As cancer therapies improve, more patients with rectal cancer are foregoing surgery.
Patients with rectal cancer who respond well to radiation and chemotherapy are increasingly opting for a watch-and-wait approach.
This is according to a study published in JAMA Oncology, which shows that the number of patients opting out of surgery rose nearly 10% between 2006 and 2020.
While surgery to remove rectal cancer can be necessary and lifesaving, it can come with significant drawbacks, like loss of bowel control.
The study, spearheaded by researchers at the Wilmot Cancer Institute, showed a shift toward ‘organ-preserving’ care, with regular monitoring by experienced oncologists over five years.
This potentially spares patients from surgery and any related long-term effects on bowel function and quality of life.
Dr Fergal Fleming, lead investigator and associate professor at the University of Rochester Medical Centre, emphasised bowel function’s profound impact on patients’ lives. He notes that avoiding surgery can significantly enhance their quality of life.
Wilmot’s Colorectal Cancer Program has been at the forefront of watch-and-wait organ preservation for nearly a decade, akin to the evolution seen in breast cancer care.
Having practised this relatively new approach to care for nearly 10 years, ‘it’s somewhat similar to the evolution of breast cancer care,’ Dr Fleming said.
While this approach is not yet standard, it is offered through clinical trials, including the Organ Preservation in Patients with Rectal Adenocarcinoma trial, where half of the patients who opted for watch-and-wait avoided surgery long-term.
Despite promising results, Dr Fleming underscores the need for more precise guidelines to broaden the adoption of watch-and-wait care.
Variations in treatment strategies and the demanding nature of follow-up programs pose challenges for patients. Establishing an optimal surveillance approach that balances early cancer detection with practicality is crucial.
Dr Fleming highlighted the importance of integrated healthcare systems like Wilmot’s, where consistent messaging and coordinated follow-up care are prioritised.
However, he acknowledges disparities in resource availability among cancer centres, underscoring the importance of equitable access to this new approach for all eligible patients.
The collaborative effort behind the JAMA Oncology study, involving experts from various institutions, underscores the collective commitment to advancing rectal cancer care.
Dr Fleming and his colleagues advocate for inclusive, patient-centric approaches to ensure all individuals receive the highest quality of care, regardless of their circumstances.
