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 offer a critical missing link, providing illustrative examples drawn from our recent colorectal cancer clinical correlation study where we demonstrated the ability to predict treatment response and identify drug resistant tumor subclones. Integrating these 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 no longer sufficient. It is time for colorectal cancer management to move toward a personalized framework that maximally benefits patient outcomes.