Journal of Clinical Medicine

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Novel Insights into the Multidisciplinary Management of Colorectal Cancer

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Dear Colleagues,

Colorectal cancer (CRC) is the third most common cancer worldwide, accounting for approximately 10% of all cancer cases, and is the second leading cause of cancer-related deaths worldwide. Biomarker-based stratification of metastatic CRC enables the use of precision therapy based on individual tumor mutational profiles. Activating mutations in the RAS/RAF/MAPK pathway downstream of EGFR signaling have, until recently, limited the use of EGFR-targeted therapies for mCRC; however, the development of anti-RAS and anti-RAF therapies, together with improved strategies to limit compensatory signaling pathways, is resulting in improved survival, which in recent clinical trials approaches 30 months. The aim of this Special Issue is to provide novel insights into the multidisciplinary management of CRC, with a special emphasis on novel approaches in the treatment of metastatic disease.

Dr. Fabio Gelsomino
Dr. Francesco Caputo
Guest Editors

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31 pages, 2065 KiB

Open AccessReview

Unique Considerations in Caring for Rural Patients with Rectal Cancer: A Scoping Review of the Literature from the USA and Canada

by Lydia Manela Rafferty, Bailey K. Hilty Chu and Fergal Fleming

J. Clin. Med. 2025, 14(12), 4106; https://doi.org/10.3390/jcm14124106 - 10 Jun 2025

Viewed by 453

Abstract

Background: Rural patients, including those with rectal cancer, continue to be underrepresented in research and medically underserved with unique challenges to accessing care. Like the rest of America, rural patients are experiencing rising rates of rectal cancer; however, unlike the rest of the country, they also have rising rectal cancer-related mortality. This study aims to review the literature regarding care for patients with rectal cancer in rural settings, from presentation and diagnosis to treatment algorithms, oncologic outcomes, their unique preferences, and the goals of care. Methods: A literature search was performed on PubMed, on 31 October 2024, using synonyms of “rural” and “rectal cancer” to identify relevant articles. Articles from outside the USA and Canada and those offering only commentary were eliminated during the initial screening/retrieval. A full-text review was performed on the remaining articles; all the studies that did not address the identified primary or secondary outcomes in rural rectal cancer patients were then excluded. All the primary and secondary outcomes are briefly summarized in narrative form, with more detail on the primary outcomes provided in tables. The variability in the key criteria between the studies is also summarized in the tables and appendices provided. Results: Thirty studies were identified that addressed the outcomes of interest in rural rectal cancer patient populations. The total number of participants could not be assessed given the use of overlapping databases. Of the articles, 21 addressed treatment modalities (surgery, chemotherapy, radiation), 13 addressed oncologic outcomes, and a mix of additional studies addressed the diagnostic work up, costs, and patient preferences. The studies addressing treatment demonstrated similar practices in regard to chemotherapy and surgical management, aside from lower rates of minimally invasive surgery, along with decreased neoadjuvant radiotherapy use and increased under-dosing in rural patients. The oncologic outcomes were overall similar to worse for rural patients as compared to urban patients, even for those receiving treatment at high-volume urban centers. Additionally, rural patients have higher healthcare costs for rectal cancer care. Discussion/Conclusions: Rural patients are an at-risk group, with a rising disease burden and worsening rectal cancer outcomes, despite advances in rectal cancer care and improving oncologic outcomes in the general population. Analysis of the situation is complicated due to the underrepresentation of rural patients in research and the lack of uniformity in the definition of “rural”. Moreover, significant gaps in the literature remain, such that the evaluation of guideline-concordant care is incomplete, including an absence of literature about watch-and-wait approaches in rural populations. While regionalization of rectal cancer care has shown promise, the improvements in outcomes may not be commensurate for rural patients. Thus, a specific focus on the impact of this shift for rural patients is necessary to mitigate unintended consequences. Full article

(This article belongs to the Special Issue Novel Insights into the Multidisciplinary Management of Colorectal Cancer)

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