Optimal timeframes & summary

Evidence-based guidelines, where they exist, should inform timeframes. Treatment teams need to recognise that shorter timeframes for appropriate consultations and treatment can promote a better experience for patients. Three steps in the pathway specify timeframes for care. They are designed to help patients understand the timeframes in which they can expect to be assessed and treated, and to help health services plan care delivery in accordance with expert-informed time parameters to meet the expectation of patients. These timeframes are based on expert advice from the Colorectal Cancer Working Group.

Timeframes for care

Step in pathway Care point Timeframe
Screening participation – National Bowel Cancer Screening Program (NBCSP) at-home bowel test is recommended for average risk and asymptomatic people aged 50–74 years, every 2 years. People should be encouraged to enter their GP’s details on the NBCSP form so the GP also receives their test results.
Presentation, initial investigations and referral Signs and symptoms Presenting symptoms should be promptly and clinically triaged with a health professional
Initial investigations initiated by GP Test results should be provided to the patient within 1 week of testing.
Referral to specialist If symptoms suggest colorectal cancer, patients should be referred and colonoscopy completed within 4 weeks

The patient should see a surgeon within 2 weeks of GP referral following a positive diagnosis of colorectal cancer via colonoscopy

Diagnosis, staging and treatment planning Diagnosis and staging Investigations should be completed within 2 weeks. 10–15% of colorectal cancers will present as an emergency; this necessitates appropriate acute care followed by multidisciplinary management
Multidisciplinary meeting and treatment planning MDM should take place within 2 weeks of diagnosis and staging
Treatment Surgery Colorectal cancer – surgery should be completed within 5 weeks of investigations and MDM if no neoadjuvant therapy required

Rectal cancer with neoadjuvant therapy – surgery should be completed 8–12 weeks after completion of neoadjuvant therapy

Neoadjuvant radiation therapy Neoadjuvant radiation therapy should begin within 3 weeks of the MDM
Systemic therapy Neoadjuvant chemotherapy should begin within 3 weeks of the MDM

Adjuvant chemotherapy should begin within 8 weeks of surgery

Seven steps of the optimal care pathway

Step 1: Prevention and early detection

Step 2: Presentation, initial investigations and referral

Step 3: Diagnosis, staging and treatment planning

Step 4: Treatment

Step 5: Care after initial treatment and recovery

Step 6: Managing recurrent, residual or metastatic disease

Step 7: End-of-life care

Colorectal cancer was the third most commonly diagnosed cancer in Australia in 2016. It is estimated that it will be the fourth most commonly diagnosed cancer in 2020 (Cancer Australia 2020b). Bowel cancer is the second highest cause of death after lung cancer. In 2019, it was estimated that the risk of an individual being diagnosed with colorectal cancer by their 85th birthday would be one in 14 (one in 12 males and one in 17 females) (Cancer Australia 2019b).