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Mroczkowski P, Atay S, Viebahn R. Assessing neoadjuvant therapy recommendations in 19 national and international guidelines for rectal cancer. Tech Coloproctol 2024; 28:94. [PMID: 39102159 DOI: 10.1007/s10151-024-02969-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 06/22/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Treatment guidelines belong to the most authoritative sources of evidence-based medicine and are widely implemented by health-care providers. Rectal cancer with an annual incidence of over 730,000 new cases and nearly 340,000 deaths worldwide, remains a significant therapeutic challenge. The total mesorectal excision (TME) leads to a dramatic improvement of local control. The addition of neoadjuvant treatment has been proposed to offer further advancement. However, this addition results in significant functional impairment and a decline in the quality of life. METHODS This review critically assesses whether the recommendation for neoadjuvant treatment in current international guidelines is substantiated. A comprehensive search was conducted in July 2022 in PubMed resulting in 988 papers published in English between 2012 and 2022. After exclusions and proofs 19 documents remained for further analysis. RESULTS Of the 19 guidelines considered in this review, 11 do not recommend upfront surgery, and 12 do not address the issue of functional impairment following multimodal treatment. The recommendation for neoadjuvant therapy relies on outdated references, lacking differentiated strategies based on current utilisation of MRI staging; numerous guidelines recommend neoadjuvant treatment also to subgroups of patients, who may not need this therapy. Also statements regarding conflicts of interest are often not presented. CONCLUSIONS An immediate and imperative step is warranted to align the recommendations with the latest available evidence, thereby affording rectal cancer patients a commensurate standard of care. A meticulous assessment of the guideline formulation process has the potential to avert heterogeneity in the future.
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Affiliation(s)
- Pawel Mroczkowski
- Department for Surgery, Ruhr-University-Bochum, Knappschafts-University-Hospital, In der Schornau 23-25, 44892, Bochum, Germany.
- Institute for Quality Assurance in Surgical Medicine Ltd., Otto-von-Guericke-University, Magdeburg, Germany.
- Department for General and Colorectal Surgery, Medical University Lodz, Lodz, Poland.
| | - Selim Atay
- Department for Surgery, Ruhr-University-Bochum, Knappschafts-University-Hospital, In der Schornau 23-25, 44892, Bochum, Germany
| | - Richard Viebahn
- Department for Surgery, Ruhr-University-Bochum, Knappschafts-University-Hospital, In der Schornau 23-25, 44892, Bochum, Germany
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Maes-Carballo M, Gómez-Fandiño Y, García-García M, Martín-Díaz M, De-Dios-de-Santiago D, Khan KS, Bueno-Cavanillas A. Colorectal cancer treatment guidelines and shared decision making quality and reporting assessment: Systematic review. PATIENT EDUCATION AND COUNSELING 2023; 115:107856. [PMID: 37451055 DOI: 10.1016/j.pec.2023.107856] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 06/07/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Physicians must share decisions and choose personalised treatments regarding patients´ beliefs and values. OBJECTIVE To analyse the quality of the recommendations about shared decision making (SDM) in colorectal (CRC) and anal cancer treatment clinical practice guidelines (CPGs) and consensus statements (CSs). METHODS Guidelines were systematically reviewed following prospective registration (Prospero: CRD42021286146) without language restrictions searching 15 databases and 59 professional society websites from January 2010 to November 2021. A validated 31-item SDM quality assessment tool was employed to extract data in duplicate. RESULTS We identified 134 guidelines. Only 46/134 (34.3 %) mentioned SDM. Fifteen (11.1 %) made clear, precise and actionable recommendations, while 9/134 (6.7 %) indicated the strength of the SDM-related recommendations. CPGs underpinned by systematic reviews reported SDM more often than those based on consensus or reviews (35.9 % vs 32.0 %; p = 0.031). Guidelines that reported following quality tools (i.e., AGREE II) more commonly commented about SDM than when it was not reported (75.0 % vs 32.0 %; p = 0.003). CONCLUSION AND PRACTICE IMPLICATIONS Most of the CRC and anal treatment guidelines did not mention SDM and it was superficial. Guidelines based on systematic reviews and those using quality tools demonstrated better reporting of SDM. Recommendations about SDM in these guidelines merit urgent improvement.
