Cori Cross, MD: Advancing Health Personalizing Care at
Memorial Hermann. This is our mission. This podcast shares the signs and
stories behind those efforts. Welcome, I'm Dr. Corey Cross. I'm excited because
today we are joined by not one, but two amazing doctors from Memorial Hermann.
Today I'm interviewing Dr. Joseph Cali and Dr. Erik Askenasy. They will discuss
the NAPRC Rectal Accreditation that was recently earned at three Memorial
Hermann facilities. Dr. Cali is an associate professor of surgery at McGovern
Medical School at UT Health Houston, affiliated with Memorial Hermann Memorial
City Medical Center. Dr. Askenasy is also an associate professor of surgery at
McGovern Medical School at UT Health Houston, and affiliated with Memorial
Hermann Southeast. Dr. Cali. Dr. Askenasy thank you for joining us.

Dr. Erik Askenasy: Great to be here.

Dr. Joseph Cali: Thank you for having us`.

Cori Cross, MD: So, Dr. Cali, let's start with you. What
does NAPRC stand for and what does NAPRC accreditation?

Dr. Joseph Cali: NAPRC stands for National Accreditation
Program for Rectal Cancer, and what it stands for is that our three campuses at
Memorial Hermann, Memorial City, Memorial Southeast and the Woodlands are
accredited as rectal cancer programs through the American College of Surgeons.
What the American College of Surgeons recognized was that there was quite a
variation in care for rectal cancer across the country. So the American College
of Surgeons developed standards of care for the treatment of rectal cancer. It
was to develop a multidisciplinary approach to rectal cancer. So we have
certain standards for testing, for treatment plans, for tumor board. All
determined by the American College of Surgeons.

Cori Cross, MD: So it's obvious that the NAPRC is a very
prestigious designation. I understand that before any hospital can apply for
the accreditation, that they must verify that their rectal program is a part of
the Commission on Cancer or the COC accredited program. Can you elaborate on
this, Dr. Askenasy?

Dr. Erik Askenasy: Yeah, sure. So the Committee on
Cancer basically ensures that patients that you are treating in your center
receive a comprehensive patient-centered care through a multidisciplinary team
approach. They'll also have access to information onto clinical and treatment
options. Ongoing monitoring of care, and lifelong patient follow up. We also
have a focus on psychological support and survivorship care. And continuous
quality improvements in care in the care provided by always looking back on
your data and making sure that you have quality improvement initiatives
throughout your process. That's the benefit of being a Commission on Care or
commission on Cancer accredited program.

Cori Cross, MD: I get that. So it's basically setting a
gold standard for how to approach a patient with rectal cancer.

Dr. Erik Askenasy: Exactly.

Cori Cross, MD: Got it. So I would assume that this
accreditation, the NAPRC accreditation takes a lot of work from physicians, but
that you also have a whole team there involved in patient care such as your
oncology, nurse navigators care coordinators, and they must all have played big
part in achieving this recognition. Can you talk a little bit about the process
and what went into earning this distinguished honor?

Dr. Joseph Cali: So the process of developing a team for
this NAPRC accreditation Involved many meetings where we had nurses, doctors,
nurse navigators all sorts of staff from the hospital system to put the whole
structure together so that we could meet the standards of the American College
of Surgeons. We had to learn how to abstract the information. We had to develop
tumor boards that are multidisciplinary and we had to have regular attendance
at these committees. As Dr. Askenasy pointed out, it starts with the diagnosis.
It starts with the evaluation, and then developing a treatment plan.

But then we follow the patient throughout their treatment plans
and follow the patient even after their chemotherapies radiation, after their
surgery to see how they're doing. We look back at our results and we also stay
abreast of the current literature because treatments do evolve. Treatment plans
do change over time and and that's what we've seen occur at our campuses here
at Memorial Hermann. We've definitely evolved for the better, for better care
for rectal cancer treatment of our patients.

Cori Cross, MD: That makes a lot of sense and it's what
you would want as a patient. Dr. Askenasy Dr. Cali May have touched on this a
little bit, but can you dive into a little bit more what a multidisciplinary
approach looks like in rectal care and what does this mean really for the
patient coming in to be treated for cancer? How is their experience different
when they're at a center that has a multidisciplinary approach?

Dr. Erik Askenasy: That's a great question. So if you
think about the way cancers many times in the past had been treated. The care
was isolated. It was siloed into different areas. Oncology did their thing,
radiation did their thing, surgery did their thing, and there was not
necessarily the communication needed in order to make sure that, individualized
care was actually being provided. So our tumor boards or multidisciplinary
approach basically involves getting everybody together at our campus. It's
every Tuesday at noon and we'll present five to 10 new or different rectal
cancer patients and have oncologists, radiation oncologists, pathologists,
nurse navigators, the surgeons, colorectal surgeons, administration, all the
key players and key stakeholders involved in that patient's care are present.

