A new study by physician-researcher Charlotte Molenaar and oncological surgeon Gerrit Slooter of Máxima MC (MMC) shows that there are large differences per country in the waiting time for colon cancer surgery. The study concludes that there should be one international guideline for the maximum waiting time for colon cancer surgery. The time to surgery can be used to make patients fitter before surgery. This research is published in The Lancet Oncology, one of the most renowned medical journals.
Colon cancer is a common condition that is often curable with surgery. Often there have been complaints for a long time (sometimes months) before the patient is referred to the hospital. The clock for the waiting time until the operation is only ticking when a patient comes to the hospital. But what is the definition of waiting time until the operation? The end point of the waiting time is fairly easy to determine, namely the operation. The starting point is more difficult to determine: is this the referral to the hospital, the date of the bowel examination, the date on which the pathologist provides evidence that there is cancer or the date on which the specialist treatment team decided what the treatment plan will be? There can be a difference of three weeks between these points.
One international guideline
In the international literature, the starting point of the ‘waiting time’ until the operation is different. The study compared the guidelines in 30 countries, and they appear to be completely unrelated to each other. Often they are not based on scientific evidence. Nevertheless, based on this information, national guidelines are drawn up for the maximum duration until surgery. The study concluded that it is time for one uniform guideline for the waiting time until the operation, which is used worldwide. “Based on the results of the study, we propose to use the date of the pathological evidence for cancer as the starting point of the waiting time and the start of treatment as the end point in all studies and guidelines,” said Gerrit Slooter, oncology surgeon at Máxima MC.
Make good use of waiting time
The researchers also searched the literature to determine how long or short the waiting time should be in order not to run a risk with regard to survival. “In any case, a waiting period does not lead to a greater chance of metastasis, larger tumor or worse chances of survival. The Dutch guideline says that patients must have started a treatment (the Treek norm) within seven weeks, so this certainly seems justified. In practice, this is often five weeks ”, says researcher Charlotte Molenaar.
“We use this five-week period in MMC to improve a patient’s condition with prehabilitation. After all, it is more important to prepare a patient well for an operation than to operate more quickly. With the 3 to 4 week prehabilitation program, patients are made fit before their surgery. This leads to fewer complications, a shorter hospital stay, a better quality of life and savings in healthcare costs. In fact, every treatment should start with prehabilitation ”, Slooter concludes.
Research on prehabilitation
Máxima MC, with the support of the Dutch Cancer Society, is leading a large international study into the effects of prehabilitation. The research is being conducted in five countries. The program is intensive and consists of 1. training on strength and condition, 2. intake of extra proteins and vitamins, diet advice, 3. quitting smoking, 4. mental support with optimal information and 5. correction of anemia. All these factors reinforce each other to achieve better outcomes for our patients. The results of this PREHAB study are expected around the summer of 2021.
Publication The Lancet
“We are extremely proud that The Lancet Oncology gives us the opportunity to spread our message,” concludes Slooter enthusiastically. The publication ‘Contradictory guidelines for colorectal cancer treatment intervals’ was published in The Lancet Oncology in February.
Photo: Oncological surgeon Gerrit Slooter and medical researcher Charlotte Molenaar