Clinical practice guidelines for rehabilitation in colorectal cancers: a critical appraisal

Purpose: To critically appraise existing clinical practice guidelines (CPGs) for colorectal cancer (CRC) and synthesize evidence-based recommendations from a rehabilitation perspective. Methods: Comprehensive literature search was conducted using health databases, CPG clearinghouse/developer websites, and grey literature up to October 2024. All CRC CPGs published in the last decade that reported systematic methods for evidence search, and clearly defined recommendations supporting evidence for rehabilitation interventions were included. Two authors independently selected potential CPGs and assessed their methodological quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Recommendations from included CPGs were qualitatively summarized from a rehabilitation perspective. Results: Twelve of 65 CPGs met the inclusion criteria. The majority of CRC CPGs were of low-moderate quality (AGREE scores of 2–6/7). The recommendations were generic, with only the American Cancer Society (ACS) guidelines providing detailed recommendations on rehabilitation interventions for longer-term issues in CRC survivors. Existing CPGs recommend coordinated multidisciplinary survivorship care, monitoring of longer-term issues, and follow-up support for patients with CRC. However, supporting evidence for these management strategies remains limited. Detailed comparison between the CPGs was not possible due to inconsistent recommendations, making it difficult to summarize the optimal rehabilitation approaches. Conclusion: Despite rehabilitation being an integral component of the management of CRC, it is notably absent in many published CPGs. Future CPGs should explicitly incorporate rehabilitation-specific interventions for improved clinical outcomes tailored to the needs of this population.