Does commission on cancer (CoC) accreditation mitigate the effect of care fragmentation on clinical outcome in localized rectal cancer?

Background: Studies of fragmented care (FC) in rectal cancer have not adjusted for indicators of hospital quality and may misrepresent the effects of FC.

Methods: We queried the National Cancer Database to identify patients undergoing care for clinical stage II and III rectal adenocarcinoma between 2006 and 2019. Those undergoing FC were sub-categorized based on whether (FC CoC) or not (FC non-CoC) they received systemic therapy at CoC accredited facilities.

Results: 44,339 patients met inclusion criteria; 23,921 (54 ​%) underwent FC, 16,929 (71 ​%) FC non-CoC. Differences in utilization of neoadjuvant therapy (92.3 ​% vs 89.7 ​% vs 89.5 ​%, p ​< ​0.01) and 5-year overall survival (76.1 vs 75.5 vs 74.1 %, p ​< ​0.01) between treatment cohorts were marginal.

Conclusion: In patients undergoing multimodality therapy for rectal cancer, care fragmentation is not associated with long-term clinical outcome. Decisions regarding where these patients go for systemic therapy may be safely made on the basis of ease of access.