EP620 - Barriers affecting adherence to surveillance in patients undergoing non-operative management of rectal cancer

Purpose/Background: Non-operative management (NOM) has become an alternative management option to surgery for locally advanced rectal cancer patients who achieve a complete clinical response (cCR) after total neoadjuvant therapy (TNT). In addition to preventing surgical morbidities associated with total mesorectal excision (TME), NOM allows for improvement in patients’ quality of life by prevention of post-surgical conditions such as temporary or permanent stomas, low-anterior resection syndrome (LARS), and urinary or sexual dysfunction. While NOM offers many patient benefits, it does commit patients to a rigorous surveillance protocol per the National Comprehensive Cancer Network (NCCN) guidelines consisting of frequent physical and endoluminal examinations in addition to diagnostic imaging studies over a 5-year period. There is currently a lack of literature detailing the effect of such extensive surveillance on patient adherence during NOM.

Methods/Interventions: In the present study, we investigated potential healthcare barriers and patient factors that may affect patient adherence with the surveillance protocol set forth by the NCCN guidelines. A retrospective study was performed and included 46 patients enrolled in the Watch and Wait program from 2016-2024 at a single institution. Adherence was measured as a percentage of patients who strictly followed the surveillance protocol while nonadherence was measured as a percentage of patients who missed one or more surveillance appointments.

Results/Outcomes: Five patients (10.9%) successfully completed 5 years of surveillance without recurrence or non-adherence. Twenty-six (56.5%) patients were actively still undergoing surveillance and deemed adherent as of October 2025. Eleven patients (23.9%) were deemed non-adherent with the surveillance program (54.5% lost to follow-up vs 27.8% due to financial burden vs 18.2% due to comorbid conditions). Three patients (6.5%) had disease recurrence while undergoing surveillance. One patient death (2.2%) without recurrence of rectal cancer was reported during the surveillance period. Factors leading to non-adherence included healthcare costs associated with the surveillance program and inability to take recurrent time away from work.

Conclusion/Discussion: The majority of patients undergoing NOM of rectal cancer were adherent to the strict surveillance guidelines. For those deemed non-adherent, financial cost and inability to take time from work were reported causes for missed appointments.