Results of an American College of Surgeons Prospective National Quality Improvement Collaborative to Successfully Overcome Barriers to Cancer Care Across the US.

Abstract

Failure to complete cancer treatment is associated with worse oncologic outcomes. This 2-year prospective National Quality Improvement (QI) Collaborative aimed to decrease patient- and program-level rates of missed radiotherapy appointments by 20% at American College of Surgeons (ACS)-accredited cancer programs. One hundred ninety-four accredited cancer programs scheduled 99,057 patients for radiotherapy while voluntarily participating in the ACS Breaking Barriers National QI Collaborative from March 2023 to December 2024. Programs identified patients who missed 3 or more planned radiotherapy treatments, completed community needs assessments, engaged in educational webinars and peer learning discussions, and implemented system-level strategies to improve treatment adherence using an ACS toolkit. Chi-square tests assessed differences in rates of missed radiotherapy treatments, barriers addressed, and interventions implemented. Reductions of 39.8% (from 8.3% to 5.0%) and 31.7% (from 8.2% to 5.6%) were seen in no-show rates at the patient and program levels, respectively. Reductions were demonstrated for all program types, for most census regions, and for breast, gynecologic, and gastrointestinal cancers. The most frequently addressed barriers were transportation (62.3%) and patient illness unrelated to toxicity (37.1%). The most frequently implemented interventions included the development of a workflow and/or protocol related to identified barriers (68.9%) and the creation of internal resources to address these barriers (54.3%). Breaking Barriers is the largest prospective study to decrease rates of missed radiotherapy appointments across multiple program types, census regions, and disease sites. These findings demonstrate the strength of ACS-led National QI Collaborative as an effective large-scale approach to address modifiable barriers to high-quality cancer care delivery.