Watch-and-Wait Approach for Rectal Cancer Maintains Good Quality of Life: JAMA

A watch-and-wait approach is associated with improved quality of life and functional outcome in patients with rectal cancer who have a clinical complete response after neoadjuvant chemoradiotherapy or radiotherapy.

The study assessed patients' quality of life and functional outcomes, including bowel, urinary, and sexual function, after a watch-and-wait approach.

The study was conducted in two prospective cohort studies which included 278 patients with rectal cancer who had a clinically complete response or near-complete response after neoadjuvant chemoradiotherapy or radiotherapy, discovered that patients who were observed using a watch-and-wait approach reported good quality of life with limited variation over time.

Quality of life was evaluated using several questionnaires, including the European Organisation for Research and Treatment of Cancer–Quality of Life Questionnaire–C30 (EORTC-QLQ-C30) and functional outcome was assessed using several different scoring systems.

The study disclosed the following clinical findings:

1. Patients observed by a watch-and-wait approach reported good quality of life, with limited variation over time. Some patients did report bowel and sexual dysfunction.
2. At 24 months, 55 patients (24.9%) reported major bowel dysfunction.
3. 48 of 151 male patients (31.8%) reported severe erectile dysfunction.
4. Female patients also reported a decrease in sexual satisfaction and overall sexual function during follow-up.
5. Patients who underwent local excision had more major bowel dysfunction (55.6%) than those who did not, but their quality-of-life scores were comparable.
6. Patients scored significantly lower on several quality-of-life subscales after total mesorectal excision.

These findings are important because they can help to counsel patients on what to expect from a watch-and-wait approach.

“A watch-and-wait strategy can result in good quality of life and functional outcomes, but patients should be aware of the possibility of bowel and sexual dysfunction. The study also emphasizes the importance of avoiding surgery whenever possible to preserve the quality of life and functional outcomes.” stated the lead author of the study, Dr. Petra Custers.

Reference:

Custers PA, van der Sande ME, Grotenhuis BA, et al. Long-term Quality of Life and Functional Outcome of Patients With Rectal Cancer Following a Watch-and-Wait Approach. JAMA Surg. Published online March 29, 2023. doi:10.1001/jamasurg.2023.0146