cancer Program accessions more than 100 but fewer than 500 newly diagnosed cases a year, a Comprehensive Community Cancer Program 500 or more, and a Hospital Associate Cancer Program 100 or fewer.
A category is kept unless the program's services or caseload change for three consecutive years.
Standard 9.1 sets minimum annual clinical research accrual by category: ACAD 6%, INCP 6%, CCCP 4%, CCP 2%, FCCP 2%, VACP 2%, PCP 50%; HACP and NCIP programs are exempt.
A renewal program that is noncompliant on at least one but fewer than 20% of rated standards is "Accredited – Corrective Action Required" and has one year to resolve the deficiencies.
The Commission on Cancer
The Commission on Cancer (CoC) of the American College of Surgeons was founded in 1922. It has more than 100 members representing more than 50 national professional organizations and accredits about 1,500 cancer programs in the United States and Puerto Rico. Accreditation requires an on-site review every three years, annual compliance with the standards, and data reporting to the National Cancer Database (NCDB).
How the 2020 standards are organized
Optimal Resources for Cancer Care (2020 Standards) took effect in January 2020 and was updated in October 2025. Its nine chapters are:
| Chapter | Title | Examples of standards |
|---|---|---|
| 1 | Institutional Administrative Commitment | 1.1 Administrative Commitment |
| 2 | Program Scope and Governance | 2.1 Cancer Committee; 2.2 Cancer Liaison Physician; 2.3 Meetings; 2.4 Attendance; 2.5 Multidisciplinary Cancer Case Conference |
| 3 | Facilities and Equipment Resources | 3.1 Facility Accreditation; 3.2 Evaluation and Treatment Services |
| 4 | Personnel and Services Resources | 4.1 Physician Credentials; 4.2 Oncology Nursing Credentials; 4.3 Cancer Registry Staff Credentials; 4.4 Genetic Counseling and Risk Assessment; 4.5 Palliative Care; 4.6 Rehabilitation; 4.7 Oncology Nutrition; 4.8 Survivorship Program |
| 5 | Patient Care: Expectations and Protocols | 5.1 CAP Synoptic Reporting; 5.2 Psychosocial Distress Screening; 5.3–5.8 operative standards (breast sentinel node biopsy, axillary dissection, melanoma wide excision, colon resection, total mesorectal excision, pulmonary resection); 5.9 Smoking Cessation |
| 6 | Data Surveillance and Systems | 6.1 Cancer Registry Quality Control; 6.4 Rapid Cancer Reporting System: Data Submission; 6.5 Follow-Up of Patients (6.2 Data Submission and 6.3 Data Accuracy were retired in 2021) |
| 7 | Quality Improvement | 7.1 Quality Measures; 7.2 Monitoring Concordance with Evidence-Based Guidelines; 7.3 Quality Improvement Initiative; 7.4 Cancer Program Goal |
| 8 | Education: Professional and Community Outreach | 8.1 Addressing Barriers to Care; 8.2 Cancer Prevention Event; 8.3 Cancer Screening Event |
| 9 | Research | 9.1 Clinical Research Accrual; 9.2 CoC Special Studies |
The registry is closest to Chapters 2, 4 (4.3), 6 and 7, but it supplies data for almost every standard. Beyond the core categories, the CoC also offers newer options such as Rural Accreditation and a Pediatric Designation; a new program must be able to show a full calendar year of abstracted registry data before its first site visit.
Program categories
Categories are assigned at the initial application, based on the type of facility, program structure, services and the number of cases accessioned. A category is retained unless the services provided and/or the caseload change for three consecutive years.
