title: "Watchful waiting" for metastatic colorectal cancer, antediluvian or an option to be considered again?
abstract: OBJECTIVE
  The role of chemotherapy in metastatic colorectal cancer (mCRC) is firmly established and the option of watchful waiting (WW) has become an alternative rarely considered. However, there may be a group of patients who are diagnosed with low volume and asymptomatic disease and who may be suitable for a WW plan.
  
  
  METHODS
  From the South Australian Cancer Registry for mCRC we examined cancer characteristics and outcomes of patients who were suitable for chemotherapy but had their treatment delayed by more than 3 months from diagnosis of metastatic disease.
  
  
  RESULTS
  Data from 417 mCRC patients who received chemotherapy as first intervention have been entered in the Registry to date and 38 (9.1%) had chemotherapy commencement delayed by more than 3 months from diagnosis. Their median age was 76.7 years (range 38-85). Overall 87% of patients had metachronous metastatic cancer with a median time to recurrence of 2.1 years (range 0.53-7.71) and 65.5% had single organ metastasis. Median delay from the diagnosis of metastatic disease to chemotherapy was 5.03 months (range 3-28). The median survival has yet to be reached. The 2-year overall survival is 65%.
  
  
  CONCLUSIONS
  We found that almost 10% of all patients with mCRC had a delay in the initiation of chemotherapy, with most due to a WW approach based on case note review. Patients with a delay in chemotherapy initiation are more likely to have a single organ site of metastatic disease and are older than those who do not. Despite the treatment delay, there is no evidence of a negative impact on survival.
authors.affiliation: Haematology-Oncology Department, The Queen Elizabeth Hospital, Woodville, Australia.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Price
authors.forename: Amanda R
authors.initials: AR
authors.lastname: Townsend
authors.forename: Carol
authors.initials: C
authors.lastname: Beeke
authors.forename: Sarwan
authors.initials: S
authors.lastname: Bishnoi
authors.forename: Robert
authors.initials: R
authors.lastname: Padbury
authors.forename: Guy
authors.initials: G
authors.lastname: Maddern
authors.forename: Christos S
authors.initials: CS
authors.lastname: Karapetis
mesh_terms: D015179:Colorectal Neoplasms / Q000473:pathology*; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary*; D057832:Watchful Waiting