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Patient Preference for Non-Operative Treatment Strategy in Locally Advanced Rectal Cancers: A Cross-Sectional Survey.

Surendran Veeraiah1, Revathy Sudhakar1, Jagan Murugan2

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Summary

Only one-third of rectal cancer patients prefer non-operative management (NOM) over surgery, with fear of progression and side effects being key factors. Patient counseling is crucial for the watch-and-wait approach in rectal cancer care.

Keywords:
Complete clinical responseFear of recurrencePatient preferenceRectal cancerTotal neoadjuvant treatmentWatch and wait

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Patient-Reported Outcomes

Background:

  • Surgical resection is the standard treatment for rectal cancer.
  • Non-operative management (NOM) after neoadjuvant radiotherapy is an emerging option for selected patients.
  • Understanding patient preferences for NOM is crucial for treatment planning.

Purpose of the Study:

  • To assess patient willingness for non-operative management (NOM) in rectal cancer.
  • To identify factors influencing patient preference between NOM and surgery.
  • To evaluate the impact of psychological parameters on NOM acceptance.

Main Methods:

  • Prospective cross-sectional study of 59 locally advanced rectal cancer patients.
  • Structured interviews assessed willingness for NOM under various conditions.
  • Psychological assessments included Fear of Progression (FOP)-12, Life Orientation Test-Revised, and MHLC-C.

Main Results:

  • 37.3% of patients expressed overall willingness for NOM.
  • Willingness for NOM decreased with increased side effects or tumor regrowth risk.
  • Fear of Progression (50% prevalence) and low optimism (79.7%) significantly influenced decisions.

Conclusions:

  • A minority of rectal cancer patients prefer NOM over surgery.
  • Patient decisions are influenced by fear of progression and treatment side effects.
  • Thorough patient counseling on NOM is essential before considering a watch-and-wait strategy.