Rectal Cancer Care: Does One Size Fit All?

Abstract

Over the past decade, rectal cancer care in the US has continued to advance rapidly. New innovations such as robotic surgery, nonoperative management, total neoadjuvant therapy, and advances in molecular diagnostics have changed the way we treat and care for rectal cancer patients. ¹ Cercek A. Roxburgh C.S.D. Strombom P. et al. Adoption of total neoadjuvant therapy for locally advanced rectal cancer. JAMA Oncol. 2018; 4 e180071 Crossref PubMed Scopus (106) Google Scholar ^{,  2} Smith J.J. Strombom P. Chow O.S. et al. Assessment of a watch-and-wait strategy for rectal cancer in patients with a complete response after neoadjuvant therapy. JAMA Oncol. 2019; 5 e185896 Crossref PubMed Scopus (85) Google Scholar ^{,  3} Jayne D. Pigazzi A. Marshall H. et al. Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: The ROLARR Randomized Clinical Trial. JAMA. 2017; 318 : 1569-1580 Crossref PubMed Scopus (322) Google Scholar Despite paradigm shifts in treatment and new technology, there continues to be persistent variation in access to high quality, guideline-concordant multidisciplinary care for patients with rectal cancer. Barriers to patient access affects both overall survival and potential surgical options. The National Accreditation Program for Rectal Cancer (NAPRC), the OSTRiCh Consortium (Optimizing the Surgical Treatment of Rectal Cancer), and the Commission on Cancer (CoC), a quality program of the American College of Surgeons, aim to accredit hospitals by evaluating a hospital's structure and processes for treating rectal cancer patients. ⁴ Monson J.R.T. Dietz D.W. Boughey J.C. You Y.N. Improving rectal cancer outcomes through advocacy, education, and research: The OSTRiCh Consortium and the new NAPRC. Bull Am Coll Surg United States. 2016; 101 : 45-46 PubMed Google Scholar Accredited hospitals are held accountable for delivering multidisciplinary, evidence-based care. Enthusiasm has been strong. NAPRC is in its early phase, with 19 hospitals successfully completing the accreditation process and dozens more in the process. NAPRC is an important first step in improving rectal cancer care in the US, but the US is a complex, large, and diverse country, and truly improving access for broad swaths of the population is going to take a coordinated effort that harnesses the passions of providers, hospitals, payors, and patients.