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Journal of Clinical Oncology : Official... Jan 2023To develop recommendations for treatment of patients with metastatic colorectal cancer (mCRC).
PURPOSE
To develop recommendations for treatment of patients with metastatic colorectal cancer (mCRC).
METHODS
ASCO convened an Expert Panel to conduct a systematic review of relevant studies and develop recommendations for clinical practice.
RESULTS
Five systematic reviews and 10 randomized controlled trials met the systematic review inclusion criteria.
RECOMMENDATIONS
Doublet chemotherapy should be offered, or triplet therapy may be offered to patients with previously untreated, initially unresectable mCRC, on the basis of included studies of chemotherapy in combination with anti-vascular endothelial growth factor antibodies. In the first-line setting, pembrolizumab is recommended for patients with mCRC and microsatellite instability-high or deficient mismatch repair tumors; chemotherapy and anti-epidermal growth factor receptor therapy is recommended for microsatellite stable or proficient mismatch repair left-sided treatment-naive wild-type mCRC; chemotherapy and anti-vascular endothelial growth factor therapy is recommended for microsatellite stable or proficient mismatch repair wild-type right-sided mCRC. Encorafenib plus cetuximab is recommended for patients with previously treated V600E-mutant mCRC that has progressed after at least one previous line of therapy. Cytoreductive surgery plus systemic chemotherapy may be recommended for selected patients with colorectal peritoneal metastases; however, the addition of hyperthermic intraperitoneal chemotherapy is not recommended. Stereotactic body radiation therapy may be recommended following systemic therapy for patients with oligometastases of the liver who are not considered candidates for resection. Selective internal radiation therapy is not routinely recommended for patients with unilobar or bilobar metastases of the liver. Perioperative chemotherapy or surgery alone should be offered to patients with mCRC who are candidates for potentially curative resection of liver metastases. Multidisciplinary team management and shared decision making are recommended. Qualifying statements with further details related to implementation of guideline recommendations are also included.Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines.
Topics: Humans; Antineoplastic Combined Chemotherapy Protocols; Cetuximab; Colonic Neoplasms; Colorectal Neoplasms; Endothelial Growth Factors; Rectal Neoplasms; Practice Guidelines as Topic
PubMed: 36252154
DOI: 10.1200/JCO.22.01690 -
Current Oncology (Toronto, Ont.) Nov 2022Research suggests that colorectal cancer (CRC) is associated with mental health disorders, primarily anxiety and depression. To synthesize this evidence, we conducted a... (Meta-Analysis)
Meta-Analysis Review
Research suggests that colorectal cancer (CRC) is associated with mental health disorders, primarily anxiety and depression. To synthesize this evidence, we conducted a systematic review and meta-analysis of studies evaluating the onset of anxiety and depression among patients with CRC. We searched EMBASE and Medline from inception to June 2022. We included original, peer-reviewed studies that: used an epidemiologic design; included patients with CRC and a comparator group of individuals without cancer; and evaluated anxiety and depression as outcomes. We used random effects models to obtain pooled measures of associations. Quality assessment was completed using the Newcastle-Ottawa scale. Of 7326 articles identified, 8 were eligible; of which 6 assessed anxiety and depression and 2 assessed depression only. Meta-analyses showed a non-significant association between CRC and anxiety (pooled HR 1.67; 95% CI 0.88 to 3.17) and a significant association between CRC and depression (pooled HR 1.78; 95% CI 1.23 to 2.57). Predictors of anxiety and depression among patients with CRC included clinical characteristics (e.g., comorbidities, cancer stage, cancer site), cancer treatment (e.g., radiotherapy, chemotherapy, colostomy), and sociodemographic characteristics (e.g., age, sex). The impacts of anxiety and depression in patients with CRC included increased mortality and decreased quality of life. Altogether, our systematic review and meta-analysis quantified the risks and impacts of CRC on anxiety and depression, particularly an increased risk of depression after CRC diagnosis. Findings provide support for oncologic care that encompasses mental health supports for patients with CRC.
Topics: Humans; Depression; Quality of Life; Anxiety; Comorbidity; Colorectal Neoplasms
PubMed: 36421342
DOI: 10.3390/curroncol29110689 -
European Journal of Oncology Nursing :... Feb 2022To explore resilience and its related factors in adult colorectal cancer patients. (Review)
Review
PURPOSE
To explore resilience and its related factors in adult colorectal cancer patients.
