Three Memorial Hermann Facilities Earn NAPRC Rectal Accreditation

Dr. Cori Cross, MD (Host): Advancing health, personalizing care. At Memorial Hermann, this is our mission. This podcast shares the science and stories behind those efforts. Welcome, I'm Dr. Cori 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 UTHealthHouston, affiliated with Memorial Hermann Memorial City Medical Center. Dr. Askenasy is also an associate professor of surgery at McGovern Medical School at UTHealth Houston, and affiliated with Memorial Hermann Southeast. Dr. Cali, Dr. Askenasy, thank you for joining us.

Dr. Askenasy: Great to be here.

Dr. Cali: Thank you for having us.

Host: So, Dr. Cali, let's start with you. What does NAPRC stand for and what is 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, 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 boards, all determined by the American College of Surgeons.

Host: 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. Askenasy: The Commission 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 on 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 Cancer accredited program.

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

Dr. Askenasy: Exactly.

Host: 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. 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 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.

Host: 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. 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 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 going to go and do my thing, and okay, then I'm going to 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.

Host: 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. 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.

Host: 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. Askenasy: For sure, for sure.

Host: 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 health care system to have three accreditations?

Dr. 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 there may be three or four oncologists that comment on a patient.

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

Host: 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. 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. 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 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. Cali: Correct.

Host: 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 colorectal cancer, visit the Memorial Hermann website at memorialhermann.org/colon. That's Memorial Hermann with two N's. That concludes this episode of Advance, the podcast series from Memorial Hermann.

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