eP222 - Barriers to Offering Organ Preservation for Rectal Cancer in a Predominantly Hispanic Safety Net Hospital

Sunday, June 2, 2024

8:00 AM – 8:05 AM ET, USA

Location: Baltimore Convention Center, Room 318-320

ePoster Presenter(s)

Bilal W. Nasim, MD

General Surgery Resident
UT Health San Antonio
UT Health San Antonio
San Antonio, TX, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

SM

Samantha Murphy, MD

General Surgery Resident
UT Health San Antonio
San Antonio, Texas, United States

Disclosure information not submitted.
JY

Jacelyn Yracheta, MD

Colorectal Surgery Fellow
UT Health Houston
Houston, Texas, United States

Disclosure information not submitted.
VK

Venkata Katabathina, MD

Radiologist
UT Health San Antonio
San Antonio, Texas, United States

Disclosure information not submitted.
MK

Mio Kitano, MD, MS

Surgical Oncologist
UT Health San Antonio
San Antonio, Texas, United States

Disclosure information not submitted.
FT

Federico Tozzi, MD

Surgical Oncologist
UT Health San Antonio
San Antonio, Texas, United States

Disclosure information not submitted.
AP

Alexander Parikh, MD, MPH

Surgical Oncologist, Chief of Division
UT Health San Antonio
San Antonio, Texas, United States

Disclosure information not submitted.
HD

Haisar Dao Campi, MD

Colorectal Surgeon
UT Health San Antonio
San Antonio, Texas, United States

Disclosure information not submitted.
SA

Sukeshi P. Arora, MD

Medical Oncologist
UT Health San Antonio
San Antonio, Texas, United States

Disclosure information not submitted.
YF

Yael Feferman, MD

Colorectal Surgeon
Rabin Medical Center
Petah Tikva, Tel Aviv, Israel

Disclosure information not submitted.
TR

Tara A. Russell, MD, MPH, PhD

Assistant Professor
University of California Los Angeles
Los Angeles, California, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.
NN

Neil Newman, MD

Radiation Oncologist
UT Health San Antonio
San Antonio, Texas, United States

Disclosure information not submitted.
AL

Alicia j. Logue, MD

Colorectal Surgeon
UT Health San Antonio
San Antonio, Texas, United States

Disclosure information not submitted.

Senior Author(s)

CC

Colin M. Court, MD, PhD

Surgical Oncologist
UT Health San Antonio
San Antonio, Texas, United States

Disclosure information not submitted.

Purpose/Background: Studies have shown that organ preservation via a watch-and-wait (WW) approach following total neoadjuvant therapy (TNT) is a safe and viable option for patients with locally-advanced rectal cancer. Despite institutional interest, we have not had any patients enroll in WW. Given the continued rise in colorectal cancer among young Hispanics, WW has major clinical and quality of life (QOL) implications for our community. We, therefore, investigated the barriers to instituting WW for the predominantly Hispanic safety net hospital at our institution.Methods/Interventions: Patients with rectal adenocarcinoma deemed eligible for TNT by a multidisciplinary tumor board were enrolled in our IRB-approved observational study. Demographic, clinical, treatment, and pathologic data were collected. A survey of institutional surgeons, oncologists, and radiation oncologists was performed to identify perceived barriers to WW.Results/Outcomes: Between 2018 and 2023, a total of 41 patients were enrolled. Most (75%) were men and predominantly (70.7%) Hispanic with a median age of 54 years. At presentation, 4.9% of patients were T2, 36.6% T3, and 58.5% T4 with a median tumor size of 6.7 cm (IQR 5.0 – 8.5 cm). Initial MRI demonstrated 7.3% of patients were N0, 29.3% N1, and 63.4% N2. Short course radiation was used in 26 (63.4%) patients and 14 (34%) of patients received induction chemotherapy followed by chemoradiation. Of 41 patients, 8 (19.5%) were lost to follow up, 7 (17.1%) are pending surgery, and 1 (2.4%) had an unresectable tumor. The other 25 (61%) patients were resected based on exam and imaging findings of residual tumor. Pathology demonstrated pCR in 5/25 (20%) patients. For pCR patients, median time from completion of TNT to MRI was 4.71 weeks and from MRI to surgery was 6.1 weeks. Re-review of MRIs by an experienced abdominal radiologist revealed that 2/5 (40%) had no or minimal residual disease and 1/5 (20%) MRIs was not of sufficient quality to determine a clinical CR. Of 41 patients, 13 (31.7%) were uninsured and required enrollment in financial assistance programs to complete treatment. Results of the stakeholder survey revealed concerns about patient compliance and resources needed for surveillance, as well as medical literacy, as being the primary barriers to recommending WW.Conclusion/

Discussion: We analyzed the outcomes of TNT for rectal cancer and the barriers to instituting WW at a predominantly Hispanic safety net hospital in South Texas. Despite advanced disease at presentation, as well as issues with follow-up, we demonstrated a pCR rate of 20% in our cohort, comparable with results from international trials. We identified institutional (dedicated radiologist and post-TNT timing) and patient (financial and follow-up assistance concerns) level barriers to instituting WW.