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Affiliation(s)
- Marta Maes-Carballo
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain; Hospital Público de Verín, Ourense, Spain; Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain; University of Santiago de Compostela, Santiago de Compostela, Spain.
| | - Yolanda Gómez-Fandiño
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain
| | - Manuel García-García
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Ourense, Spain; University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | - Khalid Saeed Khan
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain; Instituto de Investigación Biosanitaria IBS, Granada, Spain
| | - Aurora Bueno-Cavanillas
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain; Instituto de Investigación Biosanitaria IBS, Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Boyne DJ, Ngan E, Carbonell C, Wani RJ, Cirone Morris C, Martinez DJ, Cheung WY. Real-World Study to Assess Patterns of Treatment Practices and Clinical Outcomes in Metastatic Colorectal Cancer Patients with RAS Wild-Type Left-Sided Tumours in Canada. Curr Oncol 2023; 30:8220-8232. [PMID: 37754511 PMCID: PMC10528146 DOI: 10.3390/curroncol30090596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/22/2023] [Accepted: 09/04/2023] [Indexed: 09/28/2023] Open
Abstract
Minimal Canadian data are available on the RAS testing rates, treatment patterns, and corresponding overall survival (OS) in metastatic colorectal cancer (mCRC) patients. We conducted a population-based cohort study of left-sided RAS wild-type (WT) mCRC patients diagnosed between 1 January 2014 and 31 December 2019, and who were treated with first-line (1L) chemotherapy plus the epidermal growth factor receptor inhibitor panitumumab, chemotherapy plus bevacizumab, or chemotherapy alone, in Alberta, Canada, using electronic medical records and administrative health system data. Of the 2721 patients identified with left-sided mCRC, 320 patients with RAS WT mCRC were treated with 1L systemic therapy: chemotherapy plus panitumumab (n = 64), chemotherapy plus bevacizumab (n = 52), or chemotherapy alone (n = 204). Only 65% and 39% of the 320 1L-treated patients initiated second- and third-line therapy, respectively. A total of 71% of individuals with treated left-sided mCRC underwent RAS testing. The median OS for mCRC patients with RAS WT left-sided tumours was higher for patients treated with 1L panitumumab plus chemotherapy (34.3 months; 95% CI: 23.8-39.6) than for patients who received 1L chemotherapy alone (30.0 months; 95% CI: 24.9-34.1) or 1L bevacizumab plus chemotherapy (25.6 months; 95% CI: 21.2-35.7). These findings highlight an unmet need in left-sided RAS WT mCRC, with relatively few individuals receiving a biologic agent in combination with chemotherapy in the 1L setting, a high rate of attrition between lines, and a need for increased RAS testing before treatment initiation.
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Affiliation(s)
- Devon J. Boyne
- Department of Oncology, University of Calgary, Calgary, AB T2N 4N2, Canada; (C.C.); (W.Y.C.)
| | - Elaine Ngan
- Amgen Canada Inc., Mississauga, ON L5N 0A4, Canada; (E.N.); (R.J.W.); (C.C.M.); (D.J.M.)
| | - Chantelle Carbonell
- Department of Oncology, University of Calgary, Calgary, AB T2N 4N2, Canada; (C.C.); (W.Y.C.)
| | - Rajvi J. Wani
- Amgen Canada Inc., Mississauga, ON L5N 0A4, Canada; (E.N.); (R.J.W.); (C.C.M.); (D.J.M.)
| | - Carlye Cirone Morris
- Amgen Canada Inc., Mississauga, ON L5N 0A4, Canada; (E.N.); (R.J.W.); (C.C.M.); (D.J.M.)
| | - Daniel Jun Martinez
- Amgen Canada Inc., Mississauga, ON L5N 0A4, Canada; (E.N.); (R.J.W.); (C.C.M.); (D.J.M.)
| | - Winson Y. Cheung
- Department of Oncology, University of Calgary, Calgary, AB T2N 4N2, Canada; (C.C.); (W.Y.C.)
- Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 4N1, Canada
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Samawi HH, Brezden-Masley C, Afzal AR, Cheung WY, Dolley A. Real-world use of trifluridine/tipiracil for patients with metastatic colorectal cancer in Canada. ACTA ACUST UNITED AC 2019; 26:319-329. [PMID: 31708650 DOI: 10.3747/co.26.5107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Outcomes for patients with metastatic colorectal cancer (mcrc) are improving with the introduction of new treatments. Treatment for patients who are still fit after failure of all available therapies represents a significant unmet need. In the present study, we analyzed real-world treatment patterns for patients enrolled in Health Canada's trifluridine/tipiracil (ftd/tpi) Special Access Program (sap) and Taiho Pharma Canada's Patient Support Program (psp). Methods Demographic information and clinical treatment data were collected from adults with mcrc who were previously treated with, or were not candidates for, available therapies and who were enrolled in the sap and psp. For all patients, ftd/tpi treatment status, discontinuation reasons, and prior therapies were examined. Results The analysis included 717 Canadian patients enrolled in the ftd/tpi sap and psp from September 2017 to October 2018. In that cohort, 59.7% were men, median age was 65 years, and median duration of therapy was 77 days (25%-75% interquartile range: 43-106 days). Of treated patients, 67.1% maintained the same dose for the duration of therapy; 28.0% had a dose reduction.On multivariable analysis, duration of therapy was not influenced by sex, age, province, RAS mutation status, or prior therapies. However, prior oxaliplatin-based chemotherapy (capox or folfox) appeared to be associated with higher rates of discontinuation because of death or disease progression. Conclusions In advanced mcrc, ftd/tpi is a well-tolerated therapy. The large number of patients enrolled in the access programs within a short period of time is reflective of major clinical need in this area, with many patients being eligible and interested in pursuing treatment in the refractory setting.
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Affiliation(s)
- H H Samawi
- Section of Hematology/Oncology, St. Michael's Hospital, Toronto, ON
| | - C Brezden-Masley
- Section of Hematology/Oncology, St. Michael's Hospital, Toronto, ON
| | - A R Afzal
- Section of Medical Oncology, Tom Baker Cancer Centre, Calgary, AB
| | - W Y Cheung
- Section of Medical Oncology, Tom Baker Cancer Centre, Calgary, AB
| | - A Dolley
- Taiho Pharma Canada, Inc., Toronto, ON
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Liu Q, Tan YQ. Advances in Identification of Susceptibility Gene Defects of Hereditary Colorectal Cancer. J Cancer 2019; 10:643-653. [PMID: 30719162 PMCID: PMC6360424 DOI: 10.7150/jca.28542] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 12/08/2018] [Indexed: 12/17/2022] Open
Abstract
Colorectal cancer (CRC) is a common malignant tumor of the digestive system worldwide, associated with hereditary genetic features. CRC with a Mendelian genetic predisposition accounts for approximately 5-10% of total CRC cases, mainly caused by a single germline mutation of a CRC susceptibility gene. The main subtypes of hereditary CRC are hereditary non-polyposis colorectal cancer (HNPCC) and familial adenomatous polyposis (FAP). With the rapid development of genetic testing methods, especially next-generation sequencing technology, multiple genes have now been confirmed to be pathogenic, including DNA repair or DNA mismatch repair genes such as APC, MLH1, and MSH2. Since familial CRC patients have poor clinical outcomes, timely clinical diagnosis and mutation screening of susceptibility genes will aid clinicians in establishing appropriate risk assessment and treatment interventions at a personal level. Here, we systematically summarize the susceptibility genes identified to date and the potential pathogenic mechanism of HNPCC and FAP development. Moreover, clinical recommendations for susceptibility gene screening, diagnosis, and treatment of HNPCC and FAP are discussed.
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Affiliation(s)
- Qiang Liu
- Hunan Key Laboratory of Translational Radiation Oncology, Hunan cancer Hospital and The Affiliated Cancer of Xiangya School of Medicine, Central South University, Changsha, China.,Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, China.,Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China
| | - Yue-Qiu Tan
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, China.,Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China
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