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NATIONAL QUALITY FORUM Cancer Project SAMPLE BALLOT MEASURE-BY-MEASURE 0219 ______ ______ ______ 0219: Post breast conservation surgery irradiation I approve the measure currently specified I disapprove the measure currently specified I abstain from voting on this measure 0220 ______ ______ ______ 0220: Adjuvant hormonal therapy I approve the measure currently specified I disapprove the measure currently specified I abstain from voting on this measure 0221 Needle biopsy to establish diagnosis of cancer precedes surgical excision/resection I approve the measure currently specified I disapprove the measure currently specified I abstain from voting on this measure ______ ______ ______ 0223 ______ ______ ______ 0225 ______ ______ ______ 0385 ______ ______ ______ 0223: Adjuvant chemotherapy is considered or administered within 4 months (120 days) of diagnosis to patients under the age of 80 with AJCC III (lymph node positive) colon cancer I approve the measure currently specified I disapprove the measure currently specified I abstain from voting on this measure 0225: At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer. I approve the measure currently specified I disapprove the measure currently specified I abstain from voting on this measure Oncology: Chemotherapy for Stage IIIA through IIIC Colon Cancer Patients I approve the measure currently specified I disapprove the measure currently specified I abstain from voting on this measure ELECTRONIC VOTING ONLY—VOTING CLOSES THURSDAY, AUGUST 30, 2012, at 6:00 pm ET Created on: 08/14/2012 at 01:29 PM 1 0387 ______ ______ ______ 0391 ______ ______ ______ 0392 ______ ______ ______ 0559 ______ ______ ______ 1855 ______ ______ ______ 1857 ______ ______ ______ Oncology: Hormonal therapy for stage IC through IIIC, ER/PR positive breast cancer I approve the measure currently specified I disapprove the measure currently specified I abstain from voting on this measure Breast Cancer Resection Pathology Reporting- pT category (primary tumor) and pN category (regional lymph nodes) with histologic grade I approve the measure currently specified I disapprove the measure currently specified I abstain from voting on this measure Colorectal Cancer Resection Pathology Reporting- pT category (primary tumor) and pN category (regional lymph nodes) with histologic grade I approve the measure currently specified I disapprove the measure currently specified I abstain from voting on this measure C0559: Combination chemotherapy is considered or administered within 4 months (120 days) of diagnosis for women under 70 with AJCC T1c, or Stage II or III hormone receptor negative breast cancer. I approve the measure currently specified I disapprove the measure currently specified I abstain from voting on this measure Quantitative HER2 evaluation by IHC uses the system recommended by the ASCO/CAP guidelines I approve the measure currently specified I disapprove the measure currently specified I abstain from voting on this measure Patients with breast cancer and negative or undocumented human epidermal growth factor receptor 2 (HER2) status who are spared treatment with trastuzumab I approve the measure currently specified I disapprove the measure currently specified I abstain from voting on this measure ELECTRONIC VOTING ONLY—VOTING CLOSES THURSDAY, AUGUST 30, 2012, at 6:00 pm ET Created on: 08/14/2012 at 01:29 PM 2 1858 ______ ______ ______ 1859 ______ ______ ______ 1860 ______ ______ ______ 1878 ______ ______ ______ Trastuzumab administered to patients with AJCC stage I (T1c) – III and human epidermal growth factor receptor 2 (HER2) positive breast cancer who receive adjuvant chemotherapy I approve the measure currently specified I disapprove the measure currently specified I abstain from voting on this measure KRAS gene mutation testing performed for patients with metastatic colorectal cancer who receive anti-epidermal growth factor receptor monoclonal antibody therapy I approve the measure currently specified I disapprove the measure currently specified I abstain from voting on this measure Patients with metastatic colorectal cancer and KRAS gene mutation spared treatment with anti-epidermal growth factor receptor monoclonal antibodies I approve the measure currently specified I disapprove the measure currently specified I abstain from voting on this measure Human epidermal growth factor receptor 2 (HER2) testing in breast cancer I approve the measure currently specified I disapprove the measure currently specified I abstain from voting on this measure ELECTRONIC VOTING ONLY—VOTING CLOSES THURSDAY, AUGUST 30, 2012, at 6:00 pm ET Created on: 08/14/2012 at 01:29 PM 3