McKechnie Tyler, Ricci Alessandro, Brennan Kelly, Wiseman Vanessa, Shi Victoria, Bondzi-Simpson Adom, Knight Katrina, Kong Weidong, Farooq Ameer, Patel Sunil V
Department of Surgery, Division of General Surgery, McMaster University, Hamilton, Ontario, Canada.
Department of Surgery, Division of General Surgery, Queen's University, Kingston, Ontario, Canada.
J Surg Oncol. 2025 Jul;132(1):135-145. doi: 10.1002/jso.28163. Epub 2025 May 23.
Locally advanced rectal cancer is often treated with multimodal therapy. Patients may receive care at a single institution or across multiple institutions. We designed this population-level retrospective cohort to determine the association between fragmented care and timeliness of treatment and long-term oncologic outcomes.
Patients with stage II/III rectal cancer who received at least two treatment modalities between 2010 and 2019 in Ontario, Canada were included. Fragmented care was defined as receiving at least one treatment modality at two or more institutions, while nonfragmented care was defined as receiving all treatments at a single institution. The primary outcome was timeliness of treatment as defined by Cancer Care Ontario Recommendations. Secondary outcomes included overall survival (OS).
Overall, 3381 patients received fragmented care and 2026 patients received nonfragmented care. Patients receiving nonfragmented care were more likely to undergo timely initiation of treatment (OR: 1.72, 95% CI: 1.50-1.97, p < 0.0001). This was driven by timely initiation of chemotherapy (OR: 1.32, 95% CI: 1.16-1.49, p < 0.0001). There was little to no difference in OS (HR: 1.11, 95% CI: 0.95-1.30, p = 0.19).
Patients with stage II/III rectal cancer receiving multimodal therapy may experience less timely initiation of treatment if their cancer care is fragmented. This did not translate into differences in long-term oncologic outcomes.
局部晚期直肠癌通常采用多模式治疗。患者可能在单一机构接受治疗，也可能在多个机构接受治疗。我们设计了这项基于人群的回顾性队列研究，以确定分散治疗与治疗及时性及长期肿瘤学结局之间的关联。
纳入2010年至2019年在加拿大安大略省接受至少两种治疗方式的II/III期直肠癌患者。分散治疗定义为在两个或更多机构接受至少一种治疗方式，而非分散治疗定义为在单一机构接受所有治疗。主要结局是安大略癌症护理建议所定义的治疗及时性。次要结局包括总生存期（OS）。
总体而言，3381例患者接受了分散治疗，2026例患者接受了非分散治疗。接受非分散治疗的患者更有可能及时开始治疗（比值比：1.72，95%置信区间：1.50 - 1.97，p < 0.0001）。这是由化疗的及时开始所驱动的（比值比：1.32，95%置信区间：1.16 - 1.49，p < 0.0001）。总生存期几乎没有差异（风险比：1.十一，95%置信区间：0.95 - 1.30，p = 0.19）。
接受多模式治疗的II/III期直肠癌患者，如果其癌症护理分散，可能会经历治疗开始不那么及时的情况。但这并未转化为长期肿瘤学结局的差异。
