Effect of "watch and wait" on fear of recurrence in rectal cancer: a multicenter cross-sectional study

Abstract

12116 Background: Total neoadjuvant therapy (TNT) is now the standard of care for locally advanced rectal cancer. Watch-and-wait (WW) is the most commonly used approach for patients with a complete clinical response. This study aimed to investigate fear of recurrence, presence of depression, clinical symptoms, and functional capacities in WW patients and to identify differences between them and patients who underwent surgery after TNT. Methods: In this multicenter, cross-sectional study, patients were interviewed individually and completed the Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF), Patient Health Questionnaire-9 (PHQ-9), and EORTC QLQ-ANL27. The EORTC QLQ-ANL27 results in two parameters: the symptom scale (SS) and the functional scale (FS). Results: The study included 121 patients who received TNT. The median age was 60 (54-65), and male patients were in the majority at 71 (58.7%). The most common disease location was the distal rectum at 56 (46.3%). In clinical staging, the most common findings were T3 disease at 86 (71.1%) and N1 lymph node status at 63 (52.1%). The number of patients followed up with WW after TNT was 17 (14%). 27 (22.3%) patients achieved a pathological complete response (pCR) after surgery. The median disease-free survival was 21 (11-37.5) months. In surgical patients (n = 104), FCR was 16 (7.25-21), while in WW patients (n = 17), FCR was 18 (9-25), p = 0.464. The PHQ-9 score was 3 (1–10) in surgical patients and 5 (1–9) in WW patients, p = 0.669. SS was 31.7 (21.5-38.8) in surgical patients and 15.9 (12.1-38.6) in WW patients, p = 0.045. FS was 84 (61.3-87.8) in WW patients and 68.2 (61.1-78.4) in surgical patients, p = 0.045. When WW patients and pCR patients were also evaluated, no statistically significant difference was observed in terms of FCR and PHQ-9. SS was 15.9 (12.1-38.6) in WW patients and 31.8 (21.7-49.2) in pCR patients, p = 0.027. FS was 84 (61.3-87.8) in WW patients and 68.1 (50.7-78.2) in pCR patients, p = 0.027. pCR patients were evaluated according to the presence of a permanent stoma. In patients with a stoma (n:9), FCR was 19 (17.5-24.5), while in patients without a permanent stoma (n:18), FCR was 11.5 (3.75-20), p = 0.022. PHQ-9 was 12 (1.5-17) in those with a permanent stoma and 1.5 (1-8) in those without a permanent stoma, p = 0.020.There was no difference between these two groups in terms of SS and FS, p = 0.253. Conclusions: In WW patients, the fear of recurrence does not increase compared to those who underwent surgery after TNT; the level of depression is similar, but their symptoms are fewer, and their functional capacities are better. Considering both the fear of recurrence and the severe depression levels in patients who are particularly pCR and followed up with a permanent stoma, the decision to undergo WW should always be taken into account.