Surgeons caring for patients with cancer in rural communities often practice with fewer specialists, limited local services, and long travel distances separating patients from comprehensive cancer care. A new Commission on Cancer (CoC) accreditation category aims to help rural hospitals strengthen that infrastructure while enabling more patients to receive high-quality cancer care closer to home.
The ACS CoC introduced the rural accreditation category in 2026, creating a pathway that accounts for staffing and resource limitations common in rural hospitals while maintaining standards designed to improve cancer care quality.
“Research shows that CoC accreditation improves access to high-quality care and enhances outcomes, reducing complications and death,” said Ronald J. Weigel, MD, PhD, FACS, Medical Director of ACS Cancer Programs. “Previously, some rural hospitals could not pursue accreditation due to resource constraints. The new category makes accreditation, and the benefits that accompany it, more attainable by tailoring the standards to the needs and resources of rural hospitals.”
Addressing Gaps in Rural Cancer Care
Approximately 1 in 5 Americans lives in a rural area. Although cancer incidence is similar in rural and urban communities, cancer death rates are about 15% higher in rural areas, and the disparity is widening.
Limited access to the surgical and oncology workforce is one factor. An estimated 60% of rural counties lack an active general surgeon, and 66% have no oncologist. Patients also may face long travel distances for screening, specialty consultations, chemotherapy, radiation therapy, and survivorship services. As a result, rural patients are less likely to receive guideline-recommended cancer treatment.
For surgeons and other members of the cancer care team, CoC accreditation provides a framework for coordinating care across the cancer continuum, from screening and diagnosis through treatment and survivorship.
“CoC accreditation is unique in addressing the full continuum of cancer care and providing a roadmap for delivering coordinated, high-quality health care from screening through diagnosis and survivorship,” said Ingrid Lizarraga, MBBS, FACS, CoC State Chair of Iowa and a breast surgical oncologist with University of Iowa Hospitals & Clinics in Iowa City.
More than 1,400 US hospitals are CoC accredited, but fewer than 20% are in rural areas. Developed with input from rural hospitals and practitioners, the new category modifies certain staffing and patient service requirements that can present barriers for smaller hospitals while retaining a focus on standards associated with quality cancer care.
“This new category will expand access to accreditation and provide rural hospitals with a practical, evidence-based framework to strengthen their cancer programs,” Dr. Lizarraga said.
Using Accreditation to Improve Local Care
Experience at rural hospitals illustrates how stronger local cancer programs can affect both access and outcomes.
Outer Banks Health, a 19-bed hospital in Nags Head, North Carolina, increased its rate of screen-detected breast cancer from 44% to 63% after receiving accreditation from the CoC and the National Accreditation Program for Breast Centers. The proportion of cancer patients treated locally increased from approximately 10% to 20% before accreditation to more than 70%.
Research also suggests that accreditation can help improve access to evidence-based treatment for vulnerable patients. A 2025 Journal of the American College of Surgeons study found that patients with colon and rectal cancer and high social vulnerability were 95% more likely to receive guideline-recommended care and had an approximately 9% lower risk of death when treated at a CoC-accredited hospital compared with a nonaccredited hospital.
Accreditation also gives cancer teams access to data that can support quality improvement. CoC-accredited hospitals submit data to the National Cancer Database, which captures nearly 75% of US cancer cases. Hospitals receive performance reports that can be used to benchmark care, evaluate outcomes, and identify opportunities to improve cancer services.
In Iowa, Dr. Lizarraga helped implement the Iowa Cancer Affiliate Network, modeled after the Markey Cancer Center Affiliate Network at the University of Kentucky in Lexington, to help rural hospitals expand services and achieve CoC accreditation.
“Accreditation also signals to the community that high-quality cancer care is available close to home,” she said.
Hospitals in counties designated Rural-Urban Continuum Codes 4–9 are eligible for the new accreditation category. Hospitals can begin implementing the standards immediately and request a site visit after 1 calendar year of compliance.
Additional information about the rural accreditation category, including eligibility and standards, is available at facs.org/coc-rural. Details about rural cancer care and how the ACS is working to improve the delivery of care in these communities are available at facs.org/ruralcancer.
