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Surgery After Colon Cancer Diagnosis: Are Delays Safe?

Do a few weeks delay in surgery really impact outcomes for patients with colon cancer?
BY Kristie L. Kahl
PUBLISHED November 29, 2017
Most patients hear of their cancer diagnosis, and would never think to delay treatment. However, what if other factors came into effect? And better yet, what if a few weeks made no difference in the grand scheme of things?

According to researchers from the London Health Sciences Center in Ontario, Canada, patients with colon cancer who are recommended to undergo surgical resection may safely postpone treatment for a short duration of time.

“Our study suggests that patients should not be concerned about having worse treatment outcomes compared to others who had surgery quicker,” co-author of the study Kerollos Nashat Wanis, M.D., from the department of surgery at Western University, said in an interview with CURE.

It is believed that expediting surgical resection following a patient’s colon cancer diagnosis will minimize their risk for disease progression that could hypothetically occur prior to treatment, and, in turn, improve long-term outcomes.

“A diagnosis of colon cancer may cause significant anxiety for many patients,” said Wanis. “There is a perception that removing the tumor as quickly as possible will improve the odds of curing the cancer.”

However, evidence regarding this theory appear limited and vary in quality and outcome. In addition, there are a variety of patient-, provider- and system-related factors that may contribute to the need for longer waits for surgery. Of note, Wanis said some patients might benefit from additional testing and preparation before their surgery, while other patients might prefer a delayed surgery in order to attend to important events such work or family conflicts.

“Delays might also result from conflicts in hospital resources, because operating room time is a shared public resource,” he added. “Ultimately, we believe that a better understanding of how long surgery can be safely prolonged will allow physicians to better counsel patients, and hospitals to allocate surgical resources appropriately.”

Wanis and colleagues prospectively collected clinical and administrative data from 908 patients with stage 1 to stage 3 colon cancer who underwent elective surgery from 2006 to 2015. They aimed to determine the impact of a prolonged wait time on disease-free and overall survival.

In this study, published in Disease of the Colon & Rectum, patients treated within one month of diagnosis had a median wait time of 18 days, whereas patients treated after one month waited a median of 55 days for surgery.

Patients who underwent tumor resection within four weeks showed no advantage in long-term disease-free or overall survival compared with those whose surgery was deferred longer than four weeks. These results were even consistent among patients who underwent surgical resection after a four-month delay.

Even after adjusting for several known confounders – such as tumor grade and stage, age and use of adjuvant chemotherapy - treatment delay had no significant impact on survival among patients.

Wanis acknowledged patients may still experience greater anxiety about their treatment, regardless of these findings. Therefore, he recommends patients receive adequate information regarding the reasons for, and safety of, any treatment delays.

“While our study found that surgical delays of a few weeks are safe, patients with colon cancer should continue to receive prompt and efficient care,” said Wanis. “Colon cancer is becoming increasingly common. If discovered at an early stage, it can be cured with surgical removal of the tumor.”
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