Journal article
Results of an American College of Surgeons Prospective National Quality Improvement Collaborative to Successfully Overcome Barriers to Cancer Care Across the US
Journal of the American College of Surgeons, Vol.242(1), pp.247-256
01/2026
DOI: 10.1097/XCS.0000000000001637
PMID: 41217348
Abstract
Failure to complete cancer treatment is associated with worse oncologic outcomes. This two-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.
194 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 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-squared 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%). Interventions most frequently implemented included development of a workflow and/or protocol related to identified barriers (68.9%) and creation of internal resources to address 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 collaboratives as an effective large-scale approach to address modifiable barriers to high-quality cancer care delivery.
Details
- Title: Subtitle
- Results of an American College of Surgeons Prospective National Quality Improvement Collaborative to Successfully Overcome Barriers to Cancer Care Across the US
- Creators
- Kelley Chan - Loyola University ChicagoEileen Reilly - American College of SurgeonsLauren M Janczewski - Northwestern UniversitySharon Gentry - The NavigatorCamille Biggins - Franciscan HealthBruce Haffty - Rutgers, The State University of New JerseyCharles Shelton - The Outer Banks HospitalAnthony D Yang - Indiana University – Purdue University IndianapolisRonald J Weigel - University of IowaLaurie J Kirstein - American College of Surgeons
- Resource Type
- Journal article
- Publication Details
- Journal of the American College of Surgeons, Vol.242(1), pp.247-256
- DOI
- 10.1097/XCS.0000000000001637
- PMID
- 41217348
- NLM abbreviation
- J Am Coll Surg
- ISSN
- 1072-7515
- eISSN
- 1879-1190
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- Language
- English
- Electronic publication date
- 11/11/2025
- Date published
- 01/2026
- Academic Unit
- Molecular Physiology and Biophysics; Anatomy and Cell Biology; Surgery; Biochemistry and Molecular Biology
- Record Identifier
- 9985027460202771
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