Does commission on cancer (CoC) accreditation mitigate the effect of care fragmentation on clinical outcome in localized rectal cancer?

• DOI: 10.1016/j.amjsurg.2023.12.024
• Publication Date: 2023-12-21T13:12:23Z
• Authors: Simon S. Park; Raymond A. Verm; Zaid M. Abdelsattar; Sarah Kramer; James Swanson; Mitchel Fernando; Tyler Cohn; Frederick A. Luch...; Marshall S. Baker
• Keywords: Rectal Neoplasms; Humans; Combined Modality Therapy; Hospitals; Neoadjuvant Therapy; Accreditation; Neoplasm Staging; Retrospective Studies

Studies of fragmented care (FC) in rectal cancer have not adjusted for indicators of hospital quality and may misrepresent the effects of FC.We queried the National Cancer Database to identify patients undergoing care for clinical stage II and III rectal adenocarcinoma between 2006 and 2019. Those undergoing FC were sub-categorized based on whether (FC CoC) or not (FC non-CoC) they received systemic therapy at CoC accredited facilities.44,339 patients met inclusion criteria; 23,921 (54 ​%) underwent FC, 16,929 (71 ​%) FC non-CoC. Differences in utilization of neoadjuvant therapy (92.3 ​% vs 89.7 ​% vs 89.5 ​%, p ​< ​0.01) and 5-year overall survival (76.1 vs 75.5 vs 74.1 %, p ​< ​0.01) between treatment cohorts were marginal.In patients undergoing multimodality therapy for rectal cancer, care fragmentation is not associated with long-term clinical outcome. Decisions regarding where these patients go for systemic therapy may be safely made on the basis of ease of access.