Intro: Welcome to UAB MedCast, a continuing education podcast for medical professionals, providing knowledge that is moving medicine forward. Here's Melanie Cole.

Melanie Cole, MS (Host): Welcome to UAB Med Cast. I'm Melanie Cole. And we're here today to explore what it means to have NAPRC accreditation from the National Accreditation Program for rectal cancer. Joining me is Dr. Robert Hollis, he's a colorectal surgeon, the lead of the Colorectal Management Team, and an Assistant Professor at the O'Neill Cancer Center; and Ridley Brown, she's a nurse navigator and the NAPRC coordinator, and they're both at UAB Medicine.

Thank you so much for joining us today, Dr. Hollis. You were recently accredited by the National Accreditation Program for Rectal Cancer after two years of work to meet those standards in auditing. Can you please help physicians and patients understand what it means to have this very important accreditation?

Dr. Robert Hollis: Thanks, Melanie, for having us on. Colon and rectal cancer are often grouped in a word of colorectal cancer, but they're really different entities. Colon cancer, when it's not spread across the body is often addressed with surgery as a first step, but rectal cancer becomes more complex. And the confines the pelvis next to other important organs and the pelvic sidewalls and the anorectal sphincter complex, it becomes an important role of other modalities of treatment than just surgery.

Often it requires neoadjuvant therapy and locally advanced settings. And the care has become quite complex and studies really in the '90s and going into the early 2000s really started to highlight that there was a lot of variation in how rectal cancer was being treated across the U.S. and across internationally, and became this ever-pressing role for more standardization in how we treat rectal cancer. And thus, I think that's how the NAPRC Program from the American College of Surgeons originated. And the goal was that there would be specific standards by which programs would evaluate all rectal cancer patients and discuss them in a multidisciplinary fashion throughout the initial evaluation, after neoadjuvant therapy, and after surgery to ensure that certain quality standards were being met. And through that, we're starting to see some emerging data that participation in these programs can not only improve mortality, but also really enhance how our teams are caring for these patients.

Melanie Cole, MS: That's so important and interesting. So, Dr. Hollis, sticking with you for just a minute. Tell us a little bit about what this accreditation really entails.

Dr. Robert Hollis: So first of all, there is a team of members that includes not only surgeons, they're involved in rectal cancer resections, but also the GI oncologists, radiation oncologists, radiologists, and pathologists that all come together. They're named and they have certain attendance requirements and participation, but it goes beyond that. And we have on here Ridley Brown, who's our nursing navigator, who's really the magic of an NAPRC program of helping facilitate to make sure that we're meeting the standards that every patient needs are being met. And that discussions are happening in appropriate and timely fashion.

The magic of NAPRC really happens right after the diagnosis of a rectal cancer. Say, a patient has a biopsy of a tumor that's lower the rectum, say they're referred to UAB, that's when we begin by really helping with the staging process and bring in all the information so that we can have our multidisciplinary discussion. Here at UAB, we do have a multidisciplinary clinic where we can actually see patients with rectal cancer, where the surgeon-oncologist and radiation-oncologist can all see the patient in the same day.

But really, even before we see the patient in clinic, the magic is in a Zoom session where we present the case from all the information we have, we review the biopsy to make sure we agree with the diagnosis. And then, our radiologist carefully comes through the images and we look at it as a group to come up with the most appropriate treatment plan that we think we need to proceed or identify any more information we need to obtain.

Then, when we meet the patient, as a group in the clinic, we can really have a great conversation. Or if the patient's not able to come to the clinic that day, we can call them to help facilitate their care locally or such as if they want to come back for surgery or however they want to proceed.

Melanie Cole, MS: So Ridley, why don't you tell us about the program from your perspective? Tell us a little bit about what you offer at UAB, and as Dr. Hollis has mentioned, the multidisciplinary team. Why don't you expand a little bit on everybody's roles and mainly yours and how you are helping to improve patient outcomes and patient satisfaction, because the anxiety and the stress when you get that kind of diagnosis of navigating that dizzying world of a clinic? So, explain it all to us.

Ridley Brown: Yes, definitely. So in our clinic, I think we have a very special group of doctors that make up our team and we work really well together to get the best possible treatment plan together for our patients. I believe that our multidisciplinary clinic is really unique as well because we do have the opportunity to meet with patients and the clinic with coordinated visits with each of the providers, with the surgeon, the medical oncologist, and radiation oncologists. And like Dr. Hollis mentioned, we do have a Zoom meeting that we meet at prior to meeting with these patients in clinic that does have all of the members of the team, including the radiologists and pathologists on to review everything for the patient's workup.

I believe my role as the coordinator, it is to make sure that we have all the relevant information related to this patient's diagnosis, to review with our team, and then to also present to the patient a treatment plan in the clinic. And then, my role in the care is just to, like I said, gather the information, records, make sure we have all of the right staging, images, CTs, and MRIs to ensure that we have everything we need to present that patient with a cohesive and comprehensive treatment plan.

I believe that with lowering stress for patients, I actually talk with the patients in the clinic. I know what's going on from the very beginning of their diagnosis. UAB can seem like a really big cancer center, and my hope is that I provide the patients with a streamlined communication directly to me. So if they have any questions about their treatment plan or what happened during the clinic appointment, I know exactly what's going on with the patient. And I really do believe that this helps patients with their stress regarding a new diagnosis and just next steps in treatment.

Dr. Robert Hollis: I have to add on that a lot of the magic of an NAPRC program is the navigation that Ridley provides, and she is an advocate for these patients, such as if you have a referral and you need an MRI pelvis, Ridley is working through a massive complex system to make sure we get a timely MRI for these patients, ensuring that their pathology is received and appropriately analyzed. And then, after the surgeries, making sure that our pathologists are reviewing specimens in a timely fashion and that we're discussing patients and making sure we have them on the right treatment pathways, it really makes a difference for the patients.

