As advancements in cancer therapies continue to improve outcomes for patients, individuals with rectal cancer are increasingly opting for a watch-and-wait approach instead of undergoing surgery, according to a study led by researchers at the Wilmot Cancer Institute. The study, published in JAMA Oncology, revealed that the number of patients choosing to forgo surgery rose nearly 10% between 2006 and 2020. This shift reflects a growing trend towards organ preservation, a care approach that involves regular follow-ups with experienced oncologists over a five-year period. While this approach may require more frequent visits, it offers patients the potential to avoid surgery and the potential long-term impact on their bowel function and quality of life.
Dr. Fergal Fleming, a Wilmot investigator and associate professor of Surgery and Oncology at the University of Rochester Medical Center, emphasized the importance of preserving bowel function and quality of life for patients. He noted that many patients have their lives dictated by their bowel habits and that avoiding surgery can significantly improve their overall well-being. Wilmot’s Colorectal Cancer Program has been implementing the watch-and-wait approach for nearly a decade, with positive outcomes.
The shift towards organ preservation in rectal cancer care is similar to the evolution seen in breast cancer care, where breast conservation is now offered whenever possible. However, the watch-and-wait approach is not yet part of standard clinical care and is primarily available to patients through clinical trials. Wilmot Cancer Institute is involved in several clinical trials, including the national Organ Preservation in Patients with Rectal Adenocarcinoma trial, which recently reported that half of the patients who chose the watch-and-wait approach were able to avoid surgery in the long term. The other half who eventually needed surgery had similar disease-free survival rates as patients who did not undergo the watch-and-wait approach.
While the early results of these trials are promising, Dr. Fleming stresses the need for better guidance before implementing watch-and-wait care more broadly. Current treatment strategies vary, and the intensity and length of the follow-up program can be challenging for patients to adhere to. More research is required to define the optimal surveillance approach that effectively detects cancer recurrence early while being manageable for both health systems and patients.
Dr. Fleming emphasizes the importance of an integrated healthcare system, like the one at Wilmot, where everyone is aligned and provides consistent messages to patients. This integrated approach makes it easier for patients to follow up and coordinate their care across multiple units. However, not all cancer centers have the resources and experience to effectively implement the watch-and-wait approach. Dr. Fleming believes that for this new approach to benefit all eligible patients, it needs to be designed with diversity in mind and implemented equitably across the nation. Wilmot Cancer Institute is committed to providing high-quality rectal cancer care for all patients across its affiliated sites.
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it