METHODS
Three databases (CINAHL, Scopus and PubMed) were searched for literature published from January 2009 to February 2021 using the terms colorectal and resilience or resilient or resiliency. The review was registered with PROSPERO and followed the PRISMA statement guidelines.
RESULTS
The studies (n = 11) showed that most colorectal cancer patients exhibit moderate levels of resilience. Resilience was identified as a mediator in the positive or negative aspects of illness, while three studies investigated resilience as an outcome variable. Resilience was associated with social support, mental and physical burden, post-traumatic growth, hope, and quality of life. The studies showed that resilience might not be an immutable situation; social support seemed to provide patients the tools necessary for managing their illness, as well as helped them confront future events. The interventions designed to help with self-care issues and coping strategies eased a patient's mental and physical burden, and improved resilience.
CONCLUSIONS
Resilience among colorectal cancer patients was connected to both negative and positive aspects of the illness. Psychosocial and illness-related practical support might be key for strengthening resilience in these patients. However, longitudinal and intervention studies are required to confirm these indications. Research should study resilience as an outcome variable and provide information related to resilience at different phases of cancer, and what type of support is offered by professionals.
Topics: Adaptation, Psychological; Adult; Colorectal Neoplasms; Humans; Posttraumatic Growth, Psychological; Quality of Life; Resilience, Psychological; Social Support
PubMed: 34844135
DOI: 10.1016/j.ejon.2021.102079 -
BMJ (Clinical Research Ed.) Nov 2011To investigate the association between intake of dietary fibre and whole grains and risk of colorectal cancer. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To investigate the association between intake of dietary fibre and whole grains and risk of colorectal cancer.
DESIGN
Systematic review and meta-analysis of prospective observational studies.
DATA SOURCES
PubMed and several other databases up to December 2010 and the reference lists of studies included in the analysis as well as those listed in published meta-analyses.
STUDY SELECTION
Prospective cohort and nested case-control studies of dietary fibre or whole grain intake and incidence of colorectal cancer.
RESULTS
25 prospective studies were included in the analysis. The summary relative risk of developing colorectal cancer for 10 g daily of total dietary fibre (16 studies) was 0.90 (95% confidence interval 0.86 to 0.94, I(2) = 0%), for fruit fibre (n = 9) was 0.93 (0.82 to 1.05, I(2) = 23%), for vegetable fibre (n = 9) was 0.98 (0.91 to 1.06, I(2) = 0%), for legume fibre (n = 4) was 0.62 (0.27 to 1.42, I(2) = 58%), and for cereal fibre (n = 8) was 0.90 (0.83 to 0.97, I(2) = 0%). The summary relative risk for an increment of three servings daily of whole grains (n = 6) was 0.83 (0.78 to 0.89, I(2) = 18%).
CONCLUSION
A high intake of dietary fibre, in particular cereal fibre and whole grains, was associated with a reduced risk of colorectal cancer. Further studies should report more detailed results, including those for subtypes of fibre and be stratified by other risk factors to rule out residual confounding. Further assessment of the impact of measurement errors on the risk estimates is also warranted.
Topics: Case-Control Studies; Colorectal Neoplasms; Dietary Fiber; Edible Grain; Feeding Behavior; Humans; Incidence; Prospective Studies; Risk Factors
PubMed: 22074852
DOI: 10.1136/bmj.d6617 -
The International Journal of Behavioral... Sep 2020This meta-analysis evaluated the safety, feasibility and effect of exercise among individuals with colorectal cancer. (Meta-Analysis)
Meta-Analysis
BACKGROUND
This meta-analysis evaluated the safety, feasibility and effect of exercise among individuals with colorectal cancer.
METHODS
A database search (CINAHL, Ebscohost, MEDLINE, Pubmed, ProQuest Health and Medical Complete, ProQuest Nursing, Science Direct) for randomised, controlled, exercise trials involving individuals with colorectal cancer, published before January 1, 2020 was undertaken. Safety (adverse events), feasibility (withdrawal and adherence rates) and effect data (health outcomes including quality of life, QoL) were abstracted. Risk difference (RD) and standardised mean differences (SMD) were calculated to compare safety and effects between exercise and usual care (UC). Subgroup analyses were conducted to assess whether outcomes differed by exercise mode, duration, supervision and treatment. Risk of bias was assessed using the Physiotherapy Evidence Database tool.