Melanie Cole, MS: Dr. Hollis, as we're hearing about the program, the clinic, the multidisciplinary approach, and certainly Ridley's very important navigation, this is such a comprehensive approach. How does the accreditation itself improve the patient outcomes? From your point of view, what you've seen doing this for years, what have you seen as far as this accreditation, the important work that you're doing and how it really does help the patients?

Dr. Robert Hollis: Prior to accreditation, while you have all the same team members at one place, they're often not discussing each and every individual patient together, which can sometimes lead to slightly different pathways of treatment for each provider. The beauty of NAPRC is that we require a hundred percent of patients that have rectal cancer to be discussed in our meetings so that we know how patients being treated. We follow the outcomes, and it really leads to the standardization so that, as we learn new data, as new trials are coming out, that we're applying the latest knowledge and treatment pathways in a universal fashion.

Melanie Cole, MS: Ridley, why don't you tell us a little bit about some of the steps and criteria that are involved in achieving the accreditation, and how it integrates into the overall care pathway for patients with these types of cancers?

Ridley Brown: Yeah. So, NAPRC has over 20 standards, covering everything from patient care expectations, data collection, team communication, and quality improvement. Twelve of these 20 standards actually apply directly to a patient's care and treatment plan. With the patient's standards, we require pathology reviews, CT staging images, MRI pelvis images, discussion in our multidisciplinary clinic as well as getting our discussion notes to a patient's local providers, if that is their preference. It really does integrate into the clinic, because all of the information that NAPRC requires is information that our team needs to make the best treatment plan for that patient.

Melanie Cole, MS: So, it's a very well thought out accreditation?

Ridley Brown: Yes, definitely.

Dr. Robert Hollis: And these standards, which sometimes can seem onerous, when you first look at a long list of them, over time, you start to realize the benefits of them, such as small requirements for the notes that we summarize, and the requirements they have, such as for clinical trials discussed for every patient. It becomes a checklist in our mind during our discussions to make sure, yes, is this patient a candidate? Did we offer it to them? Or did we always check for mismatch repair proteins or MSI status on every tumor specimen? There's a checklist for it just keeping us accountable.

Melanie Cole, MS: Well, it does often seem with these types of accreditations, they might be arduous at the beginning, but then they really do streamline the process and put those cohesive thoughts that you doctors and navigators have all into one place. So, what about maintaining and enhancing the accreditation, Dr. Hollis, do the standards change over time? What do you see happening?

Dr. Robert Hollis: The program is growing. So, we're the second center in Alabama to offer this, and I think programs are slowly coming on board across the entire nation. And with that, the NAPRC council is updating their guidelines for 2026 with new requirements that every patient be discussed after their new adjuvant therapy and re-reviewed with new imaging. They have new standards for emerging pathways, like watch and wait, non-operative treatment for rectal cancer, and how do we have pathways in place to ensure standardization for those patients? And I think each of these things will continue to evolve as we get new evidence for these patients.

Melanie Cole, MS: I'd love to give you each a chance for a final thought here. And Ridley, I would just like you to reiterate how you facilitate the accreditation process and support patients through it as they're going through this very difficult time. Tell us about the clinic, your team, and how you have really seen patients thrive for better outcomes as a result.

Ridley Brown: Yeah. So in the clinic, I believe that, as the nurse navigator, I am able to be a resource for the patient in a huge system at UAB. They have my direct work phone number to be able to call me, ask any questions. And then, also throughout the treatment process and the completion of treatment, our providers are really good at letting me know once a patient has completed treatment. So then, I can go from there and make sure that we have all of the restaging images we need, as well as the appointment set up for the patient with the surgeon to review next steps, as well as adding them on for a discussion in our Zoom tumor board with the entire team, so that we can discuss that patient to discuss the next steps in their treatment process.

I have seen great benefit to the nurse navigator in this clinic. Patients can get very confused throughout treatment and don't really know what's going on. And when they give me a call, I am able to look them up and remember exactly what's going on with them and what needs to happen next. I think it is a great benefit to patients, because they are able to communicate with me, and it's a smooth transition throughout the treatment process.

Melanie Cole, MS: Thank you for that. And Dr. Hollis, last word to you. How do you foresee the role of NAPRC accreditation evolving in the future of cancer care? You mentioned that you'd like to see it in more institutions around the country. Speaking of your institution, what would you like to see happen? What do you see happening in the future? And what would you like other providers to take away from this podcast today?

Dr. Robert Hollis: Some of my favorite moments in our NAPRC meetings is when we're reviewing pelvic MRIs with an expert radiologist and all team members looking at it. And as surgeons, we can share what's resectable, what's not resectable? We can look at lymph nodes in their location of them and say, "That's not coming out with surgery." So when you're planning your radiation treatment, we really need to target that to hopefully have that shrink in size to decrease the complexity of a surgery in the future or moments where an oncologist shares for a frail patient about why they're not a certain candidate for a specific chemotherapy, or when they share novel opportunities for patients in the metastatic setting where there's many different variations of how we can approach patients.

I think it's those moments that improve the care for patients by sharing knowledge that we don't always see in each other's fields. So, that's really when the multidisciplinary effort really, I think, is amplified and synergizes by us all being together. So, I think as these NAPRC programs grow, yes, there will be new opportunities for us to apply, you know, trials throughout these programs. And I think we'll begin to see how the standardization really improves the quality care we provide.

Melanie Cole, MS: Thank you both so much for joining us today and for more information, you can visit our website at uabmedicine.org/physician. That concludes this episode of UAB MedCast. I'm Melanie Cole.