Improving rectal cancer outcomes through advocacy, education, and research: The OSTRiCh Consortium and the new NAPRC

Over the last three decades, there has been a significant shift in cancer care from the generalist to the specialist setting. This shift is especially true in surgical oncology, where surgeons specializing in the care of breast cancer, esophageal cancer, and pancreatic cancer have become the norm for many facilities treating cancer patients in the U.S. Much of this shift in care delivery has been evidence-based and has identified issues such as case volume for both provider and facility as a strong predictor of improved cancer-specific outcomes.

However, despite a move to rectal specialists for rectal cancer care in Europe, this is not yet the norm in U.S. surgical oncology. In many European countries, the outcomes for patients with rectal cancer are better compared with the outcomes for patients with colon cancer as a consequence of these changes in care pathways. Unfortunately, the management of patients with rectal cancer in the U.S. and their care process had not been altered until recently.

Given this shift from the generalist to specialist setting around the world and recognizing the significant variability in the quality of rectal cancer care in the U.S., the OSTRiCh (Optimizing the Surgical Treatment of Rectal Cancer) Consortium was founded in 2011 with the goal of improving rectal cancer outcomes through advocacy, education, and research. Over the past five years, OSTRiCh has expanded considerably from the founding group of 14 institutions and now includes more than 250 centers representing all facets of the U.S. health care delivery system—both large and small private clinics, university-affiliated hospitals, large health care systems, and smaller community hospitals.

While OSTRiCh was initially developed by fellows of the American Society of Colon and Rectal Surgeons (ASCRS), it was decided from the outset that the collaborative should be inclusive and not speciality based. Consequently, members of the following organizations are involved in the consortium, reflecting the modern, multidisciplinary approach to rectal cancer: the American College of Surgeons (ACS), the College of American Pathologists, the American College of Radiology, the American Society of Clinical Oncology, the American Society of Radiation Oncology, the Society of Surgical Oncology, the Society of American Gastrointestinal and Endoscopic Surgeons, and the Society for Surgery of the Alimentary Tract.

The OSTRiCh Consortium

The OSTRiCh Consortium has worked to raise awareness of the disparities that currently exist in U.S. rectal cancer care. Manuscripts have been published in peer-reviewed journals using data from the National Cancer Database (NCDB) illustrating suboptimal adherence to published guidelines for the use of neoadjuvant and adjuvant therapies in locally advanced rectal cancer and excessive rates of involved circumferential resection margins after rectal cancer resections.1,2

The consortium also maintains a website that facilitates communication between member institutions, disseminates information related to rectal cancer care, and provides a Web page where interested parties can join the consortium.

Developing the NAPRC

A primary goal of the consortium was achieved in June 2014 when the ACS Commission on Cancer (CoC) accepted an OSTRiCh proposal to create the National Accreditation Program for Rectal Cancer (NAPRC). The NAPRC is structured around evidence-based processes of rectal cancer care and employs the multidisciplinary team approach that has improved outcomes in several European countries over the past decades. OSTRiCh members are working directly with ACS and CoC leadership to write the NAPRC standards manual and to design the various components of the program. Six pilot site surveys were completed by the CoC in early 2016 in an effort to document current processes and to hone the standards and accreditation process with the goal of accepting applications to the program from interested CoC-accredited hospitals in early 2017.

In addition to developing the NAPRC, OSTRiCh has launched two major rectal cancer quality improvement initiatives in the last several months. The Transanal Total Mesorectal Excision (TaTME) Registry is tracking outcomes of a new technique in the U.S. for the surgical treatment of rectal cancer. This project is a cooperative effort with the English Low Rectal Cancer Development Programme (LOREC), which created a similar registry in 2013. The TaTME database will be identical to the LOREC registry and will allow data sharing and amalgamation in due time.3,4 The TaTME Registry has been funded by a grant from the ASCRS. The OSTRiCh Rectal Cancer Registry is a broader initiative that is open to all 250-plus OSTRiCh Consortium members, which allows users to enter their rectal cancer cases, track a number of quality indicators, and compare their own outcomes against national means. At present, 250 patient records from more than 30 registered centers have been completed within this database.

OSTRiCh continues to welcome new members. Interested centers can register for consortium membership and participation in either of these quality initiatives at the OSTRiCh Consortium website.


References

  1. Huntington CR, Boselli D, Symanowski J, Hill JS, Crimaldi A, Salo JC. Optimal timing of surgical resection after radiation in locally advanced rectal adenocarcinoma: An analysis of the National Cancer Data Base. Ann Surg Oncol. 2016;23(3):877-887.
  2. Rickles AS, Dietz DW, Chang GJ, et al. High rate of positive circumferential resection margins following rectal cancer surgery: A call to action. Ann Surg. 2015;262(6):891-898.
  3. Dayal S, Moran B. LOREC: The English Low Rectal Cancer National Development Programme. Br J Hosp Med (Lond). 2013;74(7):377-380.
  4. Moran BJ, Holm T, Brannagan G, et al. The English national Low Rectal Cancer Development Programme: Key messages and future perspectives. Colorectal Dis. 2014;16(3):173-178.

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