New ACS Initiative Aims to Improve Rectal Cancer Outcomes

The American Cancer Society estimates that 97,220 new cases of colon cancer and 43,030 new cases of rectal cancer will be reported in 2018. And although the survival rate for colorectal cancer has increased drastically over the past few decades, more needs to be done to improve colorectal cancer outcomes.

Dr Steven D Wexner is the director of the Digestive Disease Center and chair of the Department of Colorectal Surgery at the Cleveland Clinic Florida. He recently presented a session at the 18th Annual Minimally Invasive Surgery Symposium titled “A Multidisciplinary Approach to Improving Outcomes: The National Accreditation Program for Rectal Cancer (NAPRC) for Hospitals.”

Consultant360 asked Dr Wexner our burning questions.

Consultant360: What is the NAPRC?

Steven Wexner: The NAPRC is the newest initiative of the American College of Surgeons (ACS) Commission on Cancer (COC) and the first cancer-site/type-specific accreditation offered within the COC accreditation program.

The program is based on the success of similar initiatives over the last 20 years in several European countries and the findings that outcomes in the United States lag behind results in Europe. The ACS COC is one of the first of many quality programs launched and maintained by the ACS; others include the National Surgical Quality Improvement Program, the Committee on Trauma, the National Accreditation Program for Breast Centers, and the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program.

Approximately 70% of all newly diagnosed cancers are treated each year at one of the about 1500 COC-accredited institutions. The NAPRC will very soon offer the option of additional accreditation for rectal cancer treatment.

C360: Can you tell us more about the multidisciplinary approach developed by the NAPRC?

SW: Much of the success achieved in Europe has been from the communication and collaboration among specialists from the various disciplines in the evaluation and management of patients with rectal cancer. Review and discussion by the multidisciplinary team (MDT) has evolved in many aspects of patient care, especially within the realm of oncology. After initial evaluation, the surgeon will present the physical examination findings; the radiologist will review and discuss the findings on rectal cancer protocol magnetic resonance imaging, chest, abdomen, and pelvis computed tomography scans, and any other imaging; and the pathologist will review the results of biopsies.

The entire MDT, including medical and radiation oncologists, will then arrive at a collective consensus about how to best treat the patient. After surgery, the surgeon presents the details of the operation, the pathologist shows the group the specimen, and further discussion ensues to again decide upon optimal postoperative care. A minimum of one member from each of the 5 previously named disciplines must attend each MDT meeting, and the MDT must meet a minimum of every other week.

C360: How does the NAPRC apply to hospitals? 

SW: The NAPRC is an accreditation of hospitals, not of individual practitioners, although the surgeons, radiologists, and pathologists are all required to complete the educational modules created and made available by their respective societies: the American Society of Colon and Rectal Surgeons, the American College of Radiology, and the College of American Pathologists. The hospital appoints an MDT director and an MDT coordinator to ensure compliance with the NAPRC standards.   

C360: What do you hope attendees took away from this session?

SW: I hope that the attendees recognized the repeatedly documented wide variation in rectal cancer care in the United States and the fact that our outcomes continue to be inferior to the outcomes in countries in which similar programs have been instituted.

I am optimistic that the attendees are cognizant of the importance of the MDT in achieving the goal of improving patient outcomes, and I am hopeful that they will work with their colleagues and administrators to help ensure that accreditation is actively sought at interested eligible COC-accredited centers.

For more information about the conference, click here.

More information about the NAPRC is available here and here.

—Amanda Balbi