Background

Neo-adjuvant LCCRT is a standard treatment for stage 2 and 3 rectal cancer. To what extent delays in commencing treatment influences outcome is unknown. However such delays may exacerbate patient anxiety and prolong symptoms, which often significantly impacts quality of life. Currently the only identifiable guidelines are the National Health Service general cancer treatment targets of 2 months from urgent referral or 31 days from seeing a specialist. We assessed how long nonmetastatic rectal cancer patients at our institution waited to commence chemoradiotherapy.

Methods

Patients treated concurrently with 5-fluorouracil and radiation from January 2011 to December 2013 at the Royal Brisbane and Women’s Hospital were identified. Dates were retrospectively collected for multi-disciplinary team (MDT) discussion, or first radiation oncology outpatient appointment (if no MDT prior to treatment), and the start of radiation and chemotherapy.

Results

A total of 113 patients were treated during this period, of whom 25 were not discussed at MDT (18 were discussed after commencement) and 11 ultimately didn’t undergo surgery (metastases, comorbidities, patient choice). The median time from MDT discussion to start of chemoradiation was 32 days (95% CI 29-34)(range 1-69). 6 patients were found to have a reason for a longer than expected delay (co-morbid complications, floods, and patient uncertainty).

Conclusion

Currently there are no national benchmarks as to recommended time to start neo-adjuvant treatment. Development of such recommendations may assist with audit and comparison of the quality of care provided across institutions. High demand on finite services and planning requirements likely contribute to the waiting time. There is increasing interest in, and data supporting, induction chemotherapy which may be one method of shortening this time interval.