Dissemination and implementation of a network-based facilitation strategy to improve quality and comprehensiveness of cancer care for rural patients

The National Cancer Institute awarded The University of Iowa a cooperative agreement worth $668,189 on September 1, 2026, to disseminate and implement a network-based facilitation strategy that improves quality and comprehensiveness of cancer care for rural patients. The award funds the Cancer Affiliated Networks Achieve Standards of Quality (CANASQ) approach, a team-based external facilitation model that enhances rural hospital capabilities to meet Commission on Cancer accreditation standards. The strategy addresses barriers to guideline-concordant care in rural settings by positioning large cancer centers as hubs providing resources, data infrastructure support, and technical assistance to affiliate rural community hospitals. The work builds on successful adaptation of an existing Kentucky network model to create the Iowa Cancer Affiliation Network (I-CAN), which demonstrated improved delivery of guideline-concordant cancer care and development of comprehensive services including psychosocial and palliative care. The cooperative agreement is issued under the Cancer Cause and Prevention Research program (CFDA 93.393) and supports dissemination activities following the R01 research phase that developed and validated the intervention. Performance occurs in Iowa City, Iowa, with a period of performance from September 1, 2026, through August 31, 2028.

Abstract

Rural cancer patients experience worse cancer survival outcomes than urban patients despite similar incidence rates, due in part to significant barriers to accessing high-quality comprehensive care. Rural hospitals struggle to offer guideline-concordant cancer care because of financial constraints, administrative burden, staffing shortages, and physician recruitment and retention. One strategy to address this is through a network, whereby a large cancer center serves as a hub for rural community hospitals and extends its resources to support them. In our current R01 study, we successfully adapted an existing network model in kentucky shown to improve delivery of guideline-concordant care to create the iowa cancer affiliation network (i-can) with rural hospitals in iowa. Both networks use the commission on cancer (COC) accreditation program as a framework to enhance cancer care in its affiliate hospitals by providing support for achieving accreditation. The COC program employs evidence-based standards and disease-specific performance measures to ensure the collection and monitoring of cancer care data, quality improvement, and delivery of comprehensive guideline- concordant care. We identified the core functions of kentucky's intervention and iteratively developed a team- based external facilitation strategy, cancer affiliated networks achieve standards of quality (canasq). This approach was successfully used to enhance the capabilities of i-can affiliate hospitals to meet COC standards, including developing data infrastructure and offering the full range of cancer care services from psychosocial services to palliative care. Based on our findings, the COC has developed a modified accreditation track for rural hospitals tailored to their limited resources. IT is unknown whether the rural hospitals can implement the modified accreditation standards independently. We hypothesize that external facilitation within a network will continue to be necessary to successfully implement and maintain the quality standards of the rural accreditation track because of limited capacity of under-resourced hospitals to integrate the multiple components of accreditation without support. We aim to test our hypothesis with kansas and alabama, rural states with existing cancer networks, by comparing canasq to a self-directed web-based toolkit. We will train the networks in the canasq strategy and recruit 6 rural affiliate hospitals from each network to participate in a pragmatic trial. Hospitals will be randomized to the canasq strategy VS. Use of our self-directed web-based toolkit. We will compare progress towards achieving the COC standards of care and improvement in quality measures between arms, and assess the feasibility, fidelity, acceptability, and sustainability of each strategy. This work will fill in gaps in implementation research by increasing our understanding of the effectiveness of external facilitation in rural settings. Widespread dissemination of the canasq strategy to other states could result in reduced disparities in rural cancer outcomes and improved care.