EP1014 - The Other Side of Surveillance - Patients' Perspective on Surveillance Protocols in "Watch-and-Wait" Strategy for Rectal Cancer

Purpose/Background: Locally advanced rectal cancer (LARC) is a complex disease that requires management by a multidisciplinary team. Traditionally, neoadjuvant chemoradiotherapy (nCRT) had been the standard treatment, followed by surgery and subsequent adjuvant chemotherapy. More recently, the use of Total Neoadjuvant Therapy (TNT), in which both preoperative chemotherapy and chemoradiation are given upfront followed by surgery, has become widespread. The morbidity and adverse functional implications of rectal cancer surgery can be significant. In patients who have achieved a complete clinical response (cCR) after TNT, non-operative management via a "Watch-and-Wait" strategy has been implemented with the aim for organ preservation. These protocols require close follow up with frequent digital rectal examination (DRE), endoscopy and imaging. A recent study at a large institution showed less than 50% adherence to surveillance protocols in the first two years of surveillance. Noncompliance places patients at risk of worse outcomes, since tumor regrowth can occur in up to 20% of patients who achieve a cCR. Our objective is to understand patients' perspective on "Watch and Wait" surveillance protocols and identify potential barriers to adherence.

Methods/Interventions: This is a Prospective study. Inclusion, exclusion criteria, and surveillance used in this study are in accordance with "Watch and Wait" practices followed by Covenant HealthCare hospital, which is an accredited center by the National Accreditation Program for Rectal Cancer (NAPRC). Interview questionnaires were obtained from each participant.

Results/Outcomes: A total of 145 patients were diagnosed with rectal cancer and treated at our institution from October 2019 to June 2025. Of these, 72 patients (49.7%) received TNT. A cCR was achieved in 15 of the 72 patients (20.8%). Among those with cCR, local tumor regrowth was observed in 5 patients (33.3%). Ten patients were enrolled in a "Watch and Wait" surveillance protocol following cCR. Of these, seven consented to participate in this study. The primary motivation for enrolling in the "Watch and Wait" protocol, as reported by over 70% of participants, was to avoid a permanent colostomy. Surveillance compliance was 70% in the first year and 85% in the second year. All participants reported that the summary of the surveillance protocol provided to them was clear, useful, and easy to understand. However, 28% of the patients relied only on phone call reminders from the care team to schedule their tests, while 42% reported that notifications they received in the patient portal were sufficient. More than 50% of the patients felt that the tests were too frequent, though 100% strongly agreed that frequent surveillance could help identify early recurrence and believed it could lead to a good outcome.

Conclusion/Discussion: Communication played a key role in improving adherence to the surveillance protocol. Phone call reminders, along with notifications sent through the patient portal, proved to be particularly effective, though still insufficient. To further support adherence, we propose the development of a portable patient card. This card will provide a record of all tests and appointments to complete. This tool is intended to facilitate easier tracking and to encourage greater patient engagement.