Multidisciplinary Opinions (Tumor Boards) at the Center of the NAPRC
Ebony Johnson, CTR
August 30, 2019
The National Accreditation Program for Rectal Cancer (NAPRC) is one of the American College of Surgeons Commission on Cancer’s newest quality improvement initiatives. The idea of the NAPRC stems greatly from the statistically proven fact that patients treated for rectal cancer in Europe have significantly better outcomes than those diagnosed and treated in the United States. The biggest difference between the care of rectal patients in Europe and the US is the standardized multidisciplinary team approach taken by care providers in Europe compared to the siloed approach that is more popular in the US.
In 2011 Cleveland Clinic’s Steven D. Wexner, MD, PhD(Hon), FACS, FRCS, FRCS(Ed), convened with several of his colleagues from across the country to develop the Optimizing the Surgical Treatment of Rectal Cancer (OSTRiCh) consortium. Their main objective was to study the reasons why rectal cancer outcomes in the US were so inferior to those in Europe. After realizing that it had much to do with standardization and multidisciplinary teamwork, they set out to create a set of standards that hospitals across the country could adopt and thus see the improvements in their patient’s lives much like what is being seen in Europe. These standards became known as the National Accreditation Program for Rectal Cancer.
Rectal cancer programs seeking the NAPRC accreditation must commit to having a rectal cancer Multidisciplinary Team (Tumor board) which would include representation from surgery, pathology, radiology, medical oncology, and radiation oncology. They are required to convene at a minimum of twice a month and a program coordinator must be designated to coordinate their activities. Treatment planning discussions are required that include diagnostic review, clinical staging assignments, and multidisciplinary input on the patient’s individualized treatment plan. After surgery, the operative report is required to be in a standardized synoptic format because checklists are credited for the substantial decrease in inpatient complications and perioperative mortality. Studies show that in fact, information in the form of synoptic reporting as compared to narrative reporting is typically more complete and more reliable. At the next tumor board meeting (outcome discussion), images of the patient’s surgical specimens are then shared with the multidisciplinary team and the team decides on a recommendation for adjuvant therapy.
OncoLens is a multidisciplinary care planning platform for every cancer patient but can specifically help hospitals to achieve and maintain NAPRC accreditation. OncoLens replaces the labor-intensive process of tumor board preparation by using easy to use, click-based templates to create case histories and automatically routing them to pathology, radiology, research teams, and physician members of a patient’s care team. In addition, the platform merges case specific clinical trial and decision support guidelines into the meeting presentation and assists with the monitoring and reporting of accreditation metrics. The use of OncoLens has been proven to improve the quality and time to treatment for cancer patients and evolves the tumor board experience for cancer programs nationwide.