Conflicting Guidelines: A Systematic Review on the Proper Interval for Colorectal Cancer Treatment

Abstract

Background Timely treatment for colorectal cancer (CRC) is a quality indicator in oncological care. However, patients with CRC might benefit more from preoperative optimization rather than rapid treatment initiation. The objectives of this study are (1) to determine the definition of the CRC treatment interval, (2) to study international recommendations regarding this interval and (3) to study whether length of the interval is associated with outcome. Methods We performed a systematic search of the literature in June 2020 through MEDLINE, EMBASE and Cochrane databases, complemented with a web search and a survey among colorectal surgeons worldwide. Full‐text papers including subjects with CRC and a description of the treatment interval were included. Results Definition of the treatment interval varies widely in published studies, especially due to different starting points of the interval. Date of diagnosis is often used as start of the interval, determined with date of pathological confirmation. The end of the interval is rather consistently determined with date of initiation of any primary treatment. Recommendations on the timeline of the treatment interval range between and within countries from two weeks between decision to treat and surgery, to treatment within seven weeks after pathological diagnosis. Finally, there is no decisive evidence that a longer treatment interval is associated with worse outcome. Conclusions The interval from diagnosis to treatment for CRC treatment could be used for prehabilitation to benefit patient recovery. It may be that this strategy is more beneficial than urgently proceeding with treatment.

Feasibility of a tele-prehabilitation program in high-risk patients with colon or rectal cancer undergoing elective surgery: a feasibility study

“…Efforts should be made to use the available time as efficiently as possible, for example by starting screening, assessment, and prehabilitation directly after colorectal cancer diagnosis by endoscopy. Nevertheless, although essential for effective prehabilitation, these strict time constraints are not strongly supported by evidence (Franssen et al 2021a ; Strous et al 2019 ; Molenaar et al 2021 ) and not specific towards tele-prehabilitation, but involve a broader problem that is generally seen in prehabilitation studies (Boereboom et al 2019 ). Another limitation that was observed in the current study was that in 3 participants (27%) heart rate could not be used as an indicator of exercise intensity due to chronotropic incompetence.…”

Feasibility and Efficiency of the BEFORE (Better Exercise and Food, Better Recovery) Prehabilitation Program

“…The Dutch guidelines state that treatment of colorectal cancer has to be effected within 7 weeks after diagnosis [ 45 ], generally surgery is performed within 5 weeks following diagnosis [ 46 ]. The oncological outcome does not improve when colorectal patients are operated within these 5 weeks [ 47 ]. In this study, all patients were operated within this time window, some were operated before the end of the prehabilitation program.…”

Can we really conclude that treatment delays are associated with poorer outcome in patients with colorectal cancer awaiting elective surgery?

“…Although the end of the TD is generally clearly defined, the time point used as diagnosis, which is mostly taken as the starting point of TD, is defined less consistently. Definitions of diagnosis can vary from first investigation for defining malignancy to diagnosis confirmed by a multidisciplinary team meeting [2]. From experience in our own hospital, these time‐points can be as far as 7–14 days apart.…”