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Fragmentation of Multimodal Rectal Cancer Care: A Population-Level Retrospective Cohort Study.

Tyler McKechnie¹, Alessandro Ricci², Kelly Brennan²

¹Department of Surgery, Division of General Surgery, McMaster University, Hamilton, Ontario, Canada.

Journal of Surgical Oncology

|May 23, 2025

Summary

Fragmented cancer care for rectal cancer patients may delay treatment initiation. However, this fragmentation did not impact long-term survival outcomes in this study.

Keywords:

colorectal surgery fragmented care multidisciplinary care multimodal therapy rectal cancer

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Area of Science:

Oncology
Health Services Research

Background:

Locally advanced rectal cancer treatment often involves multimodal therapy.
Patient care can be fragmented across multiple institutions.
Understanding the impact of care fragmentation on treatment timeliness and outcomes is crucial.

Purpose of the Study:

To determine the association between fragmented care and treatment timeliness.
To assess the impact of fragmented care on long-term oncologic outcomes in rectal cancer patients.

Main Methods:

Population-level retrospective cohort study in Ontario, Canada (2010-2019).
Included patients with stage II/III rectal cancer receiving at least two treatment modalities.
Defined fragmented care as treatment at ≥2 institutions; nonfragmented care at a single institution.

Main Results:

3381 patients had fragmented care, 2026 had nonfragmented care.
Nonfragmented care was associated with more timely treatment initiation (OR: 1.72).
No significant difference in overall survival (OS) between fragmented and nonfragmented care groups (HR: 1.11).

Conclusions:

Fragmented multimodal therapy for rectal cancer may lead to delayed treatment initiation.
Care fragmentation did not appear to affect long-term overall survival.