Barriers to Offering Organ Preservation for Rectal Cancer in a Predominantly Hispanic Safety Net Hospital.

Autor: Nasim BW; Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas, USA., Murphy S; Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas, USA., Yracheta J; Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas, USA., Clark AL; Division of Surgical Oncology, Mays Cancer Center, University of Texas Health San Antonio, San Antonio, Texas, USA., Veluri SL; Division of Surgical Oncology, Mays Cancer Center, University of Texas Health San Antonio, San Antonio, Texas, USA., Katabathina V; Department of Radiology, University of Texas Health San Antonio, San Antonio, Texas, USA., Parikh A; Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas, USA.; Division of Surgical Oncology, Mays Cancer Center, University of Texas Health San Antonio, San Antonio, Texas, USA., Campi HD; Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas, USA., Feferman Y; Department of Surgery, Rabin Medical Center, Beilinson Hospital, Tel Aviv, Israel., Russell TA; Division of Colorectal Surgery, University of California Los Angeles, Los Angeles, California, USA., Arora SP; Division of Medical Oncology, Mays Cancer Center, University of Texas Health San Antonio, San Antonio, Texas, USA., Newman N; Department of Radiation Oncology, Mays Cancer Center, University of Texas Health San Antonio, San Antonio, Texas, USA., Logue AJ; Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas, USA.; Division of Surgical Oncology, Mays Cancer Center, University of Texas Health San Antonio, San Antonio, Texas, USA., Court CM; Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas, USA.; Division of Surgical Oncology, Mays Cancer Center, University of Texas Health San Antonio, San Antonio, Texas, USA.
Jazyk: angličtina
Zdroj: Journal of surgical oncology [J Surg Oncol] 2024 Sep 19. Date of Electronic Publication: 2024 Sep 19.
DOI: 10.1002/jso.27893
Abstrakt: Background: Total neoadjuvant therapy (TNT) for locally advanced rectal cancer (LARC) has shown promise in achieving pathologic complete response (pCR) and enabling organ preservation through watch-and-wait (WW) strategies. However, implementation of WW protocols in diverse patient populations and safety-net hospitals faces unique challenges. The objective of this study is to evaluate TNT outcomes and identify barriers to WW implementation in a predominantly Hispanic safety-net hospital in South Texas.
Methods: A retrospective review was conducted of 40 LARC patients treated with TNT at an academic tertiary referral center in South Texas between 2018 and 2023. Patient demographics, disease characteristics, and pCR rates were analyzed. A survey of multidisciplinary providers assessed perceived institutional and patient-related barriers to WW implementation.
Results: The cohort was 70% Hispanic, with a median age of 54 years. Most patients had advanced disease at diagnosis (57.5% T4, 65% N2). The pCR rate was 18.5% (5/27) among patients undergoing surgery. Re-review of MRIs for pCR patients revealed that 2/5 had minimal residual disease. The provider survey identified MRI quality variability, lack of dedicated treatment coordinators, and concerns about patient compliance and financial barriers as key obstacles to WW implementation.
Conclusions: Despite advanced disease presentation in a predominantly Hispanic population, TNT achieved pCR rates comparable to international trials. Institutional and patient-level barriers to WW were identified, informing the development of a tailored WW protocol for this unique patient population.
(© 2024 Wiley Periodicals LLC.)
Databáze: MEDLINE
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