Cornelis J H van de Velde1, Petra G Boelens2, Josep M Borras3, Jan-Willem Coebergh4, Andres Cervantes5, Lennart Blomqvist6, Regina G H Beets-Tan7, Colette B M van den Broek2, Gina Brown8, Eric Van Cutsem9, Eloy Espin10, Karin Haustermans11, Bengt Glimelius12, Lene H Iversen13, J Han van Krieken14, Corrie A M Marijnen15, Geoffrey Henning16, Jola Gore-Booth16, Elisa Meldolesi17, Pawel Mroczkowski18, Iris Nagtegaal14, Peter Naredi19, Hector Ortiz20, Lars Påhlman21, Philip Quirke22, Claus Rödel23, Arnaud Roth24, Harm Rutten25, Hans J Schmoll26, Jason J Smith27, Pieter J Tanis28, Claire Taylor29, Arne Wibe30, Theo Wiggers31, Maria A Gambacorta17, Cynthia Aristei32, Vincenzo Valentini33. 1. EURECCA and CC3, European Cancer Organization, European Society of Surgical Oncology, Department of Surgery, Leiden University Medical Center, The Netherlands. Electronic address: c.j.h.van_de_velde@lumc.nl. 2. CC3, EURECCA, Department of Surgery, Leiden University Medical Center, The Netherlands. 3. European Cancer Organization/EPAAC Catalonian Cancer Strategy Unit, Department of Health, and IDIBELL, University of Barcelona, Spain. 4. Epidemiology, Erasmus MC Rotterdam, and Research Department, Comprehensive Cancer Centre South, Eindhoven, The Netherlands. 5. Executive Board European Society Medical Oncology, Institute of Health Research INCLIVA, University of Valencia, Spain. 6. European Society Radiology, Department of Diagnostic Radiology, Karolinska University Hospital and Danderyds Hospital, Stockholm, Sweden. 7. European Society Radiology, Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands. 8. European Society Radiology, Department of Radiology, The Royal Marsden NHS Foundation Trust, Fulham Road, London, UK. 9. European Society Medical Oncology, EuropaColon, Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium. 10. Colorectal Surgery Unit, Hospital Valle de Hebron, Autonomous University of Barcelona, Barcelona, Spain. 11. ESTRO, EORTC, Department of Radiation Oncology, University Hospitals Leuven Campus Gasthuisberg, Leuven, Belgium. 12. ESTRO, Department of Radiology, Oncology and Radiation Sciences, Uppsala University, Uppsala, Sweden. 13. Aarhus University Hospital, Department of Surgery, Aarhus, Denmark. 14. European Society Pathology, Department of Pathology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. 15. ESTRO, Department of Clinical Oncology, Leiden University Medical center, The Netherlands. 16. EUROPAColon, Unit 5, Deans Farm, Stratford sub Castle, Salisbury SP1 3YP, UK. 17. Cattedra di Radioterapia, Università Cattolica S. Cuore, Rome, Italy. 18. ESCP, Department of General, Visceral and Vascular Surgery, Otto-von-Guericke University of Magdeburg, Germany. 19. European Society of Surgical Oncology, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden. 20. Spanish Society of Surgeons, ESCP, Department of Surgery, Public University of Navarra, Spain. 21. European Society of Surgical Oncology, ESCP, Department of Surgery, Uppsala University Hospital, Uppsala, Sweden. 22. European Society Pathology, Yorkshire Cancer Research Centenary Pathology and Tumour Biology, Leeds Institute of Cancer studies and Pathology, Leeds University, Leeds, UK. 23. ESTRO Radiation Oncologist, University Hospital of Frankfurt, Frankfurt, Germany. 24. European Society of Surgical Oncology, Oncosurgery Unit, HUG, Geneva, Switzerland. 25. European Society of Surgical Oncology, Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands. 26. European Society Medical Oncology, Department of Oncology/Haematology, Martin Luther University Halle, Germany. 27. European Society of Surgical Oncology, Department of Colorectal Surgery, West Middlesex University Hospital, Isleworth, UK. 28. ESSO, Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. 29. EONS St. Mark's Hospital, Harrow, Middlesex, UK. 30. European Society of Surgical Oncology, ESCP, Department of Surgery, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway. 31. European Society of Surgical Oncology, Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 32. CC3, Radiation Oncology Section,Department of Surgery, Radiology and Dentistry, University of Perugia, Italy. 33. CC3, ESTRO, Professor Cattedra di Radioterapia, Università Cattolica S. Cuore, Rome, Italy.
