A multidisciplinary care pathway for colorectal carcinoma: Impact on treatment decisions

Colorectal carcinoma predominantly affects older adults (defined as ≥75 years). A proportion of these patients are frail and have multimorbidity, reflecting multidimensional vulnerability related to comorbidities and functional status. These factors complicate treatment decisions, especially regarding surgical interventions and systemic therapies. In response, a multidisciplinary clinical care pathway was established at Catharina Hospital in 2021 to facilitate individualized treatment management for older and frail patients with colorectal cancer. This pathway was led by physicians from multiple medical specialties, including surgery, medical oncology, radiation oncology, and geriatrics, and incorporated a comprehensive geriatric assessment. This study aimed to assess how the multidisciplinary care pathway influences treatment decisions in older and frail patients with colorectal cancer.

In this retrospective cohort study, patients evaluated through the multidisciplinary care pathway between October 2021 and March 2025 were compared with a propensity score-matched control group treated prior to its implementation, between December 2018 and September 2021. The primary outcome was the deviation between the standard treatment protocol and the actual treatment received by the patient. Secondary outcomes were treatment-related complications, hospitalizations, overall survival, and local disease control.

Treatment deviation occurred more frequently in the care pathway group (51.4%) compared to the pre-care pathway group (31.1%; p = 0.01). Reasons for deviation from standard treatment included patient vulnerability and patient treatment preferences. Patients managed through the care pathway experienced fewer treatment related surgical complications (25.7% vs. 46.2%; p = 0.002) and lower hospital admission rates (49.1% vs. 72.4%; p = 0.002). In both cohorts, an American Society of Anesthesiologists Physical Status Classification ≥3 (p = 0.02 in the pre-care and p < 0.001 in the care pathway cohort) and dependent mobility (p = 0.004 and p < 0.001, respectively) predicted deviation from standard treatment. Additionally, within the care pathway cohort, Clinical Frailty Scale score ≥ 5 (p = 0.03), impaired instrumental activities of daily living (p = 0.02), Katz Index of Independence in Activities of Daily Living >1 (p = 0.01), and competing mortality risk (pl ≤0.001) were also significantly associated with treatment deviations.

Implementation of a multidisciplinary care pathway for older and frail patients with colorectal cancer led to more individualized treatment decisions, reduced treatment-related complications, and reduced hospital stays. Future research is needed to optimize patient selection for this multidisciplinary care pathway.