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In 2022, USA Health became the only health system in Alabama and the upper Gulf Coast region to achieve accreditation from the National Accreditation Program for Rectal Cancer.

Published Sep 28th, 2023

By Carol McPhail

Every other Thursday, a team of multidisciplinary specialists at USA Health convenes virtually to review the charts of patients diagnosed with rectal cancer. Medical oncologists, radiation oncologists, surgeons, pathologists and radiologists report on the results of the patients’ scans, biopsies and more, and collaborate on the best treatment. 

The group's review of each case was one of the requirements USA Health adopted to become the only health system in Alabama and the upper Gulf Coast region to achieve accreditation from the National Accreditation Program for Rectal Cancer (NAPRC). When USA Health earned the three-year accreditation in September 2022, it was one of only about 60 programs. Today, that number has grown to 85 nationwide. 

“It’s a very rigorous, well-monitored program that ensures that our care of rectal cancer is up to the standard,” said Ahmed Abdalla, M.D., a board-certified medical oncologist at the USA Health Mitchell Cancer Institute and a member of the rectal cancer team. “We are the only program in the state that received accreditation. That tells you how our care is here.” 

Taken together, colon and rectal cancer make up the fourth most common cancer and the third leading cause of cancer-related deaths in men and women in the United States, not counting some types of skin cancer, according to the Centers for Disease Control and Prevention. Rectal cancer, in particular, can be difficult to treat because of the rectum’s proximity to other vital organs and because it often is diagnosed at an advanced stage.

Historically, doctors have initially treated rectal cancer with surgery to remove the rectum along with a margin of tissue and lymph nodes. Many patients lose the function of their rectum and/or sphincter as a result and require a temporary or permanent ostomy pouch to rid the body of waste.

“Treatment for rectal cancer can have a significant impact on a patient’s quality of life,” said Leander Grimm, Jr., M.D., FACS, the Colon and Rectal Cancer Program leader at USA Health who formed its first multidisciplinary rectal cancer team in 2015.  “Not only that, but the quality of the resection by the surgeon, as well as the analysis of the specimen by pathology, have a direct impact on a rectal cancer patient’s long-term outcome.”

That goal was the driving reason behind the creation of the NAPRC quality standards by the American College of Surgeons Commission on Cancer (ASC CoC) in 2017.  Research had shown outcomes for rectal cancer patients varied a great deal based on the specialization, training and volume at the hospital where the patient is treated.  

“The NAPRC standards were created to ensure that not only is each patient’s cancer care tailored to their individual need, but also that the highest national evidence-based standards are upheld each time,” said Grimm, who also serves as director of the general surgery residency program at USA Health and a professor of surgery at the Whiddon College of Medicine. 

Even more recently, high-quality research has shown that, in many instances, patients who have a complete response to chemotherapy and radiation – meaning no evidence of a tumor remaining – can safely avoid surgery altogether, markedly increasing their long-term quality of life through organ preservation without compromising their cancer outcomes. “Outside the NAPRC, many institutions would not be able to keep up with rapidly changing, yet high-impact, treatment paradigms such as these, as well as others certain to come in the future,” Grimm said.

The NAPRC model emphasizes program structure, patient care processes, performance improvement and performance measures. “Here at USA Health, the adoption of these rigorous standards and national recognition by the ACS CoC of us as the only accredited institution in the state and the upper Gulf Coast region have not only ensured that people in lower Alabama get the best care possible, but they also have led patients to seek their rectal cancer care with us,” Grimm said.

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