Original Investigation 

Association of Rectal Cancer Accreditation with Patient Volume and Procedural Trends in the US

Anthony Loria, Yusheng Jia, Ronald J. Weigel, et al

JAMA Surg Published Online: May 6, 2026

doi: 10.1001/jamasurg.2026.1259

Key Points

Question  Is National Accreditation Program for Rectal Cancer (NAPRC) accreditation associated with changes in rectal cancer patient volume, procedural volume, and care fragmentation at accredited hospitals?

Findings  In this difference-in-differences study, NAPRC accreditation was associated with a statistically significant increase of approximately 4 additional patients with rectal cancer per year at accredited centers compared with nonaccredited centers. Procedural volumes for early-stage (stage I) rectal cancer significantly increased, whereas procedural volumes for locally advanced (stage II/III) disease did not change, a pattern consistent with national treatment trends; accreditation was not associated with increased care fragmentation.

Meaning  In this study, NAPRC accreditation was associated with increased overall patient and early-stage procedural volumes without worsening care fragmentation, supporting its potential institutional and clinical value in rectal cancer care.

Abstract

Importance  Hospital accreditation programs aim to improve quality of care and patient outcomes but often require substantial institutional investment in staffing, infrastructure, and regulatory compliance. Despite these costs, the broader institutional impact of accreditation, particularly on patient volumes and care patterns, are poorly understood.

Objective  To evaluate whether National Accreditation Program for Rectal Cancer (NAPRC) accreditation is associated with changes in rectal cancer patient volume, stage-specific procedural volumes, and care fragmentation.

Design, Setting, and Participants  This cohort study used a quasi-experimental difference-in-differences design. A total of 316 US Commission on Cancer–accredited (COC) hospitals, including 80 that received NAPRC-accreditation and 236 matched nonaccredited centers. Participants included adult patients diagnosed with primary rectal adenocarcinoma between 2010 and 2022 from the National Cancer Database. These data were analyzed from April 2025 to August 2025.

Exposure  Hospital-level NAPRC accreditation, which requires adherence to multidisciplinary rectal cancer care standards, external audits, and specialized training.

Main Outcomes and Measures  Annual hospital-level rectal cancer patient volume, stage-specific procedural volumes (stage I and stage II/III), and care fragmentation. Care fragmentation was defined as any case in which the diagnosis and first-course treatment (or decision not to treat) were not completed at the reporting COC-accredited facility. Outcomes were assessed using linear fixed-effects multivariable regression models.

Results  Prior to matching, 1336 COC-accredited facilities were identified, including 80 that achieved NAPRC accreditation and 1256 that never attained accreditation. After propensity score matching, the final analytic sample included 316 hospitals: 80 NAPRC-accredited and 236 nonaccredited facilities. NAPRC accreditation was associated with a mean annual increase of 4.3 patients with rectal cancer per institution (β = 4.29; 95% CI, 0.55-8.03; P = .03). Sensitivity analyses demonstrated increases beginning in the first postaccreditation year, with larger point estimates in subsequent years, though later estimates were not statistically significant. Accreditation was associated with an increase in stage I procedural volume (β = 1.01; 95% CI, 0.016-1.99; P = .05), but not stage II/III surgical volume. No significant changes in care fragmentation were observed.

Conclusions and Relevance  In this study, NAPRC accreditation was associated with increased institutional rectal cancer patient volumes and higher procedural volume for early-stage disease without evidence of increased care fragmentation. These findings suggest that accreditation may promote institutional growth while preserving care continuity, offering a potential strategic incentive for hospitals to pursue NAPRC accreditation beyond quality improvement alone. Understanding these dynamics may inform hospital investment decisions, payer strategies, and policy efforts to support high-quality oncologic care delivery.