We all can give input. We present the patient and then we
figure out an individualized care pathway for that specific patient taking into
account, not just their medical history, but their social status, their
economic abilities, kind of everything in order to make sure that this patient
gets the best possible care that they can. So it is a different mentality
rather than just, hey, I'm the captain of this ship. I'm gonna go and do my
thing, and okay, then I'm gonna hand the baton off to you. It's not that
mentality anymore. It's much more of a team based approach, and it really,
really does improve the quality of care that patients receive.

Cori Cross, MD: I would imagine it does, because in
medicine one of the things I find most frustrating is that we do seem to think
of each even body system separate, when really in the body, they're all working
together. So I think the more that we can treat a patient as an individual and
as a whole being, the better care that we can provide. You mentioned that part
of this is that you do Qi projects and that you look at the outcomes. And I was
just curious since, implementing this approach, how have you seen outcomes
change? How has patient satisfaction changed? Because I'm assuming that it's
not just changing their outcomes with regard to their cancer, but their
outcomes with regard to how they feel about the treatment they're receiving.

Dr. Erik Askenasy: Yeah, so just an example of this
would be the way we traditionally treated rectal cancer in this part of the
country really, was that you would initially get chemo radiation followed by
surgery, followed by adjuvant or after surgery chemotherapy. And new algorithms
have kind of emerged that have indicated that if you do all the chemotherapy
and the chemo radiation before surgery that many patients would actually have a
complete clinical response. In other words, they would have no evidence of
disease of cancer remaining in their body on either physical exam, endoscopy,
or MRI.

Therefore many patients now have the opportunity to have organ
preservation. we call this approach watch and wait. That's what it's been, you
know, coined all over the place, and so now a large percent of our patients are
able to avoid surgery as long as they agree to a very aggressive surveillance
program for their rectal cancer, which is obviously of significant benefit to
patients.

Cori Cross, MD: Now I can imagine that's hugely
impactful to just quality of life and. How you feel about dealing with this
because not to have to go undergo surgery is amazing, even if you do have to do
lots more surveillance.

Dr. Erik Askenasy: For sure, for sure.

Cori Cross, MD: Wonderful. So I just wanted to talk a
little bit about the fact that Memorial Hermnan has been able to achieve this
accreditation, not just on one hospital or one facility, but in three
facilities, and that seems amazing given the number of facilities nationwide
that are actually accredited, do you know how unique it is for one healthcare
system to have three accreditations?

Dr. Joseph Cali: I think that it's extremely unique. in
fact, there are very few centers accredited here, even within the city of
Houston. So this is a really big, feather in the hat of Memorial Hermann to
have three campuses accredited with the American College of Surgeons for the
excellence of care for rectal cancer. I mean, this is tremendous for the
patients. They're getting standardized high quality care, and they're getting
opinions at these multidisciplinary meetings by multiple doctors, not just
their own doctors. So they're may be three or four oncologists that comment on
a patient.

They have radiation oncologists, pathologists, colorectal
surgeons, gastroenterologists. So this has reallyelevated the level of care at
these centers of excellence for Memorial Herman here in Houston.

Cori Cross, MD: Well, it really is impressive and you
know, as a patient that is what you want. You want a whole team looking at your
case, deciding on your care, and that's the way you usually get the best care
possible. So it sounds like that's exactly what's going on. Congratulations on
really being the gold standard, it sounds like there in Houston.

Dr. Joseph Cali: Thank you. This was a huge effort by
the doctors, the nurses, and all the administrative staff and all the people
from Memorial Hermann. It was just a huge, investment, but I think it's really
paid off because we really have robust tumor boards and, I think patients are
getting great care. Erik, wouldn't you agree with me that we're seeing patients
that have advanced disease, that are living a long time now.

Dr. Erik Askenasy: Oh, absolutely. We're seeing patients
with quite advanced disease that are having complete clinical responses and not
even requiring surgery. It's fantastic. And like JR was saying, he and I get
to, you know, do a little interviews and stuff like that, which is wonderful,
but the reality is there is an entire team of people in the background that has
made this possible. So kudos to them because this is really improving.

Dr. Joseph Cali: Correct.

Cori Cross, MD: Hats off. Dr. Cali, Dr. Askenasy, this
has been such an interesting discussion. Thank you both for taking the time out
of your busy schedules To chat with us today. To learn more about Cole Rectal
Cancer, visit Memorial Herman website at memorialhermann.org/colon. That's
Memorial Herman with two n's. That concludes this episode of Advance, the
podcast series from Memorial Hermann.

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Dr. Corey Cross.