Clinical pathway for rectal cancer
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. ...
