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Utilizing Patient Input in Rectal Cancer Trial Design.

Janet Alvarez¹, Wini Zambare¹, Manju George²

¹Memorial Sloan Kettering Cancer Center, New York, NY, United States.

Journal of the National Cancer Institute

|March 20, 2025

Summary

Patients with rectal cancer prefer chemotherapy escalation and selective watch-and-wait (WW) management when offered after total neoadjuvant therapy (TNT). Patient input is crucial for designing future clinical trials in rectal cancer treatment.

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Area of Science:

Oncology
Clinical Trial Design
Patient-Reported Outcomes

Background:

Watch-and-wait (WW) is a management option for locally advanced rectal cancer patients achieving clinical complete response (cCR) after total neoadjuvant therapy (TNT).
Understanding patient knowledge and preferences is essential for refining WW strategies and clinical trial design.

Purpose of the Study:

To assess patient knowledge and preferences regarding WW management for rectal cancer.
To incorporate patient input into the design of future clinical trials.

Main Methods:

Surveys were distributed to rectal cancer patients in advocacy groups (COLONTOWN/Rectalburgh and Fight CRC).
Questions addressed perceptions of treatment strategies, tolerable risks, and clinical trial design preferences.
Surveys were re-administered in 2023 to reflect the evolving landscape of WW management.

Main Results:

All respondents favored trials incorporating patient input.
76% preferred chemotherapy escalation over radiation escalation.
When WW was an option after TNT, 82% chose selective WW over surgery, compared to 58% choosing surgery when WW was not an option after chemoradiation.

Conclusions:

Patient advocacy groups are valuable resources for gathering patient perspectives.
Patients demonstrate a preference for chemotherapy escalation, selective WW, and active involvement in clinical trial design.
Informed patients make complex decisions, highlighting the importance of patient-centered approaches in oncology research.