| Category | Key features (per the CoC category definitions) |
|---|---|
| CCP – Community Cancer Program | More than 100 but fewer than 500 newly diagnosed cancer cases a year; the full range of services on-site or by referral |
| CCCP – Comprehensive Community Cancer Program | 500 or more newly diagnosed cancer cases a year; a broad range of services on-site or by referral |
| ACAD – Academic Comprehensive Cancer Program | More than 500 newly diagnosed cases a year and participation in postgraduate medical education (residency) programs |
| INCP – Integrated Network Cancer Program | Multiple facilities that form an integrated network and seek accreditation as one program under the CoC's INCP/NCIN guidelines |
| NCIP – NCI-Designated Comprehensive Cancer Center Program | Holds an NCI Cancer Center Support Grant and is designated a Comprehensive Cancer Center by the NCI |
| NCIN – NCI-Designated Network Cancer Program | A network whose facilities hold an NCI support grant as a designated comprehensive cancer center consortium |
| FCCP – Free Standing Cancer Center Program | A non-hospital-based program offering at least one cancer treatment modality; referral to CoC-accredited programs is preferred |
| HACP – Hospital Associate Cancer Program | 100 or fewer newly diagnosed cancer cases a year, with a limited range of diagnostic and treatment services on-site |
| PCP – Pediatric Cancer Program | A pediatric facility or program with the full range of pediatric services and required participation in clinical trials |
| VACP – Veterans Affairs Cancer Program | Serves military veterans, with the full range of services on-site or by referral |
Category drives the research accrual target (Standard 9.1)
| Category | Minimum % of patients accrued to cancer-related clinical research each year |
|---|---|
| ACAD | 6% |
| INCP | 6% |
| CCCP | 4% |
| CCP | 2% |
| FCCP | 2% |
| VACP | 2% |
| PCP | 50% |
| HACP, NCIP | Exempt |
The Clinical Research Coordinator reports annual enrollment to the cancer committee in the first quarter of the following year. Standard 9.1 counts several kinds of cancer-related research, including treatment, screening, genetic and epidemiological studies and patient registries used in clinical research.
Site visits, ratings and awards
- Preparation: programs upload evidence to the Pre-Review Questionnaire (PRQ), formerly called the Survey Application Record (SAR), using templates, cancer committee minutes and reports with all protected health information removed.
- Site visit: a trained CoC site reviewer visits every three years, reviews documentation, meets the cancer committee and the CLP, and attends a cancer conference.
- Ratings: each standard is rated Compliant, Noncompliant or Not Applicable by consensus of the site reviewer and CoC staff, with an executive review group adjudicating when needed. Any Noncompliant rating is a deficiency.
| Accreditation status | When it is awarded | Consequences |
|---|---|---|
| Accredited | Full compliance with all applicable standards after a site visit | Listed on "Find an Accredited Program"; certificate awarded |
| Accredited – Corrective Action Required (renewal programs only) | Noncompliant on at least one standard but fewer than 20% of the standards rated | Stays listed; one year to resolve; certificate issued when "Accredited" status is reached |
| Not Accredited – Corrective Action Required (initial applicants only) | Noncompliant on four or fewer standards | Not listed; one year to resolve; no NCDB access until accredited |
| Not Accredited | Renewal program noncompliant on more than 20% of standards; initial applicant with five or more noncompliant standards; or deficiencies not resolved in time | No Quality Portal or NCDB tools; not listed; may reapply as an initial applicant after one calendar year of compliance with all applicable standards |
Annual compliance timing
Standards judged on a full year of data (2.5, 4.4, 4.5, 4.8, 5.2 and 9.1) must be reported at the first-quarter committee meeting of the following year. Activity-based standards (2.2, 5.1, 5.9, 6.1, 6.4, 7.1, 7.2, 7.3, 7.4, 8.2 and 8.3) must be presented within the calendar year of the activity and cannot be carried into the next year's first quarter. The registrar usually keeps the compliance calendar.
A hospital program that accessions about 340 newly diagnosed cancer cases a year, with no residency programs, most likely holds which CoC category?
Hospital Associate Cancer Program (HACP)
Community Cancer Program (CCP)
Comprehensive Community Cancer Program (CCCP)
Academic Comprehensive Cancer Program (ACAD)
At its renewal site visit, an accredited program is rated noncompliant on 3 standards, which is fewer than 20% of the standards rated. What status does the program receive?
Not Accredited, because any deficiency at renewal ends accreditation
Accredited – Corrective Action Required, with one year to resolve the noncompliant standards
Not Accredited – Corrective Action Required, with no NCDB access until the deficiencies are resolved
Accredited, because deficiencies are only counted at initial surveys
What is the minimum annual clinical research accrual percentage for a Comprehensive Community Cancer Program under CoC Standard 9.1?
2%
4%
6%
50%
Sections you finish are checked off in the contents.