Research Article
Volume 9 Issue 6 - 2022
Colorectal Cancer Survival at Dr. Orlando Smith Hospital, Tortola, BVI
David Nelson*
Gastroenterology Surgery, British Virgin Islands Health Services Authority
*Corresponding Author: David Nelson, Gastroenterology Surgery, British Virgin Islands Health Services Authority.
Received: November 05, 2021; Published: May 27, 2022




Abstract

Introduction: Colon cancer is the 4th leading cause of cancer deaths in the Caribbean, no study of colorectal cancer has been done previously on British Virgin Islands population, therefore there is limited data available on mortality and prevalence in this population. Our Multidisciplinary tumor board team was first established in 2016 and reviews all cancer patient at the Dr. Orland Smith Hospital, These Multidisciplinary tumor boards are intended to improve the outcomes of this group of patients. This is consistent with previous research in the UK by Mac Demid., et al [1] and Greece by Loannidis., et al [2]. In 2016 a systemic review by B. Pillay., et al [3] suggested that there was limited evidence that Multidisciplinary tumor board meetings resulted in improved patient outcomes. So how has Multidisciplinary tumor boards affected our patient outcomes at the Dr. Orlando Smith Hospital for colorectal cancer? Has there been any improvement in colorectal cancer survival?

Aim and Method: The aim of this study is to determine if there has been any difference in overall survival in colorectal cancer patients since the establishment of the Multidisciplinary tumor board at our principal referring hospital (Dr. Orlando Smith Hospital).A retrospective study was done reviewing all patients diagnosed with colorectal cancer from 2013 to 2019. Demographic, pathologic and treatment data were collected from the patients charts and electronic medical data base. All the pathology reports over this time period was also reviewed to capture all the patients with colorectal cancer. This data was then computed in excel and analyzed using SPSS. Additional data collected included, clinical presentation, screening, type of surgical management, postoperative complications and staging.

Results: 32 new patients were diagnosed with colorectal cancer over the 7-year period. The majority of patients presented late (stage 4) and a significant amount presented as intestinal obstruction requiring acute surgical care. The mean age at diagnosis was 70.2 years, 60% of patients were male, 43% had left sided tumors. Mortality was the same in both left and right sided tumors however 88% of rectal cancer patient died. 90% of patients had no screening done prior to diagnosis. overall survival time was 16.7 months. 63% of patients were discussed at multidisciplinary tumor boards. When a comparison was made between case discussed at multidisciplinary tumor boards and those who were not, there was no significance difference in the survival curve (p = 0.600).

Conclusion: The evidence does not support an improvement in patient overall survival in colorectal cancer after the implementation of the multidisciplinary tumor boards. There has been an increase in cases over the last 3 years, these cases present, with poor prognostic factors. The majority are stage 4 disease (43%), 23% presents as emergencies with intestinal obstruction, 50% have hypertension etc. Hence these patients have a decreased probability of overall survival even before being discussed at multidisciplinary tumor boards. A national screening program would definitely help in early detection and together with targeted care to British virgin island population, overall survival can be improved.

 

