A new study suggests that the hospital where a person receives treatment for rectal cancer may strongly affect the quality of care they receive and possibly their long-term health outcomes.
Researchers found that patients treated at hospitals accredited by the American College of Surgeons National Accreditation Program for Rectal Cancer, also called NAPRC, were less likely to have cancer left behind after surgery. This is important because cancer cells remaining after surgery can increase the risk that the disease will return later.
The study was published in the Journal of the American College of Surgeons.
Rectal cancer is a type of cancer that develops in the rectum, which is the lower part of the large intestine close to the anus. Treating rectal cancer can be complicated because doctors often need to combine surgery, chemotherapy, radiation therapy, and careful testing to achieve the best results.
Successful treatment usually requires close coordination between many specialists, including surgeons, cancer doctors, radiologists, pathologists, and nurses. Because of this complexity, some hospitals have developed specialized rectal cancer programs designed to follow strict quality standards.
The NAPRC accreditation program was created by the American College of Surgeons to make sure hospitals meet high standards for rectal cancer care. Accredited hospitals must show that they have experienced teams, proper training, strong communication systems, and evidence-based treatment plans.
Researchers wanted to know whether patients treated at these accredited hospitals actually experienced better outcomes.
To investigate this question, the research team used information from the National Cancer Database, which collects cancer treatment data from more than 1,500 hospitals accredited by the ACS Commission on Cancer.
The researchers studied outcomes from 800 hospitals between 2018 and 2021. Among these hospitals, only 57 had achieved NAPRC accreditation during the study period. In total, 2,716 patients received rectal cancer care at NAPRC-accredited hospitals.
One of the most important measurements in the study was something called circumferential resection margin positivity, often shortened to CRM positivity. This refers to whether cancer cells are found at the edge of tissue removed during surgery.
When cancer cells are found at the surgical edge, it suggests that some cancer may have been left behind inside the body. Positive surgical margins are strongly linked to a higher risk of cancer recurrence.
The study found that accredited hospitals had better results in this area. Patients treated at NAPRC-accredited hospitals were less likely to have positive surgical margins after surgery compared with patients treated at non-accredited hospitals.
After adjusting for differences between hospitals and patient groups, researchers found that accreditation was associated with an absolute reduction of 1.1 percent in positive margins. This represented an 8.7 percent relative reduction compared with non-accredited hospitals.
The researchers also found differences in another important area of care: pretreatment carcinoembryonic antigen testing, usually called CEA testing.
CEA is a protein that can become elevated in some people with rectal cancer. Measuring CEA levels before treatment can help doctors monitor the disease, guide treatment decisions, and watch for cancer returning after treatment.
Patients treated at accredited hospitals were more likely to receive this important blood test before treatment began.
The study found that NAPRC-accredited hospitals achieved a 4.2 percent absolute increase in pretreatment CEA testing compared with non-accredited hospitals.
Interestingly, the study did not find major differences in how quickly treatment started after diagnosis.
Dr. Ronald J. Weigel, medical director of ACS Cancer Programs and one of the study authors, said the findings highlight the value of specialized cancer programs. According to the researchers, accreditation helps ensure patients receive care from experienced teams following proven treatment standards.
Another study published recently in JAMA Surgery found that hospitals treated more rectal cancer patients after receiving NAPRC accreditation. Researchers also found that patient care did not become more fragmented after accreditation, meaning patients were still able to receive coordinated treatment.
The findings may also have financial importance for hospitals. Researchers suggested that investing in accreditation programs may attract more patients while improving treatment quality.
For patients and families facing a rectal cancer diagnosis, the study highlights the importance of researching treatment centers carefully. Asking whether a hospital has specialized accreditation may help patients find programs with more experience and stronger systems for managing complex cancer care.
Still, the researchers noted that accreditation alone does not guarantee perfect outcomes, and the study cannot fully prove cause and effect. Other factors may also contribute to differences between hospitals.
Overall, the research provides strong evidence that specialized accreditation programs may improve the quality of rectal cancer treatment. The study’s biggest strength is its use of a large national database involving many hospitals and patients.
However, because the differences in outcomes were relatively modest, future research will be important to understand which specific parts of accreditation programs produce the greatest benefits for patients.
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Source: American College of Surgeons.
