title: Cancer pathways are associated with improved long-term survival.
abstract: BACKGROUND
  The impact of cancer patient pathways (CPP) on long-term outcome after surgery for colorectal cancer has not been documented. This study aimed to investigate the effect of CPP on survival in patients who underwent surgery for colorectal cancer.
  
  
  METHODS
  This was a retrospective cohort study performed in a single centre on prospectively collected data from a national database, the Danish Colorectal Cancer Group. In total, we reviewed 309 consecutive patients (145 females) with a median age of 70 years (range: 30-92 years), who underwent surgery for colorectal cancer between 2007 and 2009.
  
  
  RESULTS
  A total of 148 patients who underwent elective surgery after the introduction of CPP on 1 April 2008 had a decrease in the median number of days from referral to endoscopy (from 8 to 6, p = 0.001, from referral to oncological treatment (from 46.5 to 32 days, p < 0.001) and from referral to surgery (from 28 to 22 days, p = 0.066), but this latest reduction was not significant. Overall survival (OS) was analysed using the Kaplan Meier method; and variables were compared with the log rank test. The 60-month OS was significantly improved from 61.1% in those who were operated before 1 April 2008 (n = 161) to 72.6% in the CPP group operated after 1 April (p = 0.026). Using the Cox regression model, we found that CPP was an independent factor associated with survival (p = 0.032, hazard ratio = 0.661, 95% confidence interval: 0.454-0.964).
  
  
  CONCLUSIONS
  Introduction of CCPs in a single centre was associated with a significant improvement of overall sur-vival, and using Cox regression we found that the CPP was an independent marker for survival. Larger studies are needed to clearly understand the effect of CPP.
authors: Department of Surgery and Transplantation C2122, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark. k_hoejsgaard@hotmail.com.
authors: Kenneth Højsgaard
authors: KH
authors: Jensen
authors: Pierre Jean-Claude
authors: PJ
authors: Maina
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000401:mortality* / Q000601:surgery; D019091:Critical Pathways / Q000706:statistics & numerical data*; D016208:Databases, Factual; D003718:Denmark / Q000453:epidemiology; D017558:Elective Surgical Procedures / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000401:mortality* / Q000601:surgery; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors