Survey results of US radiation oncology providers’ contextual engagement of watch-and-wait beliefs after a complete clinical response to chemoradiation in patients with local rectal cancer

Jehan Yahya, Daniel Herzig, Matthew Farrell, Catherine Degnin, Yiyi Chen, John Holland, Simon Brown, Christina Binder, Jerry Jaboin, Vassiliki Liana Tsikitis, Nima Nabavizadeh, Charles R. Thomas Jr, Timur Mitin


Background: Watchful waiting in rectal cancer patients with a complete clinical response (cCR) to chemoradiation therapy (CRT) forgo upfront resection has been proposed. Growing evidence suggests that a watch-and-wait approach using resection for salvage of local recurrence may improve quality of life without jeopardizing outcomes. The current acceptance of watch-and-wait by US radiation oncologists (ROs) is unknown.
Methods: US ROs completed our IRB-approved anonymous e-survey regarding non-surgical management of patients who achieved a cCR to neoadjuvant CRT. Self-ranked knowledge of the OnCoRe Project—UK prospective observational study of watch-and-wait—was tested for its association with ROs’ attitudes using the Chi-squared or Fisher’s test, as indicated. Supporters of observation are self-identified.
Results: Of the 220 respondents, 48% (n=106) of respondents support watchful waiting and 48% claimed familiarity with the OnCoRe Project. Respondents supporting observation were more likely to be familiar with the publication (P=0.029). Among watch-and-wait supporters, 59% (n=62) felt comfortable discussing this approach and 41% preferred the conversation be initiated by other specialists. There was no association between comfort level in discussing watch-and-wait and familiarity with the OnCoRe Project. ROs treating more than 10 locally advanced rectal cancer (LARC) patients annually felt more comfortable discussing watch-and-wait (P=0.015) compared to ROs seeing fewer patients.
Conclusions: Almost half of surveyed US ROs support watch-and-wait, though many do not feel comfortable discussing this paradigm with patients. Knowledge of the OnCoRe Project is associated with support of watch-and-wait, yet not comfort level in leading the discussion. These results inform provider attitudes toward future clinical study participation.