I commend Drs. Phang and Cirocco for authoring “Improving Care for Rectal Cancer Patients in Rural Canada.” I also thank them for allowing me to offer some comments about their excellent study.
Rectal cancer care has been revolutionized during the past half-century, as noted by the authors, due in part to the impetus and passion of Prof. R. J. “Bill” Heald, CBE, MChir, FACS(Hon). Dr. Heald’s teachings led to improvements in rectal cancer outcomes in many European countries, including decreases in the rates of creation of permanent stoma and in local recurrence and increases in survival. Other added benefits included decreased morbidity and mortality and more frequent use of evidence-based guidelines.
A US initiative began in 2011 to improve and optimize the outcomes of rectal cancer care throughout the nation. The program now known as the National Accreditation Program for Rectal Cancer (NAPRC) was endorsed by the Commission on Cancer and the ACS Board of Regents in the spring of 2014.1 At present, almost 100 programs either have received or are in various stages of seeking NAPRC accreditation.2 Thus, the 2011 goal of matching improved multidisciplinary team outcomes in Europe is well under way.
Dr. Phang and colleagues in Canada led a similar initiative in British Columbia and Alberta including—as noted in the article’s Figure 1—an evolving practice of referring distal third rectal cancers to high-volume centers. Geography and lack of resources create potential challenges to offering NAPRC care throughout the US. Specifically, it is incumbent upon us to ensure that access to evidence-based standards practice care in rectal cancer care can be made available to patients throughout the country. A previous study from the mountain states shows, unfortunately, adherence to such care is not universal. Specifically, Swords and colleagues revealed that nearly 20% of patients in the intermountain region did not undergo appropriate evidence-based staging or treatment.3 These omissions were associated with increased rates of circumferential margin positivity, node positivity, and local recurrence.
Therefore, there is definite opportunity for us to strategically ensure that NAPRC multidisciplinary team evidence-based standards practice care designed to improve and optimize outcomes for patients with rectal cancer is accessible to all US patients. We are cognizant of this issue and will certainly work to ensure that these goals are met.
One initial step that can be taken to ensure fulfillment of this goal is that all surgeons who care for patients with rectal cancer can access the American Society of Colon and Rectal Surgeons (ASCRS) Fundamentals of Rectal Cancer Surgery educational module.4 This tremendous resource helps ensure that surgeons caring for rectal cancer patients are completely up to date with the comprehensive body of literature and familiar with the technical nuances, facets, and challenges of rectal cancer surgery. Companion modules exist for both radiologists, as designed by the American College of Radiology, and pathologists, as designed by the College of American Pathologists. Therefore, even surgeons who do not work in an NAPRC-accredited centers can avail themselves of the very robust Fundamentals of Rectal Cancer Surgery module, regardless of ASCRS membership.
