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ESMO Patient Guides COVID19 1000x250

Outpatient visits

High priority

Your outpatient appointment may be a high priority if:

  • You are experiencing new symptoms, disease progression, complications after surgical or radiotherapy treatments, or side effects such as diarrhoea or severe skin issues
  • You have recently been diagnosed with colorectal cancer and you are experiencing cancer-related symptoms  

Medium priority

Your outpatient appointment may be a medium priority if:

  • You have recently been diagnosed with colorectal cancer, you have not had surgery for your cancer and you are not experiencing cancer-related symptoms 
  • You have recently been diagnosed with colorectal cancer, you are not experiencing cancer-related symptoms, but you have had surgery for your cancer and need an appointment to discuss potential adjuvant or first-line treatment
  • You are experiencing serious side effects from chemotherapy or radiotherapy
  • You are receiving treatment for colorectal cancer but are considered stable and are not experiencing any new problems or symptoms

Low priority

Your outpatient appointment may be a low priority if:

  • You are seeking a second opinion on an aspect of your colorectal cancer
  • shutterstock_1709413390
    You are due to undergo blood tests and imaging as part of screening for colorectal cancer. If possible, these tests will take place at a local clinic and an appointment conducted via telephone
  • Your appointment is a routine follow-up visit
  • You have metastatic colorectal cancer and the purpose of your appointment is to restage your cancer, but there is no intention to perform curative surgery on primary or metastatic tumours
  • The purpose of your appointment is to restage your cancer after you have already received two or three previous treatments
  • You are receiving maintenance therapy and your appointment is a routine follow-up visit. If possible, blood tests and imaging will take place at a local clinic and an appointment conducted via telephone

Imaging

High priority

Your appointment may be a high priority if:

  • shutterstock_1191560233
    You need imaging to confirm a serious complication, such as intestinal occlusion, bleeding, bowel perforation or post-surgical issues
  • You need imaging to confirm a bone fracture due to metastasis

Medium priority

Your appointment may be a medium priority if:

  • Your doctor thinks you may have colorectal cancer and you need tests to confirm the diagnosis
  • You are at high risk of developing colorectal cancer based on your family history or the presence of polyps

Low priority

Your appointment may be a low priority if:

  • You are due to undergo blood tests and imaging as part of screening for colorectal cancer. If possible, these tests will take place at a local clinic and an appointment conducted via telephone. These tests may be replaced by a faecal occult blood test
  • Your appointment is a routine follow-up visit
  • You have metastatic colorectal cancer and the purpose of your appointment is to restage your cancer, but there is no intention to perform curative surgery on primary or metastatic tumours
  • The purpose of your appointment is to restage your cancer after you have already received two or three previous treatments

Surgery

High priority

Your appointment may be a high priority if:

  • shutterstock_1152709175
    You were recently diagnosed with colorectal cancer and you need surgery to treat an intestinal occlusion
  • You need surgery to relieve symptoms of colorectal cancer-related complications such as bowel perforation, peritonitis or gastrointestinal bleeding
  • You need surgery to treat complications following a previous surgical procedure, colonoscopy, or other procedure such as a liver or lung biopsy (e.g. bowel perforation, peritonitis, bleeding)
  • You need surgery to treat spinal cord compression due to metastasis

Medium priority

Your appointment may be a medium priority if:

  • You need surgery for stage I, II or III colon cancer
  • You need surgery for stage I rectal cancer
  • You need surgery for stage II or III rectal cancer after neoadjuvant treatment
  • You have limited metastases and need surgery to remove a metastasis as a first-line treatment or after neoadjuvant treatment

Low priority

Your appointment may be a low priority if:

  • You have early-stage rectal cancer and have achieved a complete response with neoadjuvant radiotherapy. In these cases, your doctor may decide to take a ‘watch and wait’ approach rather than proceeding with surgery immediately
  • You are at high risk of developing colorectal cancer and were due to undergo prophylactic surgery
  • You have metastatic colorectal cancer, have already received several previous treatments, and were due to undergo a biopsy to help decide your next treatment. In these cases, your doctor will proceed with treatment without the analyses from the biopsy. It may be possible in some cases to use blood-based analyses rather than biopsies

Radiotherapy

High priority

Your appointment may be a high priority if:

  • You have experienced severe complications due to disease progression (e.g. compression, bone fractures, brain metastases) and require radiotherapy. In these cases, outpatient appointments will be avoided and you will likely be admitted straight to the hospital ward

Medium priority

Your appointment may be a medium priority if:

  • You are scheduled to undergo neoadjuvant or adjuvant radiotherapy for stage II or III rectal cancer
  • You are unsuitable for systemic treatment and are scheduled to undergo internal radiotherapy to treat limited metastases

Low priority

Your appointment may be a low priority if:

  • Your treatment is expected to have a modest benefit
  • You have a low level of disease and slow disease progression
  • Your cancer has returned following previous treatment, but it is slow-growing
Additional considerations for radiotherapy for early-stage rectal cancer
  • To reduce hospital visits, short radiotherapy courses may be used instead of long courses
  • When radiotherapy is to be given in combination with chemotherapy, oral treatment with capecitabine may be used rather than intravenous fluorouracil