Keywords: Colorectal Cancer Survival; Orlando Smith Hospital; BVI

References

  1. Mac Dermid E., et al. “Improving patients Survival with the Colorectal Cancer Multi-Disciplinary Team”. Colorectal Disease 3 (2008): 291-295.
  2. Loannidis A., et al. “Impact of Multidisciplinary Tumor Boards on patients with Rectal Cancer”. Molecular and clinical Oncology 2 (2018): 135-137.
  3. Pilly B., et al. “The Impact of Multidisciplinary Team Meetings on Patient Assessment, Management and Outcomes in Oncology Settings: A Systemic Review of the Literature”. Cancer Treatment Reviews 42 (2016): 56-72.
  4. Saghir EL., et al. “Tumor Boards: Optimizing the Structure and Improving Efficiency of Multidisciplinary Management Of Patients With Cancer Worldwide”. American Society of Clinical Oncology, Annual Meeting 34 (2014): e461-e466.
  5. Smith JT. “Ensuring Quality Cancer Care by the use of Clinical Practice Guidelines and Critical Pathways”. Journal of Clinical Oncology; An American Society of Clinical Oncology Journal 11 (2001).
  6. Metwally IH., et al. “Epidemiology and survival of colon Cancer Among Egyptians: A Retrospective Study”. Journal of Coloproctology 1 (2018): 24-29.
  7. Sacerdate C., et al. “Hospital Factors And Patient Characteristics in The Treatment of Colorectal Cancer: A population Base Study”. BMC Public Health 12 (2012): 775.
  8. Dienstmann R., et al. “Prediction of overall survival in stage 2 and 3 Colon Cancer Beyond TNM system: A Retrospective, Pooled Biomarker Study”. Annals of Oncology 28 (2017): 1023-1031.
  9. Kalcon S., et al. “Evaluating factors Affecting Survival in Colon and Rectum Cancer: A Prospective Cohort Study with 161 patients”. Journal of Cancer Research and Therapeutics 2 (2018): 416-420.
  10. Lykke J., et al. “Lymph Node yield and Tumor Subsite are Associated with Survival in Stage 1-3 Colon Cancer: Results from a national Cohort Study”. World Journal of Surgical Oncology 1 (2019): 62.
  11. Aoyama T., et al. “Clinical Impact of Tumor location on the Colon Cancer Survival and Recurrence: Analysis of Pooled Data from 3 Large Phase 3 Randomized Clinical Trials”. Cancer Medicine 11 (2017): 2523-2530.
  12. Nakagawa-senda., et al. “Prognostic Impact of Tumor Location in colon Cancer: the Monitoring of Cancer Incidence in Japan (MCI) Project”. BMC Cancer 19 (2019): 431.
  13. Compton C., et al. “Pathology And Prognostic determinants of Colorectal Cancer’ (2020).
  14. Kassim S., et al. “Clinicopathological And Epidemiological Characteristics of Prognostic Factors in Post-Surgical Survival of Colorectal cancer patients in Jiangsu Province, China”. Cancer Epidemiology 62 (2019): 101565.
  15. Dahdateh F., et al. “Obstruction Predicts Worse Long-Term Outcomes in Stage 3 Colon Cancer: A secondary Analysis of the N0147 Trial”. Surgery 6 (2018): 1223-1229.
  16. Levin T., et al. “Effects Of Organized Colorectal Cancer Screening on cancer Incidence and Mortality in a Large Community-Based population”. Gastroenterology 5 (2018): 1383-1391e5.
  17. Yoshida Y., et al. “The Impact of Screening on Cancer Incidence and Mortality in Missouri, USA, 2004-2013”. Public Health 154 (2018): 51-58.
  18. Miller E., et al. “Effect of Flexible Sigmoidoscopy Screening on Colorectal Cancer Incidence and Mortality: Long-Term Follow-up of the Randomized US PLCO Cancer Screening Trial”. The Lancet; Gastroenterology and Hepatology 2 (2019): 101-110.
  19. Macrae F., et al. “Colorectal Cancer: Epidemiology”. Risk Factors and Protective Factors’ (2020).
  20. Gillis A., et al. “A Patient-Centered Approach Toward Surgical Wait Times for Colon Cancer: A Population-Based Analysis”. Canadian Journal of Surgery 2 (2014): 94-100.
  21. Flemming J., et al. “Association Between the Time to Surgery and Survival Among patients with Colon cancer: A Population-Based Study”. European Journal of Surgical Oncology 8 (2017): 1447-1455.
  22. Robertson S., et al. “Waiting times for Cancer patients in Sweden: A Nationwide Population-Based study”. Scandinavian Journal of Public Health 3 (2017): 230-237.
  23. Strous ATM., et al. “Impact of Therapeutic delay in Colorectal Cancer on Overall Survival and Cancer Recurrence- Is there a Safe Timeframe for Prehabilitation?”. European Journal of Surgical Oncology 12 (2019): 2295-2301.
  24. Frostberg E., et al. “Clinical characteristics and a Rising incidence of Early-onset Colorectal cancer in a nationwide cohort of 521 patients aged 18-40 years”. Cancer Epidemiology 66 (2020): 101704.
  25. Kelty E., et al. “Familial and Non-Familial Risk Factors Associated with incidence of Colorectal cancer in Young and middle-aged persons in western Australia”. Cancer Epidemiology 62 (2019): 101591.
  26. Dragovich T., et al. “Colon Cancer”. Medscape (2020).
  27. Thirunavukarasu P., et al. “C-Stage in Colon Cancer”. Journal of National Cancer Institute 8 (2011): 689-697.
