Quantifying preferences for watch-and-wait compared with surgery after a clinical complete response in locally...

Watch-and-wait (W&W) has emerged as an alternative to major surgery for locally advanced rectal cancer in patients with a clinical complete response (cCR) after neoadjuvant chemoradiotherapy. Evidence on preferences for W&W versus surgery after cCR is limited.

We used a discrete choice experiment to quantify preferences. We chose two adult online survey sub-populations: (i) those with experience of any cancer, as there is evidence of biases when respondents are or related to cancer survivors, and (ii) those without experience of cancer, as surrogates of 'what if' future cancer patients. Respondents chose between the options of W&W versus major surgery based on seven attributes: chance of local regrowth; chance of distant metastases; chance of faecal urgency; time to stoma formation; frequency of hospital follow-up visits; survival; and quality of life. We modelled preferences using uncorrelated random parameters logit models. Additionally, we predicted the probabilities of W&W uptake in models using most plausible real-world data ('realistic scenario').

There were 346 participants with experience of any cancer; 834 participants without experience of cancer. There was no intrinsic preference for W&W versus surgery; respondents made their choices based on the attributes. Respondents indicated strongest preference for quality of life and survival attributes but there was evidence of preference heterogeneity for most attributes. In the realistic scenario, the predicted uptake probability of choosing W&W was 52.9 % in participants with any cancer experience and 57.2 % in participants without cancer experience.

These findings indicate that individuals do not have an inherent preference for either W&W or surgery and make their decision based on other attributes. The decision process is complex involving consideration of several attributes and the preferences are heterogeneous.