RESULTS
For the 19 trials included, there was no difference in adverse event risk between exercise and UC (RD = 0.00; 95% CI:-0.01, 0.01, p = 0.92). Median withdrawal rate was 12% (0-22%) and adherence was 86% (42-91%). Significant effects of exercise compared to UC were observed for QoL, fatigue, aerobic fitness, upper-body strength, depression, sleep and reduced body fat (SMD = 0.21-0.66, p < 0.05). Subgroup analyses suggested larger benefits (p < 0.05) for QoL and fatigue for supervised interventions; for QoL, aerobic fitness and reduced body fat for ≥12-week interventions; and for aerobic fitness when interventions were during chemotherapy.
CONCLUSION
Although reporting of safety and compliance data was lacking in most trials, findings support that exercise is safe and feasible in colorectal cancer. Further, participation in mixed-mode exercise, including unsupervised exercise, leads to improvements in various health-related outcomes.
Topics: Aged; Colorectal Neoplasms; Exercise Therapy; Female; Humans; Male; Middle Aged; Outcome Assessment, Health Care; Patient Safety; Quality of Life; Treatment Adherence and Compliance
PubMed: 32972439
DOI: 10.1186/s12966-020-01021-7 -
Gastroenterology Apr 2021Patients with inflammatory bowel disease (IBD) have an increased risk of colorectal cancer (CRC). We performed a systematic review and meta-analysis to identify all... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND AIMS
Patients with inflammatory bowel disease (IBD) have an increased risk of colorectal cancer (CRC). We performed a systematic review and meta-analysis to identify all prognostic factors for advanced colorectal neoplasia (aCRN, high-grade dysplasia, or CRC) in patients with IBD.
METHODS
A systematic literature search was conducted according to the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. Risk of bias was assessed using the Quality in Prognostic Studies tool. Random-effects models were created separately for odds and hazard ratios, different study designs, and univariable or multivariable data. The evidence for all prognostic factors was categorized as "weak", "moderate", or "strong", based on estimate of effect sizes, heterogeneity, and risk of bias.
RESULTS
A total of 164 studies were included, allowing pooled analysis of 31 potential prognostic factors. In the univariable analysis, the evidence for extensive disease was classified as strong while evidence for low-grade dysplasia, strictures, primary sclerosing cholangitis, post-inflammatory polyps, family history of CRC, and ulcerative colitis versus Crohn's disease was considered moderate. Evidence for any dysplasia, colon segment resection, aneuploidy, male sex, and age was classified as weak. In addition, histologic inflammation was identified as a risk factor in multivariable analysis (weak evidence). The evidence for the protective factors colonoscopic surveillance, 5-Aminosalicylic Acid, thiopurines, and smoking was moderate in univariable analysis. Multivariable analysis provided weak evidence for statin use.
CONCLUSIONS
In this systematic review and meta-analysis, we identified 13 risk factors and 5 protective factors for aCRN in IBD patients, based on univariable and/or multivariable pooled analyses. These findings might lay the groundwork for an improved CRC risk stratification-based surveillance in IBD.
Topics: Colitis, Ulcerative; Colitis-Associated Neoplasms; Colorectal Neoplasms; Crohn Disease; Humans; Neoplasm Grading; Prognosis; Protective Factors; Risk Assessment; Risk Factors
PubMed: 33385426
DOI: 10.1053/j.gastro.2020.12.036 -
BMC Cancer Sep 2021Artificial intelligence (AI) is increasingly being used in medical imaging analysis. We aimed to evaluate the diagnostic accuracy of AI models used for detection of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Artificial intelligence (AI) is increasingly being used in medical imaging analysis. We aimed to evaluate the diagnostic accuracy of AI models used for detection of lymph node metastasis on pre-operative staging imaging for colorectal cancer.
METHODS
A systematic review was conducted according to PRISMA guidelines using a literature search of PubMed (MEDLINE), EMBASE, IEEE Xplore and the Cochrane Library for studies published from January 2010 to October 2020. Studies reporting on the accuracy of radiomics models and/or deep learning for the detection of lymph node metastasis in colorectal cancer by CT/MRI were included. Conference abstracts and studies reporting accuracy of image segmentation rather than nodal classification were excluded. The quality of the studies was assessed using a modified questionnaire of the QUADAS-2 criteria. Characteristics and diagnostic measures from each study were extracted. Pooling of area under the receiver operating characteristic curve (AUROC) was calculated in a meta-analysis.
