Colorectal cancer is the third most frequent cancer for men and second most frequent for
women in Switzerland (1). Rectal cancer requires a multidisciplinary treatment involving many
specialists such as surgeons, oncologists, gastroenterologists, radio-oncologists, pathologists
and general practitioners (GP). Their cooperation is crucial and has a great impact on the
patient’s clinical pathway and its outcomes.
But what does « clinical pathway » mean? It means all the different appointments, examinations
and treatments a patient suffering from rectal cancer will face during his journey and follow-up.
Indeed, a person suffering of rectal cancer will see different physicians and und will undergo
many different examinations and treatments. Initially, most patients consult their GPs with
symptoms and then will be referred to a specialist for diagnosis and treatment. The GP’s role is
very important as they refer the patient to the specialist and initiate medical care. For example,
in Israel, it has been described (2-3) that 52% of the patients had a diagnosis delay of up to 6
weeks or more. The responsibility for these delays could be attributed to a practitioners-related
component in 47% and for 54% to a patient-component such as lack of education. However,
administrative factors have been responsible for 26% of delay involving more than one
speciality/person in 27%.
With this GPs-component, the UK (4) government had introduced since 2000 a two-weeks rule
for colonic and rectal cancer. This rule says that all the patients with a suspected rectal or
colonic cancer have to be referred to a specialist within two weeks in order to get their
colonoscopy and diagnosis. Indeed, prospective studies (4) have demonstrated that this 2
weeks rule allowed patients to reduce the wait to see a specialist but unfortunately didn’t affect
the overall wait to treatment start or staging of the disease. The delay between the diagnosis
and treatment was still cited as a significant problem in the medical care of the patients.
Nevertheless, this 2 weeks rule didn’t show any impact on survival as it only refers to a small
proportion of the patient’s pathway. For these reasons, the entire pathway from symptoms to
diagnosis and to treatment has to be carefully assessed.
Jensen et al. from Denmark (5) observed in a study in 2014 on colorectal cancers that
implementing a « cancer patient pathway », in accordance with the national guidelines, could
significantly decrease the time delays from referral to endoscopy and oncological treatment
and also increased 60-month overall survival. This study proved that improvement of the
clinical pathway can affect survival.
The aim of the herein presented study were to evaluate the pathways of patients with rectal
cancer treated at the University Hospital Lausanne (CHUV), to identify points of improvement
and to define a multidisciplinary clinical pathway to optimize and standardize medical care.
Where can the medical care be more efficient? What can be improved?