CHICAGO — The American College of Surgeons (ACS) Commission on Cancer (CoC) has introduced a new rural accreditation category to expand access to high-quality cancer care in rural communities, where long travel times and specialist shortages often limit care.
“Research shows that CoC accreditation improves access to high-quality care and enhances outcomes, reducing complications and death,” said Ronald J. Weigel, MD, FACS, PhD, medical director of the 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.”
CoC accreditation helps hospitals deliver comprehensive, patient-centered cancer care through evidence-based standards. More than 1,400 U.S. hospitals are accredited, but fewer than 20% are in rural areas. Workforce shortages, limited access to specialty services, and other challenges can make it difficult for rural hospitals to achieve and sustain accreditation.
Developed with direct input from rural hospitals and practitioners, the new category modifies accreditation requirements, including certain staffing and patient service criteria, while maintaining a strong focus on standards shown to improve the quality of cancer care.
Bringing Quality Cancer Care Closer to Home
About 1 in 5 Americans live in a rural area. Although cancer incidence in rural areas is similar to urban areas, cancer death rates are about 15% higher in rural communities, and the gap is widening.
These disparities are driven in part by reduced access to screening, specialists, and coordinated care, as well as longer travel distances and higher rates of underlying health conditions. An estimated 60% of rural counties lack an active general surgeon, and 66% of rural counties have no oncologist. As a result, rural patients are less likely to receive guideline-recommended cancer treatment, including chemotherapy, radiation, and survivorship services.
“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 the University of Iowa Hospitals & Clinics. “This new category will expand access to accreditation and provide rural hospitals with a practical, evidence-based framework to strengthen their cancer programs.”
Accreditation in Action: Enhancing Outcomes and Access
Research shows that accreditation improves outcomes, expands services, and strengthens local care:
- Outer Banks Health (Nags Head, North Carolina): After receiving accreditation from the CoC and the National Accreditation Program for Breast Centers, this 19-bed hospital increased the rate of screen-detected breast cancer from 44% to 63% and improved survival among men with advanced prostate cancer. The share of cancer patients treated locally also expanded — from about 10–20% before accreditation to more than 70% after achieving accreditation.
- Expanded access to evidence-based care: A 2025 Journal of the American College of Surgeons study found that colon and rectal cancer patients with high social vulnerability were 95% more likely to receive guideline-recommended care and had about a 9% lower risk of death if treated at a CoC-accredited hospital compared to a hospital not accredited.
- Objective performance data: Accredited hospitals submit data to the National Cancer Database, a national clinical cancer registry that captures nearly 75% of U.S. cancer cases and includes more than 250 data points, including cancer staging and the first-line treatment administered. Hospitals receive detailed performance reports, enabling them to evaluate their performance, track outcomes, and identify gaps in care within their own hospital.
“Using CoC standards strengthens hospitals’ ability to provide comprehensive cancer care and continuously improve quality,” said Dr. Lizarraga.
In Iowa, Dr. Lizarraga helped implement the Iowa Cancer Affiliate Network, modeled after the Markey Cancer Center Affiliate Network at the University of Kentucky, to support rural hospitals in Iowa in expanding services and achieving CoC accreditation.
“Accreditation also signals to the community that high-quality cancer care is available close to home,” she added.
Hospitals in counties designated as RUCC 4–9 are eligible to apply for the rural accreditation category. RUCC is a USDA classification system that measures how urban or rural a county is based on factors including population size and its relationship to nearby metropolitan areas.
Hospitals can begin implementing standards immediately and request a site visit after one year of compliance. Additional details are available through the CoC.
More information about rural cancer care and how the ACS is working to improve the delivery of care in these communities is available on the ACS website.
