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Clinical Studies

Treatment interval in curative treatment of colon cancer, does it impact (cancer free) survival? A non-inferiority analysis

British Journal of Cancer volume 130, pages 251–259 (2024)Cite this article

Subjects

Abstract

Background

In treatment of colon cancer, strict waiting-time targets are enforced, leaving professionals no room to lengthen treatment intervals when advisable, for instance to optimise a patient’s health status by means of prehabilitation. Good quality studies supporting these targets are lacking. With this study we aim to establish whether a prolonged treatment interval is associated with a clinically relevant deterioration in overall and cancer free survival.

Methods

This retrospective multicenter non-inferiority study includes all consecutive patients who underwent elective oncological resection of a biopsy-proven primary non-metastatic colon carcinoma between 2010 and 2016 in six hospitals in the Southern Netherlands. Treatment interval was defined as time between diagnosis and surgical treatment. Cut-off points for treatment interval were ≤35 days and ≤49 days.

Findings

3376 patients were included. Cancer recurred in 505 patients (15.0%) For cancer free survival, a treatment interval >35 days and >49 days was non-inferior to a treatment interval ≤35 days. Results for overall survival were inconclusive, but no association was found.

Conclusion

For cancer free survival, a prolonged treatment interval, even over 49 days, is non-inferior to the currently set waiting-time target of ≤35 days. Therefore, the waiting-time targets set as fundamental objective in current treatment guidelines should become directional instead of strict targets

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Fig. 1
Fig. 2: Forest plots showing multivariate Hazard Ratio and error bars representing the 95% confidence interval for a longer treatment interval tested to a standard Hazard Ratio of 1 and the Non-Inferiority Margin.

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Data availability

Data and material cannot be shared publicly because of ethical concerns. Patients were included on a no objection base to conduct retrospective data studies and publish findings, but were not asked for permission to publish full encrypted data. Data are available from the VieCuri Institutional Data Access (contact via wetenschapsbureau@viecuri.nl) for researchers who meet the criteria for access to confidential data.

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Acknowledgements

This study was financed by the Research fund VieCuri Medical Centre. The authors thank the registration team of the Netherlands Comprehensive Cancer Organisation (IKNL) for the collection of data for the Netherlands Cancer Registry. The results of this study were presented at ESSO 41 on the 19th October 2022 in Bordeaux, France.

Author information

Authors and Affiliations

  1. Department of Surgery, VieCuri Medical Centre, Venlo, The Netherlands

    Maud T. A. Strous & F. Jeroen Vogelaar

  2. Department of Epidemiology, GROW School for Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands

    Maud T. A. Strous, Ruud F. W. Franssen, Jarno Melenhorst, Maryska L. G. Janssen-Heijnen & F. Jeroen Vogelaar

  3. Department of Surgery, Maxima Medical Centre, Veldhoven, The Netherlands

    Charlotte J. L. Molenaar & Gerrit D. Slooter

  4. Department of Epidemiology, VieCuri Medical Centre, Venlo, the Netherlands

    Frits van Osch & Maryska L. G. Janssen-Heijnen

  5. Department of Surgery, Zuyderland Hospital, Heerlen, The Netherlands

    Eric Belgers

  6. Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands

    Johanne G. Bloemen

  7. Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands

    Jarno Melenhorst

  8. Department of Surgery, Laurentius Hospital, Roermond, The Netherlands

    Jeroen Heemskerk

  9. Department of Pathology, VieCuri Medical Centre, Venlo, The Netherlands

    Adriaan P. de Bruïne

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  1. Maud T. A. Strous
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Contributions

Guarantor of the integrity of the study: MS. Conceptualisation: MS, RF, CM, MJ, and FV. Literature research: MS, RF, and CM. Methodology: MS, FO, MJ, and FV. Formal analysis: MS and FO. Investigation: MS, RF, and CM. Recourses: EB, JB, GS, JM, JH, and FV. Data curation, analysis and interpretation: MS and FO. Manuscript preparation: MS, RF, and CM. Manuscript editing and review: FO, EB, JB, GS, JM, JH, AB, MJ, and FV. Visualisation: MS and RF. Project administration: MS. Funding acquisition: MS, AB, MJ, and FV.

Corresponding author

Correspondence to Maud T. A. Strous.

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Competing interests

The authors declare no competing interest.

Ethics approval and consent to participate

This study was approved by the research committee and the Board of Directors of all six participating hospitals. Data were obtained under the Dutch law ‘scientific research and statistics in the interest of public health, where asking for permission is not possible or inappropriate for several reasons’, unless patients had objected to the general use of their personal medical record for scientific research. Data were encrypted with an encryption key provided by the NCR. Encryption was shortly lifted to access the patients’ number for accessing his/her medical record. A waiver of informed consent was given by the METC Zuyderland under the reference number METCZ20200069.

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Strous, M.T.A., Molenaar, C.J.L., Franssen, R.F.W. et al. Treatment interval in curative treatment of colon cancer, does it impact (cancer free) survival? A non-inferiority analysis. Br J Cancer 130, 251–259 (2024). https://doi.org/10.1038/s41416-023-02505-6

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