NAPRC Accreditation Is Associated with Increased Rectal Cancer Treatment, Especially in Early Stages

Loria A, Jia Y, Weigel RJ, et al. Association of Rectal Cancer Accreditation with Patient Volume and Procedural Trends in the US. JAMA Surg. May 2026. 

To determine whether accreditation through the ACS National Accreditation Program for Rectal Cancer (NAPRC) is associated with changes in rectal cancer patient volume, stage-specific procedural volume, and care fragmentation, the authors performed a cohort study with a quasi-experimental difference-in-differences design. 

The study included 316 Commission on Cancer (CoC)–accredited hospitals in the US, including 80 hospitals that obtained NAPRC accreditation and 236 matched nonaccredited hospitals. Adult patients diagnosed with primary rectal adenocarcinoma between 2010 and 2022 were identified using data from the National Cancer Database. Data analysis was conducted between April 2025 and August 2025.

Primary outcomes included annual hospital-level rectal cancer patient volume, stage-specific procedural volumes (stage I and stage II/III disease), and care fragmentation. Care fragmentation was defined as cases in which diagnosis and first-course treatment (or the decision not to treat) were not completed at the reporting CoC-accredited institution. Outcomes were evaluated using multivariable linear fixed-effects regression models.

Before matching, 1,336 CoC-accredited hospitals were identified, including 80 hospitals that achieved NAPRC accreditation and 1,256 hospitals that did not. NAPRC accreditation was associated with a mean annual increase of 4.3 patients with rectal cancer per hospital (β = 4.29; 95% CI, 0.55-8.03; P = .03). Sensitivity analyses demonstrated increases beginning in the first year after accreditation, with larger point estimates in later years, though later estimates were not statistically significant. 

Accreditation was also associated with increased stage I procedural volume (β = 1.01; 95% CI, 0.016-1.99; P = .05), while no significant association was observed for stage II/III surgical volume. No significant differences in care fragmentation were identified.

These findings suggest that accreditation may support institutional growth while maintaining continuity of care, providing hospitals with potential strategic incentives to pursue NAPRC accreditation beyond quality improvement alone. Improved understanding of these effects may help guide hospital investment decisions, payer policies, and broader efforts to advance high-quality oncologic care delivery.