Do delays in chemotherapy affect long-term outcomes for rectal cancer patients?

This study evaluated the impact of delayed chemotherapy on long-term outcomes in rectal cancer patients.

Treatment for rectal cancer patients often involves neoadjuvant chemoradiation therapy (chemotherapy and radiation therapy given before surgery). Patients can also receive chemotherapy after surgery to reduce the risk of the cancer returning. Complications after surgery may delay chemotherapy, which could increase the risk of the cancer returning and reduce patient survival time. 

The authors examined medical records from 183 rectal cancer patients who were prescribed chemotherapy after rectal surgery. Of the 183 patients, the timing of treatment was recorded for 165 patients. 66.6% of these patients received chemotherapy within 8 weeks of surgery and 33.3% received it more than 8 weeks after surgery (delayed). Patient survival and time till cancer returned was analyzed for all patients.

31% of the patients had complications after surgery. The most common complication was infection at the site of surgery, which occurred in 52-54% of patients. A higher rate of patients whose chemotherapy was delayed had surgical complications, 44% compared to 25% who began chemotherapy on time. More patients whose chemotherapy was delayed had been readmitted to hospital after surgery, 20% compared to 5% who began chemotherapy on time.

Patients whose chemotherapy was delayed had worse long-term outcomes than patients who received it within 8 weeks. Cancer returned near to the original site (local recurrence) after an average of 142.1 months for patients whose chemotherapy was delayed, compared to 195.8 months for patients who received it on time. Patients who received chemotherapy within 8 weeks also had better overall survival. The odds of survival were 3.1 times higher for patients who received chemotherapy within 8 weeks.

The authors concluded that complications and hospital readmission were risk factors for delayed chemotherapy. Patients who waited more than 8 weeks for chemotherapy had worse long-term outcomes.