  28. Soetikno R., et al. “Prevalence of nonpolypoid (flat and depressed Colorectal Neoplasms in Asymptomatic and Symptomatic Adults”. The Journal of the American Medical Association 9 (2008): 1027-1035.
  29. Bressler B., et al. “Rates of New or Missed Colorectal Cancers After Colonoscopy and Their Risk Factors: A Population-Based Analysis”. Gastroenterology1 (2207): 96-102.
  30. Adrian-de-Ganzo Z., et al. “Uptake of Colon capsule Endoscopy vs Colonoscopy for Screening Relatives of Patients with Colorectal Cancer”. Clinical Gastroenterology and Hepatology 13 (2015): 2293-2301.
  31. Littlejohn C., et al. “Systemic Review and meta-Analysis of the Evidence for Flexible Sigmoidoscopy as a Screening Method for the Prevention of Colorectal Cancer”. British Journal of Surgery 11 (2012): 1488-1500.
  32. Carney K., et al. “Bowel Cancer Screening”. Surgery 3 (2017): 132-139.
  33. Public Health England. Bowel Cancer Screening Programme Overview”. Gov.UK (2019).
  34. Rutter M., et al. “British Society of Gastroenterology/Association of Coloproctology for Great Britain and Ireland/Public Health England post-Polypectomy and Post-Colorectal Cancer Resection Surveillance guidelines”. BMJ 69 (2019): 201-223.
  35. Gupta S., et al. “Recommendations for Follow-up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal cancer”. Gastroenterology4 (2020): 1131-1153.
  36. Sepulveda AR., et al. “Molecular Biomarkers for the Evaluation of Colorectal Cancer: Guidelines from the American Society for Clinical Pathology, College of American Pathologist”. Association for Molecular Pathology and the American Society of Clinical Oncology’ Journal of Clinical Oncology 13 (2017): 1453-1486.
  37. Markowitz SD., et al. “Molecular Basis of Colorectal cancer”. The New England Journal of Medicine 361 (2009): 2449-2460.
  38. Stay Well. “Types of Colon Resections”. Mount Nittany Health (2019).
  39. Boller AM., et al. “Colon and Rectal Cancer: Laparoscopic or Open?”. Clinical Cancer Research 13 (2007): 6894s-6896s.
  40. Jayne DG., et al. “Randomized trial of laparoscopic Assisted resection of Colorectal carcinoma: 3-year Results of the UK MRC classic Trial Group”. Journal Clinical Oncology 21 (2007): 3061-3068.
  41. Rodriguez-Bigas MA., et al. “Overview of management of primary Colon cancer’ (2020).
  42. Cancer research UK. “Chemotherapy’ Bowel cancer UK/ Beating bowel Cancer Together (2020).
  43. Song M., et al. “Fiber intake and Survival After Colorectal Cancer Diagnosis”. JAMA Oncology 1 (2018): 71-79.
  44. Bleday R., et al. “Rectal Cancer: Surgical Techniques’ (2020).
  45. Willet CG., et al. “Neoadjuvant Chemotherapy, Radiotherapy and Chemotherapy for rectal adenocarcinoma’ (2020).
  46. Cagir B., et al. “Rectal Cancer”. Medscape (2020).
  47. Net Editorial Board. Colorectal Cancer: Risk Factors and Prevention”. Cancer.Net (2019).
  48. Gomez D., et al. “Anatomical Distribution of Colorectal cancer over 10years period in a district general Hospital: Is There a ‘True Rightward Shift’?” Postgrad Medical Journal 80 (2004): 667-669.
  49. Saha S., et al. “Tumor Size Predicts Long-term Survival in colon cancer: Analysis of the National Cancer Data Base”. The American Journal of Surgery 3 (2015): 570-574.
  50. Li X., et al. “Prognostic Value the Tumor Size in Respectable Colorectal Cancer with Different Primary Locations: A Retrospective Study with the Propensity Score Matching”. Journal of Cancer 2 (2019): 313-322.
  51. Mejri N., et al. “Prognostic Value of Tumor Size in Stage 2 and 3 Colorectal”. Cancer 4 (2018): 113-119.
  52. Saha S., et al. “Tumor size as a prognostic Factor for Patients with Colon Cancer Undergoing Sentinel Lymph Node Mapping and Conventional Surgery”. Journal of Clinical Oncology 4 (2013): 546-546.
  53. Plummer JM., et al. “Colorectal Cancer Survival in Jamaica”. Annals of Medicine and Surgery 6 (2016): 26-29.
  54. Cancer research UK. Survival’ Bowel cancer UK/ Beating bowel Cancer Together (2020).
  55. Joachim C., et al. “Overall Survival of Colorectal Cancer by stage at Diagnosis Data form the Martinique Cancer Registry”. Medicine35 (2019): e16941.
  56. Telem DA., et al. “Risk Factors for Anastomotic Leak Following Colorectal Surgery: A Case-Control Study”. Archives of Surgery 4 (2010): 371-376.
  57. Veyrie N., et al. “Anastomotic Leakage After Elective Right versus Left Colectomy for Cancer: Prevalence and Incident Risk Factors”. Journal of the American College of Surgeons 6 (2007): 785-793.
  58. Suding P., et al. “Definitive Risk Factors for Anastomotic leaks in Elective Open Colorectal Resection”. Archives of Surgery 9 (2008): 907-911.
  59. Tevis SE., et al. “Postoperative Complications: Looking Forward to a Safer Future”. Clinics in Colon and Rectal Surgery 3 (2016): 246-252.
