Newswise — Everyone diagnosed with cancer wants to be treated immediately--the sooner, the better. Is that always wise? In this era of healthcare economics, both patients and their doctors often scratch their heads at which course to take.
In the December 2017 issue of Diseases of the Colon and Rectum, Canadian researchers sought to study this question in detail with respect to colon cancer. Do treatment delays influence survival? This study has enormous implications in light of the projected surgeon shortage in the years ahead. Dr. Wanis and colleagues from Western University in London, Ontario, studied over 900 patients diagnosed with stage I – III colon cancer over a nine-year period and divided them into two groups: those who had their treatment within a month of diagnosis, and those who had their treatment more than one month after cancer diagnosis. In fact, this second group was even subdivided into those who had their treatment delayed from 30-59 days, from 60-89 days, from 90-119 days, and more than 4 months from a cancer diagnosis. Their main outcome measure was overall survival, which was defined as the time from cancer diagnosis to death. They also chose to examine how long patients remained cancer-free. Importantly, there were no significant differences between the groups with respect to types of patients (gender, age) or cancer stage or pathology characteristics. Using complex statistical techniques, the authors found no effect of treatment delay on overall survival or on patients remaining cancer free (disease-free survival), even in the 4-month delay group. In their health system, the median (most common) treatment wait time was 38 days. In the United Kingdom, there is an expectation that patients with a new cancer diagnosis be seen within 2 weeks of referral to a specialist and have treatment within 62 days of the referral. Quote from author Kerollos Wanis, M.D.: "We hope that publication of our manuscript in Diseases of the Colon & Rectum will result in discussion regarding the appropriateness of the existing recommendations regarding optimal wait time to surgery targets. We also hope that our study will assuage provider and patient anxiety regarding surgical treatment delay, particularly when additional pre-operative work-up and optimization is required."
Citation: Wanis KN, Patel SVB, Brackstone M. Title: Do Moderate Surgical Treatment Delays Influence Survival in Colon Cancer? Dis Colon Rectum 2017;60:1241-1259.
Accompanying this article is a thoughtful editorial by Brendan J. Moran, an eminent British surgeon, citing that some delays might actually be beneficial in terms of optimizing a patient’s fitness for surgery, but also emphasizing that further study is needed. Quote from author Brendan J. Moran, M.Ch., F.R.C.S.I.: "Additional work is needed, but moderate delays are unlikely to have major consequences and benefits may outweigh disadvantages for many of our patients."
Citation: Moran BJ. When treatment delay may be beneficial in patients: further investigation needed. Dis Colon Rectum 2017;60:1229-1230.
A prepublication copy is available upon request. Please email Margaret Abby, Managing Editor, Diseases of the Colon and Rectum, at [email protected]
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Diseases of the Colon and Rectum