Surgical Treatment Delay May Not Result in Worse Outcomes in Patients With Colon Cancer
A “reasonable” delay prior to surgery for colon cancer may not result in worse outcomes, according to the results of a retrospective study presented by Amri et al in the Annals of Surgical Oncology. Flexibility in scheduling surgery may lead to an improvement in the quality and safety of resection and treatment.
For some time, surgical oncologists have supported the concept that any treatment delay between cancer diagnosis and surgery may lead to diminished outcomes. Some studies have shown that treatment delays may increase the risk of metastasis and decrease the number of treatment possibilities. Detrimental effects due to treatment delays have been associated with cancers of the prostate, rectum, lungs, and pancreas. However, other studies have shown no such detrimental effects in cancers of the stomach and bronchus. As for the significance of treatment delays in patients with colon cancer, the findings of clinical trials have been mixed.
Thus, Amri and colleagues at Massachusetts General Hospital and Harvard Medical School, Boston, undertook a study to determine what effect, if any, delays between diagnosis and surgery had in patients with colon cancer. They also examined whether there was a difference in outcomes between patients in the general population and those in the high-risk population.
Study Details and Results
The investigators analyzed the medical records of 741 patients who underwent surgery for colonic adenocarcinoma at Massachusetts General Hospital. Patient outcomes included overall survival, duration of survival, local and distant tumor recurrence rates, and duration of the disease-free interval.
Treatment delay was divided over four quartiles. The median treatment delays for each quartile were 8, 19, 29, and 55 days, respectively, for quartiles 1 through 4. For every treatment-delay quartile increase, the odds of death and metastatic tumor recurrence decreased by an odds ratio of 0.78 (P = .001). A shorter survival duration was linked to a hazard ratio of 0.81 (P = .001), and a shorter disease-free survival was associated with a hazard ratio of 0.72 (P < .001). Similar patterns were seen in high-risk patient subsets, including those with stage III disease, ethnic minorities, patients with positive margins, and patients with extramural vascular invasion.
As for the results based upon patient outcomes, over a median follow-up of 142 weeks, the median survival was 189 weeks, and the median disease-free survival was 103 weeks.
Inverse Relationship Between Treatment Delay and Death/Recurrence Rates
An inverse relationship was found between treatment delay and death and recurrence rates. A longer treatment delay was associated with lower death and tumor recurrence rates. This was also true of patients considered to be at high risk. However, patients who were treated more quickly after diagnosis had poorer outcomes.
Due to the discovery of this inverse relationship, the investigators suggested that a reasonable delay between diagnosis and subsequent surgery may not be detrimental to patient outcomes. This finding may be a point for consideration by surgical oncologists in scheduling certain patients with colon cancer for surgery.
Clinical Implications
It can be inferred from the results of this study that treatment delay may enable surgical oncologists to have more flexibility in scheduling surgeries. This flexibility may allow additional time to complete appropriate preoperative evaluation and staging. The investigators also noted that the flexibility in scheduling may lead to improvement of the quality and safety of resection and treatment.
The investigators remarked, “The unexpected association of better survival with longer treatment delay should not be viewed as an encouragement to make treatment delays longer, nor does it mean that waiting longer to be treated is necessarily useful to achieve better outcomes. However, it is additional evidence to demonstrate to clinicians and their patients that what is considered a reasonable delay between diagnosis and treatment in current practice does not appear to put patients at any significantly increased risk of worse outcomes.”
David L. Berger, MD, of the Division of General Surgery and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, is the corresponding author of the article in the Annals of Surgical Oncology.The authors reported no potential conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
