scholarly journals Cost Effectiveness of Watch and Wait Versus Resection in Rectal Cancer Patients with Complete Clinical Response to Neoadjuvant Chemoradiation

2021 ◽  
Author(s):  
Christina Liu Cui ◽  
William Yu Luo ◽  
Bard Clifford Cosman ◽  
Samuel Eisenstein ◽  
Daniel Simpson ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Cost Effectiveness ◽  
Clinical Response ◽  
Disease Progression ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiation ◽  
Complete Clinical Response ◽  
Watch And Wait ◽  
Recurrence Rates ◽  
Life Years

Abstract Background Watch and wait (WW) protocols have gained increasing popularity for patients diagnosed with locally advanced rectal cancer and presumed complete clinical response after neoadjuvant chemoradiation. While studies have demonstrated comparable survival and recurrence rates between WW and radical surgery, the decision to undergo surgery has significant effects on patient quality of life. We sought to conduct a cost-effectiveness analysis comparing WW with abdominoperineal resection (APR) and low anterior resection (LAR) among patients with stage II/III rectal cancer. Methods In this comparative-effectiveness study, we built Markov microsimulation models to simulate disease progression, death, costs, and quality-adjusted life-years (QALYs) for WW or APR/LAR. We assessed cost effectiveness using the incremental cost-effectiveness ratio (ICER), with ICERs under $100,000/QALY considered cost effective. Probabilities of disease progression, death, and health utilities were extracted from published, peer-reviewed literature. We assessed costs from the payer perspective. Results WW dominated both LAR and APR at a willingness to pay (WTP) threshold of $100,000. Our model was most sensitive to rates of distant recurrence and regrowth after WW. Probabilistic sensitivity analysis demonstrated that WW was the dominant strategy over both APR and LAR over 100% of iterations across a range of WTP thresholds from $0–250,000. Conclusions Our study suggests WW could reduce overall costs and increase effectiveness compared with either LAR or APR. Additional clinical research is needed to confirm the clinical efficacy and cost effectiveness of WW compared with surgery in rectal cancer.

scholarly journals Management of the Complete Clinical Response

2017 ◽  
Vol 30 (05) ◽  
pp. 387-394 ◽  
Author(s):  
Guilherme São Julião ◽  
Bruna Vailati ◽  
Ivana Castro ◽  
Debora Raffaele ◽  
Angelita Habr-Gama
Keyword(s):  
Rectal Cancer ◽  
Clinical Response ◽  
Radical Surgery ◽  
Local Relapse ◽  
Neoadjuvant Chemoradiation ◽  
Complete Clinical Response ◽  
Watch And Wait ◽  
Long Term Outcomes

AbstractOrgan preservation is considered in the management of selected patients with rectal cancer. Complete clinical response observed after neoadjuvant chemoradiation for rectal cancer is one of these cases. Patients who present complete clinical response are candidates to the watch-and-wait approach, when radical surgery is not immediately performed and is offered only to patients in the event of a local relapse. These patients are included in a strict follow-up, and up of 70% of them will never be operated during the follow-up. This strategy is associated with similar oncological outcomes as patients operated on, and the advantage of avoiding the morbidity associated to the radical operation. In this article we will discuss in detail the best candidates for this approach, the protocol itself, and the long-term outcomes.

COMPLETE CLINICAL RESPONSE OF RECTAL CANCER TO CHEMORADIOTHERAPY: TACTICS

2017 ◽  
Vol 63 (6) ◽  
pp. 838-842
Author(s):  
Oleg Kit ◽  
Yuriy Gevorkyan ◽  
Natalya Soldatkina ◽  
Marina Gusareva ◽  
Dmitriy Kharagezov ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Clinical Response ◽  
Low Anterior Resection ◽  
Standard Treatment ◽  
Preoperative Radiotherapy ◽  
Complete Clinical Response ◽  
Watch And Wait ◽  
Recurrence Rates ◽  
Pelvic Organs ◽  
Intestinal Stoma

We analyzed literature data and our results of preoperative radiotherapy for 179 patients with resectable rectal cancer T2-4N0-2M0. The purpose of the study was to analyze the complete clinical response to chemoradiotherapy for rectal cancer. The results showed the advantages of monitoring patients with complete clinical response before total mesorectumectomy: no complications and deaths after surgery; absence of a syndrome of low anterior resection of the rectum and dysfunction of the pelvic organs; low intestinal stoma rates; similar overall survival of patients. The problems associated with the “Watch and Wait” tactics were: absence of standardized criteria for including patients in the protocol and absence of the standard protocol of treatment; no reliable criteria for the complete clinical response; high recurrence rates. Thus the “Watch and Wait” approach could be applied during a clinical study at a reference center with a multidisciplinary medical team; otherwise, total mesorectumectomy should be used as the standard treatment for rectal cancer.

Pilot Study of Patients’ Preferences for Immediate Resection Versus a Watch and Wait Approach After Neoadjuvant Chemoradiation for Locally Advanced Rectal Cancer

2020 ◽  
pp. OP.20.00158
Author(s):  
Ashray Gunjur ◽  
Grace Chazan ◽  
Genni Newnham ◽  
Sue-Anne McLachlan
Keyword(s):  
Rectal Cancer ◽  
Locally Advanced ◽  
Survival Rates ◽  
Complete Response ◽  
Advanced Rectal Cancer ◽  
Recurrence Risk ◽  
Locally Advanced Rectal Cancer ◽  
Neoadjuvant Chemoradiation ◽  
Watch And Wait ◽  
Time Tradeoff

PURPOSE: In patients with rectal cancer who achieve a clinical complete response to neoadjuvant chemoradiation, it may be reasonable to adopt a watch-and-wait (W&W) strategy rather than proceed to immediate resection of the rectum. Patient preferences for this strategy are unknown. The primary aim of the current study was to determine the feasibility of assessing hypothetical recurrence and survival differences that relevant patients would tolerate to avoid immediate resection of the rectum. A secondary aim included estimating patients’ tolerance thresholds and the factors that might predict them. METHODS: We developed a study-specific written questionnaire based on a previously validated instrument. Hypothetical time tradeoff tasks were used to determine the recurrence rate patients would accept to adopt a W&W strategy and the survival benefit that would be needed to justify choosing immediate resection over W&W. Feasibility was measured on the basis of response rate, the stated ease of completion and the satisfaction of task, and time used. RESULTS: Twenty of 31 potentially eligible patients completed the study-specific questionnaire. The majority of respondents felt that questions were clear (70%) and not hard to understand (65%). The median acceptable recurrence risk to adopt a W&W strategy was 20% (interquartile range [IQR], 10%-35%). Patients required a median of 2.0 extra years of survival (IQR, 1.0-3.0 years) over a baseline 7.0 years, and they required a median extra 10% (IQR, 4%-19%) over baseline 70% survival rates to justify immediate resection. CONCLUSION: Measuring the preferences of patients with rectal cancer using time tradeoff methods seemed to be feasible. Larger studies are needed to confirm how acceptable a W&W strategy would be for relevant patients.

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