The Patient Journey and Guideline Concordant Care in Colorectal Cancer – Is Current Practice Enough?

Colorectal cancer is a major healthcare burden, and modern management of non-metastatic disease relies heavily on guideline concordant care with a basis in histopathologic staging and empiric systemic therapy. While multidisciplinary care pathways and standardized guidelines have improved outcomes at a population level, they fall short in addressing the inter-patient and intra-tumoral heterogeneity that drives lack of response, recurrence, and unnecessary toxicity. Using a hypothetical patient journey, our commentary highlights how current practice often fails to align with patient needs despite being “guideline concordant”. We discuss limitations of current treatment paradigms and the shortcomings of even modern tools like genomic profiling, highlighting the continued need for complementary approaches.We hypothesize that functional precision medicine approaches have the potential to complement existing treatment paradigms and may contribute to improved therapeutic stratification. We provide illustrative examples of potential utility drawn from our recent colorectal cancer clinical correlation study where we reported an association between assay outcomes and clinical response in a retrospective cohort, as well as the ability to identify intra-patient heterogeneity in ex-vivo drug response, suggestive of phenotypically distinct subpopulations with differential drug sensitivity. Further investigation leading to integration of these or similar technologies alongside genomic and minimal residual disease assessments could refine therapy selection and improve existing surveillance strategies.Ultimately, we suggest that while guideline concordant care remains necessary, it is not sufficient for all patients, and that with continued research efforts utilizing functional precision medicine technologies, colorectal cancer management can move toward a personalized framework that maximally benefits patient outcomes.