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ARE WE WATCHING OR JUST WAITING? PREDICTIVE FACTORS FOR ADHERENCE WITH SURVEILLANCE AFTER TOTAL NEOADJUVANT THERAPY
Kamil Erozkan, Imran Khan
*, Blake R. Buchalter, David R. Rosen, Keshinro ajaratu, Joshua Sommovilla, Arielle E. Kanters, Michael Valente, Emre Gorgun, Scott Steele, David Liska
Colorectal Surgery, Cleveland Clinic, Cleveland, OH
Background: Total neoadjuvant therapy (TNT) has emerged as a current standard in locally advanced rectal cancer treatment. TNT results in increased complete response rates and thereby enables more patients to be offered organ preservation using watch-and-wait (WW) protocols. Rigorous surveillance during WW is recommended in current guidelines, to allow for the early detection of tumor regrowth. However, adherence to these surveillance protocols can be suboptimal, and predictors influencing adherence have not been thoroughly investigated. We aim to assess compliance with WW surveillance among patients achieving clinical complete response (cCR) following TNT. We hypothesized that perfect compliance with our rigorous surveillance protocol is low, and that overall compliance is associated with demographic factors and socioeconomic status.
Methods: A retrospective review was conducted on patients who were treated with TNT for rectal cancer between 2015 and 2023. The study included patients who achieved a cCR, opted for organ preservation and were subsequently enrolled in WW surveillance. The primary outcome of this study was rate of compliance, which was defined as the ratio of attended surveillance examinations to the total recommended examinations. The secondary outcome was identifying factors associated with adherence.
Results: The study included 113 patients, of which 41 were female (36.3%). The mean age of patients was 59.8 (±12.9) years old. The compliance rate observed was 76.9%, with a median WW and follow-up times of 14 and 30 months, respectively (
Table 1). Notably, only 35 patients (30.9%) achieved perfect compliance, defined as 100% adherence to all surveillance examinations. Patients followed the schedule more closely at the beginning of the WW period (p=0.044). Furthermore, the analysis revealed that compliance with surveillance was not significantly associated with demographic factors such as age, sex, race, socioeconomic status, residential area, or distance from the hospital (
Table 2). However, the study did highlight noteworthy trends: mortality was higher in patients with low adherence (p=0.024) and tumor regrowth was detected more frequently in patients with high adherence (p=0.043).
Conclusion: The study demonstrated that perfect compliance with a rigorous WW protocol is rare. While patients may initially demonstrate good adherence with close surveillance, this compliance tends to diminish over time. The degree of adherence was not associated with educational level and socioeconomic status. Increased focus on patient education, navigation, and coordination is necessary to improve adherence with rigorous WW surveillance protocols.
Table 1
Table 2
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