BEYOND THE NATIONAL ACCREDITATION PROGRAM FOR RECTAL CANCER (NAPRC): THE POTENTIAL BENEFITS OF POOLING DATA AND RESOURCES FROM MULTIPLE RECTAL CANCER TUMOR BOARDS AND EXPANDING BEYOND NAPRC STANDARDS
Molly Kobritz*1,4,3, Vernon Wu1,4,3, Baho Sidiqi1,4,3, Maureen Giordano2, Mary LaGrassa3,4, Qian Lin5, Sasha Suarez5, Nicholas LaGamma1,3,4, Daniel A. King1,3,4, Richard L. Whelan5,1
1Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY; 2Huntington Hospital, Huntington, NY; 3North Shore University Hospital, Manhasset, NY; 4Long Island Jewish Medical Center, New Hyde Park, NY; 5Lenox Hill Hospital, New York, NY
Introduction: Over the past two decades, U.S. outcomes for rectal cancer have shown to be highly variable and are associated with hospital volume, specialization, and training. This realization made clear the need for multidisciplinary care teams, standardized approaches, and rigorous data collection to optimize patient outcomes. The National Accreditation Program for Rectal Cancer (NAPRC), was established by the Optimizing the Surgical Treatment of Rectal Cancer Consortium and the American College of Surgeons Commission on Cancer (COC), and developed standards to improve the quality of rectal cancer care and ultimately patient outcomes. Individual hospitals apply for accreditation which, if obtained, insures a high standard of care. The NAPRC requires that each multi-disciplinary Tumor Board (TB) have a designated Data Coordinator to gather and track all rectal cancer (RC) patients (pts). Each TB must develop a unique database (DB); 1 year's data is needed prior to site review. RC TB's with dedicated staff to maintain the DB provide a great research opportunity. The development of a common DB to be used by multiple RC TB's would result in a sizable RC patient population and permit high quality clinical research. Also, the purview of the NAPRC TB's and DB's could be extended to include "Watch and Wait" (W&W) patients, which is currently not part of the NAPRC program. The purpose of this effort was to: build a DB for 3 NAPRC TB's within a large healthcare system, pool the combined data for research purposes, and integrate a W&W program into the NAPRC TB's and DB.
Methods: A multi-institutional and multi-disciplinary team (Surgery, Medical Oncology, Radiation Oncology) of NAPRC data coordinators, faculty physicians, residents and administrators built and refined a REDCap DB and also formed a research team that extracted data from the individual DB's. An initial review of RC cases for the past 2 to 3 years for the 3 sites was performed. The W&W population was also considered and a follow up program developed.
Results: A single DB has been formulated and is now being used by all 3 NAPRC accredited sites. Data concerning a total of 526 pts has been reviewed during this process (Figure 1). Two abstracts regarding studies done with the collective data have been submitted to meetings. A consensus W&W program that includes q 6 month assessment (flex sig/digital, MRI, and markers), TB presentation and associated Case Report Forms to be included in the NAPRC REDCap DB has been instituted.
Conclusions: Rigorous methods of multi-institutional data collection are critical to identifying areas for improvement in quality of care and outcomes. We demonstrate the feasibility of expanding beyond the NAPRC standards to better serve, both clinically and from the research perspective, the RC population.
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