RESULTS
Seventeen eligible studies were identified for inclusion in the systematic review, of which 12 used radiomics models and five used deep learning models. High risk of bias was found in two studies and there was significant heterogeneity among radiomics papers (73.0%). In rectal cancer, there was a per-patient AUROC of 0.808 (0.739-0.876) and 0.917 (0.882-0.952) for radiomics and deep learning models, respectively. Both models performed better than the radiologists who had an AUROC of 0.688 (0.603 to 0.772). Similarly in colorectal cancer, radiomics models with a per-patient AUROC of 0.727 (0.633-0.821) outperformed the radiologist who had an AUROC of 0.676 (0.627-0.725).
CONCLUSION
AI models have the potential to predict lymph node metastasis more accurately in rectal and colorectal cancer, however, radiomics studies are heterogeneous and deep learning studies are scarce.
TRIAL REGISTRATION
PROSPERO CRD42020218004 .
Topics: Artificial Intelligence; Bias; Colorectal Neoplasms; Deep Learning; Humans; Lymph Nodes; Lymphatic Metastasis; Magnetic Resonance Imaging; Preoperative Care; Publication Bias; ROC Curve; Radiologists; Rectal Neoplasms; Sensitivity and Specificity; Tomography, X-Ray Computed
PubMed: 34565338
DOI: 10.1186/s12885-021-08773-w -
International Journal of Surgery... Mar 2017Prehabilitation programs aim to optimise patients in order to enhance post-operative recovery. This study aims to review the composition of prehabilitation programs for... (Review)
Review
INTRODUCTION
Prehabilitation programs aim to optimise patients in order to enhance post-operative recovery. This study aims to review the composition of prehabilitation programs for patients undergoing major abdominal cancer surgery and define the outcome measures that are used to evaluate this intervention.
METHODS
A systematic literature review of all comparative studies on prehabilitation versus standard care in patients undergoing abdominal cancer surgery was performed in accordance with PRISMA guidelines. Literature search was performed using Medline, OVID, EMBASE, Google Scholar, and Cochrane databases. Outcomes of interest included prehabilitation program composition (exercise, nutritional, and psychological interventions), duration, mode of delivery, and outcome measures used to determine impact of prehabilitation versus standard care.
RESULTS
9 studies (7 randomised controlled and 2 prospective non-randomised trials) comprising of 549 patients (281 prehabilitation versus 268 standard care) were included in this review. 5 studies reported patients undergoing surgery for colorectal cancer, 2 for bladder tumours, 1 for liver resections, and 1 involving unspecified abdominal oncological operations. The 6 min walk test (6MWT) was used in 4 studies to measure functional capacity with a threshold of >20 m improvement at 4-8 weeks post-operatively deemed significant (distance range from 278 to 560 m). Changes in anaerobic threshold and VO with prehabilitation were evaluated in 5 studies (ml/kg/min). Health-related quality of life was evaluated using SF-36 system, anxiety assessed using hospital anxiety and depression score (HADS). Post-operative complications were classified according to the Clavien-Dindo classification with no significant difference between prehabilitation and standard care groups.
CONCLUSION
Prehabilitation programs in patients undergoing abdominal cancer surgery remain heterogeneous in their composition, mode of administration, outcome measures of functional capacity that are used to evaluate their impact. All these aspects require standardisation prior to the evaluation of prehabilitation on a larger scale.
Topics: Abdominal Neoplasms; Colorectal Neoplasms; Exercise; Humans; Outcome Assessment, Health Care; Postoperative Complications; Postoperative Period; Preoperative Care; Prospective Studies; Quality of Life; Recovery of Function
PubMed: 28161527
DOI: 10.1016/j.ijsu.2017.01.111 -
Journal of the National Cancer Institute Apr 2022KRAS and BRAF mutations are well-established predictive and prognostic factors in metastatic colorectal cancer; however, their impact in the adjuvant setting has not yet... (Meta-Analysis)
Meta-Analysis
BACKGROUND
KRAS and BRAF mutations are well-established predictive and prognostic factors in metastatic colorectal cancer; however, their impact in the adjuvant setting has not yet been established.
METHODS
We performed a meta-analysis of adjuvant phase III trials in patients with stage II and III colon cancer with available data on the impact of KRAS or BRAF mutations on both disease-free survival (DFS) and overall survival (OS). Trials were subgrouped based on whether adjustment for microsatellite instability (MSI) was performed and the subgroup effect was analyzed through a meta-regression. To increase the precision of the estimates, a joint DFS-OS (so-called "multivariate") meta-analysis was performed. All statistical tests were 2-sided.
