Erin D Kennedy, Anna M Borowiec1, Selina Schmocker2, Charles Cho, James Brierley3,4, Shirley Li5, J Charles Victor6,7, Nancy N Baxter6,8,7,9. 1. Department of Surgery, University of Alberta, Edmonton, Alberta, Canada. 2. Division of General Surgery and Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada. 3. Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada. 4. Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada. 5. Department of Information Analysis and Distribution, Kingston General Hospital, Kingston, Ontario, Canada. 6. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. 7. Sunnybrook Health Sciences Centre, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. 8. Department of Surgery, University of Toronto, Toronto, Ontario, Canada. 9. Division of General Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Although the body of evidence supporting nonoperative management for rectal cancer has been accumulating, there has been little systematic investigation to explore how physicians and patients value the tradeoffs between oncologic and functional outcomes after abdominal perineal resection and nonoperative management. OBJECTIVE: The purpose of this study was to elicit patient and physician preferences for nonoperative management relative to abdominal perineal resection in the setting of low rectal cancer. DESIGN: We conducted a standardized interviews of patients and a cross-sectional survey of physicians. SETTINGS: Patients from 1 tertiary care center and physicians from across Canada were included. PATIENTS: The study involved 50 patients who were previously treated for rectal cancer and 363 physicians who treat rectal cancer. INTERVENTIONS: Interventions included standardized interviews using the threshold technique with patients and surveys mailed to physicians. MAIN OUTCOMES MEASURES: We measured absolute increase risk in local regrowth and absolute decrease in overall survival that patients and physicians would accept with nonoperative management relative to abdominal perineal resection. RESULTS: Patients were willing to accept a 20% absolute increase for local regrowth (ie, from 0% to 20%) and a 20% absolute decrease in overall survival (ie, from 80% to 60%) with nonoperative management relative to abdominal perineal resection, whereas physicians were willing to accept a 5% absolute increase for local regrowth (ie, from 0% to 5%) and a 5% absolute decrease in overall survival (ie, from 80% to 75%) with nonoperative management relative to abdominal perineal resection. LIMITATIONS: Data were subject to response bias and generalizable to only a select group of patients with low rectal cancer. CONCLUSIONS: Offering nonoperative management as an option to patients, even if oncologic outcomes are not equivalent, may be more consistent with the values of patients in this setting. See Video Abstract at http://links.lww.com/DCR/A688.
BACKGROUND: Although the body of evidence supporting nonoperative management for rectal cancer has been accumulating, there has been little systematic investigation to explore how physicians and patients value the tradeoffs between oncologic and functional outcomes after abdominal perineal resection and nonoperative management. OBJECTIVE: The purpose of this study was to elicit patient and physician preferences for nonoperative management relative to abdominal perineal resection in the setting of low rectal cancer. DESIGN: We conducted a standardized interviews of patients and a cross-sectional survey of physicians. SETTINGS: Patients from 1 tertiary care center and physicians from across Canada were included. PATIENTS: The study involved 50 patients who were previously treated for rectal cancer and 363 physicians who treat rectal cancer. INTERVENTIONS: Interventions included standardized interviews using the threshold technique with patients and surveys mailed to physicians. MAIN OUTCOMES MEASURES: We measured absolute increase risk in local regrowth and absolute decrease in overall survival that patients and physicians would accept with nonoperative management relative to abdominal perineal resection. RESULTS:Patients were willing to accept a 20% absolute increase for local regrowth (ie, from 0% to 20%) and a 20% absolute decrease in overall survival (ie, from 80% to 60%) with nonoperative management relative to abdominal perineal resection, whereas physicians were willing to accept a 5% absolute increase for local regrowth (ie, from 0% to 5%) and a 5% absolute decrease in overall survival (ie, from 80% to 75%) with nonoperative management relative to abdominal perineal resection. LIMITATIONS: Data were subject to response bias and generalizable to only a select group of patients with low rectal cancer. CONCLUSIONS: Offering nonoperative management as an option to patients, even if oncologic outcomes are not equivalent, may be more consistent with the values of patients in this setting. See Video Abstract at http://links.lww.com/DCR/A688.
Authors: J W A Leijtens; L J H Smits; T W A Koedam; R G Orsini; S M van Aalten; M Verseveld; P G Doornebosch; E J R de Graaf; J B Tuynman Journal: Tech Coloproctol Date: 2022-08-27 Impact factor: 3.699
Authors: F Al Rashid; A S Liberman; P Charlebois; B Stein; L S Feldman; J F Fiore; L Lee Journal: Tech Coloproctol Date: 2022-03-03 Impact factor: 3.699
Authors: Seth I Felder; Sebastian Feuerlein; Arthur Parsee; Iman Imanirad; Julian Sanchez; Sophie Dessureault; Richard Kim; Sarah Hoffe; Jessica Frakes; James Costello Journal: Abdom Radiol (NY) Date: 2020-10-28
Authors: Erin D Kennedy; Marko Simunovic; Kartik Jhaveri; Richard Kirsch; Jim Brierley; Sébastien Drolet; Carl Brown; Patrick M Vos; Wei Xiong; Tony MacLean; Selliah Kanthan; Peter Stotland; Simon Raphael; Gil Chow; Catherine A O'Brien; Charles Cho; Cathy Streutker; Raimond Wong; Selina Schmocker; Sender Liberman; Caroline Reinhold; Neil Kopek; Victoria Marcus; Alexandre Bouchard; Caroline Lavoie; Stanislas Morin; Martine Périgny; Ann Wright; Katerina Neumann; Sharon Clarke; Nikhilesh G Patil; Thomas Arnason; Lara Williams; Robin McLeod; Gina Brown; Alex Mathieson; Amandeep Pooni; Nancy N Baxter Journal: JAMA Oncol Date: 2019-07-01 Impact factor: 31.777