Nonoperative Management for Rectal Cancer: A Qualitative Study of Patient Perceptions, Priorities, Barriers, and Facilitators to Surveillance.
Source: PubMed, NCBI / U.S. National Library of Medicine
Nonoperative management for rectal cancer is increasingly used, offering organ preservation for patients with a clinical complete response after neoadjuvant therapy. However, patients undergoing nonoperative management face a heightened risk of local regrowth and undergo intensive surveillance. Despite growing interest in nonoperative management, the patient experience and factors contributing to suboptimal surveillance are not well characterized. To explore patient perceptions, priorities, barriers, and facilitators related to care while undergoing nonoperative management after total neoadjuvant therapy for rectal cancer. Qualitative descriptive study using semistructured Zoom interviews that explored the patient experience with nonoperative management. Inductive thematic analysis was performed on interview transcripts. Single academic institution. Purposively sampled adults diagnosed with stage I to III rectal adenocarcinoma who completed total neoadjuvant therapy, achieved a clinical complete or near complete response, and elected nonoperative management were included. Patient perceptions and priorities in rectal cancer care for those on nonoperative management, as well as the barriers and facilitators to achieving recommended surveillance. Fifteen patients (8 women, 13 White individuals, median age 66 years [range, 56-81 years]) who were a median of 5 years from their decision to pursue nonoperative management participated in this study. Local regrowth occurred in 5 patie
Abstract
Nonoperative management for rectal cancer is increasingly used, offering organ preservation for patients with a clinical complete response after neoadjuvant therapy. However, patients undergoing nonoperative management face a heightened risk of local regrowth and undergo intensive surveillance. Despite growing interest in nonoperative management, the patient experience and factors contributing to suboptimal surveillance are not well characterized. To explore patient perceptions, priorities, barriers, and facilitators related to care while undergoing nonoperative management after total neoadjuvant therapy for rectal cancer. Qualitative descriptive study using semistructured Zoom interviews that explored the patient experience with nonoperative management. Inductive thematic analysis was performed on interview transcripts. Single academic institution. Purposively sampled adults diagnosed with stage I to III rectal adenocarcinoma who completed total neoadjuvant therapy, achieved a clinical complete or near complete response, and elected nonoperative management were included. Patient perceptions and priorities in rectal cancer care for those on nonoperative management, as well as the barriers and facilitators to achieving recommended surveillance. Fifteen patients (8 women, 13 White individuals, median age 66 years [range, 56-81 years]) who were a median of 5 years from their decision to pursue nonoperative management participated in this study. Local regrowth occurred in 5 patients, 4 experienced distant metastases, and 1 had a permanent stoma. Treatment team recommendations strongly influenced treatment choice. Facilitators of surveillance included trusting, communicative provider relationships, positive patient outlook, and social support. Frequent appointments and uncertainty surrounding recurrence contributed to anxiety, which interfered with engagement in surveillance. This study is limited by selection bias and focus on a single-institution experience. Patients undergoing nonoperative management generally reported positive experiences supported by provider relationships and social networks. However, emotional burden and social and logistical demands posed significant barriers to surveillance. These findings can inform shared decision-making and highlight the need for system-level interventions to support patients throughout nonoperative management. See Video Abstract. ANTECEDENTES:El tratamiento no quirúrgico del cáncer rectal se utiliza cada vez más, ya que permite preservar el órgano en pacientes con una respuesta clínica completa tras la terapia neoadyuvante. Sin embargo, los pacientes sometidos a tratamiento no quirúrgico se enfrentan a un mayor riesgo de recidiva local y son objeto de una vigilancia intensiva. A pesar del creciente interés por el tratamiento no quirúrgico, la experiencia de los pacientes y los factores que contribuyen a una vigilancia subóptima no están bien caracterizados.OBJETIVO:Explorar las percepciones, prioridades, barreras y facilitadores de la atención de los pacientes mientras se someten a un tratamiento no quirúrgico después de una terapia neoadyuvante total para el cáncer rectal.DISEÑo:Estudio descriptivo cualitativo mediante entrevistas semiestructuradas por Zoom que exploraron la experiencia de los pacientes con el tratamiento no quirúrgico. Se realizó un análisis temático inductivo de las transcripciones de las entrevistas.ENTORNO:Una sola institución académica.PACIENTES:Adultos seleccionados deliberadamente diagnosticados con adenocarcinoma rectal en estadio I-III que completaron la terapia neoadyuvante total, lograron una respuesta clínica completa o casi completa y optaron por el tratamiento no quirúrgico.PRINCIPALES MEDIDAS DE RESULTADO:Percepciones y prioridades de los pacientes en la atención del cáncer rectal para aquellos en tratamiento no quirúrgico, así como las barreras y los facilitadores para lograr la vigilancia recomendada.RESULTADOS:Participaron quince pacientes (8 mujeres, 13 blancos, edad media de 66 años [rango: 56-81 años]), con una mediana de 5 años desde su decisión de seguir un tratamiento no quirúrgico. Se produjo un recidiva local en 5 pacientes, 4 experimentaron metástasis a distancia y 1 tuvo un estoma permanente. Las recomendaciones del equipo de tratamiento influyeron considerablemente en la elección del tratamiento. Los facilitadores de la vigilancia incluyeron la confianza, las relaciones comunicativas con los proveedores, la actitud positiva de los pacientes y el apoyo social. Las citas frecuentes y la incertidumbre en torno a la recurrencia contribuyeron a la ansiedad, lo que interfirió en la participación en la vigilancia.LIMITACIONES:Este estudio tiene limitaciones debido al sesgo de selección y al hecho de centrarse en la experiencia de una sola institución.CONCLUSIONES:Los pacientes sometidos a un tratamiento no quirúrgico informaron en general de experiencias positivas respaldadas por la relación con el proveedor y las redes sociales. Sin embargo, la carga emocional y las exigencias sociales y logísticas supusieron importantes obstáculos para la vigilancia. Estos resultados pueden servir de base para la toma de decisiones compartida y ponen de relieve la necesidad de intervenciones a nivel del sistema para apoyar a los pacientes a lo largo del tratamiento no quirúrgico. (AI-generated translations ).