Do patients consider preoperative chemoradiation for primary rectal cancer worthwhile?

Area of Science:

• Oncology
• Surgical Oncology
• Patient-Centered Care

Background:

• Rectal cancer treatment often involves preoperative chemoradiation (pre-CRT) followed by surgery.
• Current guidelines recommend pre-CRT for specific stages of rectal cancer.
• Patient preferences are crucial for treatment decisions and guideline development.

Purpose of the Study:

• To assess future patients' preferences regarding pre-CRT for rectal cancer.
• To compare patient preferences with existing treatment guidelines.
• To understand the trade-offs patients consider between treatment options.

Main Methods:

• A threshold task was used during standardized interviews with healthy individuals.
• Participants evaluated risks and benefits of surgery alone (SA) versus pre-CRT with surgery (CR+S).
• The acceptable risk of local recurrence for CR+S was systematically determined to elicit preference changes.

Main Results:

• 54% of participants required a local recurrence risk of ≤5% with CR+S to prefer it over SA.
• This indicates a need for at least a 10% absolute risk reduction for patients to opt for pre-CRT.
• No predictive variables for patient preferences were identified in regression analysis.

Conclusions:

• Patients highly value functional outcomes, potentially accepting higher local recurrence risks.
• Future rectal cancer guidelines may need to position pre-CRT as an option, not a mandate, for stage II/III tumors.
• Incorporating patient-reported outcomes and preferences is vital for personalized rectal cancer care.