Current practice in preoperative therapy and surgical management of locally advanced rectal cancer: a bi‐national survey¹

Abstract

Evidence-based international guidelines for the management of rectal cancer have changed little in the last 10 years. Despite this, there is a clear gap between these and clinical practice. The main variance relates to the role of radiotherapy in locally advanced rectal cancer. Despite considerable evidence that radiotherapy reduces local recurrence for all stages of rectal cancer, current practice in Australasia is for its selective use.

Treatment patterns among colorectal cancer patients in South Australia: a demonstration of the utility of population‐based data linkage

“…Suboptimal provision of chemotherapy for patients with locally advanced colon cancers has been reported in numerous other studies in various settings including Canada [10,11,16], USA [12,35,36], France [37], and the Netherlands [14], as well as Australia [20]. Likewise, several studies from USA [38], Canada [13], Ireland [39], Spain [40] and Australia [41] have highlighted inadequate provision of radiotherapy for high-risk rectal cancers despite evidence-based guidelines indicating benefits. Lack of referral to an oncologist was identified as a major barrier to receiving adjuvant chemotherapy [10,13].…”

Use of guideline‐recommended adjuvant therapies and survival outcomes for people with colorectal cancer at tertiary referral hospitals in South Australia

“…Combined modality treatment for rectal cancer increases both acute and late morbidity, and tri‐modal treatment is often difficult for patients to endure. Various chemoradiotherapy regimes have been the standard of care for rectal cancer since the 1990s, and lower concordance is not surprising given conflicting information from trials and the large volumes of evidence that need to be incorporated into decision making . Furthermore, many guideline recommendations for patients with high‐risk stage B/C rectal cancers are to generally treat them alike.…”

“…The classification and treatment of upper rectal and rectosigmoid cancers as a colon or rectal cancer can also affect interpretation of need for adjuvant therapy as was evident in our study with only 16% of these cancers receiving radiotherapy. In the 2010 national survey of Australasian colorectal surgeons, 53% of surgeons reported that they would not offer preoperative therapy for high‐risk upper rectal cancer . It was noted in the survey that treatment differences in Australasia may reflect varying radiological expertise in staging, patient preferences, access to resources, and oncology unit practices .…”

“…In the 2010 national survey of Australasian colorectal surgeons, 53% of surgeons reported that they would not offer preoperative therapy for high‐risk upper rectal cancer . It was noted in the survey that treatment differences in Australasia may reflect varying radiological expertise in staging, patient preferences, access to resources, and oncology unit practices . A study in New South Wales elected not to include rectosigmoid cancers when assessing receipt of adjuvant care due to controversies as to how they should be treated …”

Evidence‐based routine use vs selective use of neoadjuvant therapy in practice: toward personalized management of advanced rectal cancer

“…In 2010, 108 colorectal surgeons from Australia and New Zealand were surveyed on the preoperative management of patients with rectal cancer [1]. The authors concluded that despite the evidence, uptake in clinical practice is slow and that current practice in Australasia favours selective use of neoadjuvant therapy.…”