  60. Longo WE., et al. “Risk Factors For morbidity and Mortality After Colectomy for Colon cancer”. Disease of the Colon and Rectum 1 (2000): 83-91.
  61. Klaudia K., et al. “A5894 Colorectal Cancer and Hypertension”. Journal of Hypertension 36 (2018): e173.
  62. Seretis A., et al. “Association Between Blood Pressure and Risk of Cancer development: a systemic review and Meta-Analysis of Observational Studies”. Scientific Reports 9 (2019): 8565.
  63. Sturmer T., et al. “Metabolic Abnormalities and Risk for Colorectal Cancer in the Physicians’ Health Study’ Cancer Epidemiology”. Biomarkers and Prevention 12 (2006): 2391-2397.
  64. Ahmadi A., et al. “Prevalence of Hypertension and Type 2 Diabetes Mellitus in Patients with Colorectal Cancer and Their Median Survival Time: A Cohort Study”. Journal of Research in Medical Science9 (2014): 850-854.
  65. Ma Y., et al. “Type 2 Diabetes and Risk of Colorectal Cancer in Two Large U.S Prospective Cohorts”. British Journal of Cancer 119 (2018): 1436-1442.
  66. Cho E., et al. “Alcohol Consumption and the Risk of Colon Cancer by Family History of Colorectal Cancer”. The American Journal of Clinical Nutrition 2 (2012): 413-419.
  67. Safiri S., et al. “The Global, Regional and national burden of Colorectal Cancer and its attributable Risk Factors in 195 countries and Territories, 1990-2017: A Systemic Analysis for the Global Burden of Disease Study 2017”. The Lancet Gastroenterology and Hepatology 4 (2017): 913-933.
  68. Caribbean Source: Globocan. International Agency for Research on Cancer. World Health Organization (2018).
  69. Country Report: British Virgin Islands’ Health in the Americas’ Pan American Health Organization, World Health Organization, Americas.
  70. Razzaghi H., et al. “Leading Causes of Cancer Mortality-Caribbean Region 2003-2013”. Morbidity and Mortality Weekly Report 49 (2016): 1395-1400.
  71. Colorectal Cancer Screening in the Americas Situation and Challenges. Pan American Health Organization, World Health Organization, Americas (2020).
  72. McKigney N., et al. “Bowel Cancer Screening”. Surgery1 (2020): 18-26.
  73. Minhhuyen N., et al. “Colorectal Cancer (Colon Cancer)’MSD Manual professional version (2019).
Citation: David Nelson. “A Mobile App to Train in Laparoscopic Surgery”. EC Gastroenterology and Digestive System 9.6 (2022): 49-66.

PubMed Indexed Article


EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005


EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777


EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347


EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478


EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253


EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033


EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992


EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505


EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793


EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211


EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047


EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560


EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318


EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819


EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840


EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344


EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476


EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658


EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489


EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278


EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108


EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571


EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333


EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883


EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001


EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937


EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723


EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726


EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603


EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646


EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616


EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290


EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226


EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812


EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268


News and Events


November Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the November issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for Upcoming Issue

ECronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before December 15, 2022.

Certificate of Publication

ECronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

ECronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.