Abstract
BACKGROUND: Care for patients with colon and rectal cancer has improved in the last 20years; however considerable variation still exists in cancer management and outcome between European countries. Large variation is also apparent between national guidelines and patterns of cancer care in Europe. Therefore, EURECCA, which is the acronym of European Registration of Cancer Care, is aiming at defining core treatment strategies and developing a European audit structure in order to improve the quality of care for all patients with colon and rectal cancer. In December 2012, the first multidisciplinary consensus conference about cancer of the colon and rectum was held. The expert panel consisted of representatives of European scientific organisations involved in cancer care of patients with colon and rectal cancer and representatives of national colorectal registries. METHODS: The expert panel had delegates of the European Society of Surgical Oncology (ESSO), European Society for Radiotherapy & Oncology (ESTRO), European Society of Pathology (ESP), European Society for Medical Oncology (ESMO), European Society of Radiology (ESR), European Society of Coloproctology (ESCP), European CanCer Organisation (ECCO), European Oncology Nursing Society (EONS) and the European Colorectal Cancer Patient Organisation (EuropaColon), as well as delegates from national registries or audits. Consensus was achieved using the Delphi method. For the Delphi process, multidisciplinary experts were invited to comment and vote three web-based online voting rounds and to lecture on the subjects during the meeting (13th-15th December 2012). The sentences in the consensus document were available during the meeting and a televoting round during the conference by all participants was performed. This manuscript covers all sentences of the consensus document with the result of the voting. The consensus document represents sections on diagnostics, pathology, surgery, medical oncology, radiotherapy, and follow-up where applicable for treatment of colon cancer, rectal cancer and metastatic colorectal disease separately. Moreover, evidence based algorithms for diagnostics and treatment were composed which were also submitted to the Delphi process. RESULTS: The total number of the voted sentences was 465. All chapters were voted on by at least 75% of the experts. Of the 465 sentences, 84% achieved large consensus, 6% achieved moderate consensus, and 7% resulted in minimum consensus. Only 3% was disagreed by more than 50% of the members. CONCLUSIONS: Multidisciplinary consensus on key diagnostic and treatment issues for colon and rectal cancer management using the Delphi method was successful. This consensus document embodies the expertise of professionals from all disciplines involved in the care for patients with colon and rectal cancer. Diagnostic and treatment algorithms were developed to implement the current evidence and to define core treatment guidance for multidisciplinary team management of colon and rectal cancer throughout Europe.
BACKGROUND: Care for patients with colon and rectal cancer has improved in the last 20years; however considerable variation still exists in cancer management and outcome between European countries. Large variation is also apparent between national guidelines and patterns of cancer care in Europe. Therefore, EURECCA, which is the acronym of European Registration of Cancer Care, is aiming at defining core treatment strategies and developing a European audit structure in order to improve the quality of care for all patients with colon and rectal cancer. In December 2012, the first multidisciplinary consensus conference about cancer of the colon and rectum was held. The expert panel consisted of representatives of European scientific organisations involved in cancer care of patients with colon and rectal cancer and representatives of national colorectal registries. METHODS: The expert panel had delegates of the European Society of Surgical Oncology (ESSO), European Society for Radiotherapy & Oncology (ESTRO), European Society of Pathology (ESP), European Society for Medical Oncology (ESMO), European Society of Radiology (ESR), European Society of Coloproctology (ESCP), European CanCer Organisation (ECCO), European Oncology Nursing Society (EONS) and the European Colorectal CancerPatient Organisation (EuropaColon), as well as delegates from national registries or audits. Consensus was achieved using the Delphi method. For the Delphi process, multidisciplinary experts were invited to comment and vote three web-based online voting rounds and to lecture on the subjects during the meeting (13th-15th December 2012). The sentences in the consensus document were available during the meeting and a televoting round during the conference by all participants was performed. This manuscript covers all sentences of the consensus document with the result of the voting. The consensus document represents sections on diagnostics, pathology, surgery, medical oncology, radiotherapy, and follow-up where applicable for treatment of colon cancer, rectal cancer and metastatic colorectal disease separately. Moreover, evidence based algorithms for diagnostics and treatment were composed which were also submitted to the Delphi process. RESULTS: The total number of the voted sentences was 465. All chapters were voted on by at least 75% of the experts. Of the 465 sentences, 84% achieved large consensus, 6% achieved moderate consensus, and 7% resulted in minimum consensus. Only 3% was disagreed by more than 50% of the members. CONCLUSIONS: Multidisciplinary consensus on key diagnostic and treatment issues for colon and rectal cancer management using the Delphi method was successful. This consensus document embodies the expertise of professionals from all disciplines involved in the care for patients with colon and rectal cancer. Diagnostic and treatment algorithms were developed to implement the current evidence and to define core treatment guidance for multidisciplinary team management of colon and rectal cancer throughout Europe.
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