Medical management of early-stage colon cancer

High priority

Your appointment may be a high priority if:

  • You have experienced severe complications following treatment with surgery, chemotherapy or radiotherapy and require treatment in hospital. In these cases, outpatient appointments will be avoided and you will likely be admitted straight to the hospital ward

Medium priority

Your appointment may be a medium priority if:

  • shutterstock_1166511901
    You have undergone surgery for high-risk stage II colon cancer and are scheduled to receive adjuvant treatment. You may undergo molecular testing to help decide your treatment
  • You have undergone surgery for low- or high-risk stage III colon cancer and are scheduled to receive adjuvant treatment. In these cases, your doctor may decide to replace an intravenous chemotherapy with an oral one, if possible

Low priority

Your appointment may be a low priority if:

  • You are due to have weekly blood tests. These will only take place if your clinical condition and symptoms require them
  • You are due to have imaging tests. In these cases, your doctor will discuss the potential benefit of the imaging tests versus the risk of COVID‑19 infection and will advise on the best approach for you
Additional considerations for the medical management of early colon cancer
  • Tests that are crucial to guide treatment decisions (e.g. microsatellite instability testing) are likely to go ahead as planned
  • If possible, oral treatment with capecitabine will be used rather than intravenous fluorouracil
  • For some patients, adjuvant chemotherapy may be given for 3 months rather than 6 months, depending on the individual patient’s clinical condition and risk assessment
  • Weekly blood tests will be avoided unless there are signs of infection or other complications
  • Telephone appointments will be used for regular monitoring of treatment side effects and to discuss any adjustments to doses
  • Blood testing prior to oxaliplatin administration may be undertaken in a local clinic. A telephone appointment can be used to discuss whether the next cycle of oxaliplatin should be delayed
  • Patients at risk of febrile neutropenia may be treated with prophylactic growth factors to reduce the risk of hospitalisation

Medical management of early-stage rectal cancer

High priority

Your appointment may be a high priority if:

  • You have experienced severe complications following treatment with surgery, chemotherapy or radiotherapy and require treatment in hospital. In these cases, outpatient appointments will be avoided and you will likely be admitted straight to the hospital ward

Medium priority

Your appointment may be a medium priority if:

  • You are scheduled to receive neoadjuvant or adjuvant treatment for stage II or III rectal cancer
  • You are receiving treatment as part of a clinical trial

Low priority

Your appointment may be a low priority if:

  • You are due to have weekly blood tests. These will only take place if your clinical condition and symptoms require them
  • You are due to have imaging tests. In these cases, your doctor will discuss the potential benefit of the imaging tests versus the risk of COVID‑19 infection and will advise on the best approach for you

Medical management of advanced colorectal cancer

High priority

Your appointment may be a high priority if:

  • shutterstock_1276483171
    You have experienced severe complications following treatment with surgery, chemotherapy or radiotherapy and require treatment in hospital. In these cases, outpatient appointments will be avoided and you will likely be admitted straight to the hospital ward

Medium priority

Your appointment may be a medium priority if:

  • You are in good general health and are scheduled to receive first-line treatment to reduce the symptoms of advanced colorectal cancer
  • You are in good general health and are scheduled to receive first-line treatment to reduce the size of the tumour in order to attempt curative surgery
  • You are in good general health and are scheduled to receive first-line treatment for advanced disease after your cancer returned quickly following surgery and adjuvant treatment for early-stage disease
  • You are in good general health and are scheduled to receive second-line treatment after your cancer progressed following an initial response to first-line treatment
  • You have cancer with high microsatellite instability and are scheduled to receive second-line treatment with immunotherapy
  • You are receiving treatment as part of a clinical trial

Low priority

Your appointment may be a low priority if:

  • Your planned treatment is expected to have a modest benefit
  • You are receiving maintenance therapy
  • You have a low level of disease and slow disease progression
  • You are in poor general health and have additional health conditions
  • You previously experienced severe complications with adjuvant treatment
  • Your cancer has returned following previous treatment but it is slow-growing
Additional considerations for the medical management of advanced colorectal cancer
  • First-line treatment with chemotherapy and/or targeted therapy could be administered in an outpatient clinic. In these cases, support must be provided to prevent side effects (e.g. patients at risk of febrile neutropenia may be treated with prophylactic growth factors to reduce the risk of hospitalisation)
  • First-line treatment with targeted therapy may be adjusted to reduce the number of clinic visits. For example, cetuximab may be administered every 2 weeks rather than weekly
  • Patients with slow disease progression might receive second-line treatment every 2 weeks
  • Maintenance therapy may be administered every 3 weeks, and oral treatment with capecitabine may be used rather than intravenous fluorouracil
  • For patients undergoing third-line treatment, appointments to monitor side effects will take place via telephone and blood tests will be performed in local clinics if possible

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