The importance of time in colorectal cancer treatment

Abstract

Aim To investigate aspects of time in colorectal cancer treatment and explore a method for predicting response to neoadjuvant treatment. Methods Paper I analyzed the association between age and time to diagnosis of colorectal cancer. Paper II investigated if a longer time interval from diagnosis to treatment was associated with survival. Paper III explored if quantification of the immune response predicted tumor response to neoadjuvant treatment. Paper IV reported short-term outcomes at six months in patients managed with a watch and wait strategy for rectal cancer. Results Younger age was significantly associated with a longer waiting time before seeking medical care for symptoms of colorectal cancer. Survival was not worse if waiting 1-2 months from diagnosis to treatment, compared to <1 month. The immune response showed some associations with response to neoadjuvant treatment, but not sufficiently to provide clinical usefulness. Out of 211 patients, local regrowth was detected in 33 (16%) and distant metastases in 3 (1.4%). Resection surgery for regrowth was performed in 32 out of 33 patients. Conclusions Younger age was associated with increased patient´s delay. A waiting time of up to two months between diagnosis and treatment appeared safe for colon cancer. Short term outcomes indicated that most patients could be salvaged by surgery if regrowth occurred during follow up in a watch and wait program for rectal cancer.