RESULTS
Nine trials were selected (QUASAR 2, PETACC-8, N0147, CALGB-89803, NSABP-C07, NSABP-C08, PETACC-3, QUASAR, MOSAIC) including a total of 10 893 patients. In the primary meta-analysis, KRAS mutation was associated with poor DFS (pooled hazard ratio [HR] = 1.36, 95% confidence interval [CI] = 1.15 to 1.61, P < .001) and OS (pooled HR = 1.27, 95% CI = 1.03 to 1.55, P = .03) and BRAF mutation was also associated with poor DFS (pooled HR = 1.33, 95% CI = 1.00 to 1.78, P = .05) and OS (pooled HR = 1.49, 95% CI = 1.31 to 1.70, P < .001). The effect of the mutations on outcome was enhanced in the MSI-adjusted subgroup for both the KRAS mutation (pooled HR for DFS = 1.43, 95% CI = 1.15 to 1.79, P = .001; and pooled HR for OS = 1.33, 95% CI = 1.03 to 1.71, P = .03) and the BRAF mutation (pooled HR for DFS = 1.59, 95% CI = 1.22 to 2.07, P = .001; and pooled HR for OS = 1.67, 95% CI = 1.37 to 2.04, P < .001). The interaction between BRAF and MSI adjustment was statistically significant for DFS (Pinteraction = .02). This interaction was even more pronounced in the DFS-OS multivariate meta-analysis.
CONCLUSIONS
Both KRAS and BRAF mutations were statistically significantly associated with both DFS and OS, with the mutation effect being enhanced by MSI adjustment. Effective adjuvant treatment for microsatellite-stable BRAF or KRAS-mutated colon cancer represents an unmet clinical need, and exploring the use of recently available BRAF and KRAS inhibitors in this setting would be highly desirable.
Topics: Colonic Neoplasms; Colorectal Neoplasms; Humans; Male; Microsatellite Instability; Mutation; Neoplasm Staging; Prognosis; Proto-Oncogene Proteins B-raf; Proto-Oncogene Proteins p21(ras); Testicular Neoplasms
PubMed: 34542636
DOI: 10.1093/jnci/djab190 -
BMC Medicine Jun 2020There is a clear need for systematic appraisal of models/factors predicting colorectal cancer (CRC) metastasis and recurrence because clinical decisions about adjuvant... (Meta-Analysis)
Meta-Analysis
Risk factors and risk prediction models for colorectal cancer metastasis and recurrence: an umbrella review of systematic reviews and meta-analyses of observational studies.
BACKGROUND
There is a clear need for systematic appraisal of models/factors predicting colorectal cancer (CRC) metastasis and recurrence because clinical decisions about adjuvant treatment are taken on the basis of such variables.
METHODS
We conducted an umbrella review of all systematic reviews of observational studies (with/without meta-analysis) that evaluated risk factors of CRC metastasis and recurrence. We also generated an updated synthesis of risk prediction models for CRC metastasis and recurrence. We cross-assessed individual risk factors and risk prediction models.
RESULTS
Thirty-four risk factors for CRC metastasis and 17 for recurrence were investigated. Twelve of 34 and 4/17 risk factors with p < 0.05 were estimated to change the odds of the outcome at least 3-fold. Only one risk factor (vascular invasion for lymph node metastasis [LNM] in pT1 CRC) presented convincing evidence. We identified 24 CRC risk prediction models. Across 12 metastasis models, six out of 27 unique predictors were assessed in the umbrella review and four of them changed the odds of the outcome at least 3-fold. Across 12 recurrence models, five out of 25 unique predictors were assessed in the umbrella review and only one changed the odds of the outcome at least 3-fold.
CONCLUSIONS
This study provides an in-depth evaluation and cross-assessment of 51 risk factors and 24 prediction models. Our findings suggest that a minority of influential risk factors are employed in prediction models, which indicates the need for a more rigorous and systematic model construction process following evidence-based methods.
Topics: Colorectal Neoplasms; Female; Humans; Male; Neoplasm Metastasis; Neoplasm Recurrence, Local; Prognosis; Risk Factors
PubMed: 32586325
DOI: 10.1186/s12916-020-01618-6