QS133 - Sorry We Missed You: A System for Missed Surveillance Intervals in Watch and Wait

Sunday, June 2, 2024

2:00 PM – 2:03 PM ET, USA

Location: Room 327

Quick Shot Presenter(s)

Chad Becnel, MD, MBA

Research Fellow
Ochsner Clinic Foundation
New Orleans, LA, United States

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

Author(s)

HG

Heather Green, MS

Senior Clinical Research Coordinator
Ochsner Health
New Orleans, Louisiana, United States

Disclosure information not submitted.
William Kethman, MD, FACS, FASCRS

Staff Surgeon
Ochsner Health
New Orleans, Louisiana, United States

Disclosure information not submitted.
DK

Danielle Kay, MD

Staff Surgeon
Ochsner
New Orleans, LA, United States

Disclosure information not submitted.
W. Forrest Johnston, MD

Ochsner Health
University of Queensland
New Orleans, LA, United States

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

Senior Staff Surgeon and Vice Chair
Ochsner Clinic
New Orleans, Louisiana, United States

Disclosure information not submitted.
Brian R. Kann, MD, FACS, FASCRS

Chairman & Program Director, Deptartment of Colon & Rectal Surgery
Ochsner Medical Center
University of Queensland/Ochsner Clinical School
New Orleans, Louisiana, United States

Disclosure information not submitted.
CW

Charles Whitlow, M.D., F.A.C.S., F.A.S.C.R.S.

Associate Medical Director, Surgery
Ochsner Medical Center
New Orleans, Louisiana, United States

Disclosure information not submitted.
Jennifer L. Paruch, MD MS FASCRS (she/her/hers)

Staff Surgeon
Ochsner Medical Center
Ochsner Medical Center
New Orleans, Louisiana, United States

Disclosure information not submitted.

Senior Author(s)

MF

Michelle N. Fakler, MD

Colorectal Surgeon
Mount Auburn Hospital
Newtonville, Massachusetts, United States

Disclosure information not submitted.

Purpose/Background: Rigorous adherence to a defined surveillance protocol is critical to the successful management of rectal cancer for patients entered into a Watch and Wait program. As the central member in the multidisciplinary management team, surgeons possess unique responsibilities in surveillance. The goals of this study were to assess regional practice patterns of surveillance, characterize missed surveillance intervals within our system, and design a system to improve surveillance completeness.

Methods/Interventions: We surveyed a group of surgeons at a regional colorectal meeting to assess practice strategies for tracking patients enrolled in Watch and Wait. We then performed a retrospective review of a prospectively maintained database at our institution. Patients were included if they: 1) had a complete clinical response to TNT on endoscopy, DRE, and pelvic MRI, and 2) elected to pursue Watch and Wait. The surveillance protocol included endoscopy with DRE every 3 months and pelvic MRI and CT scan alternating every 6 months. The RedCap database is maintained by a clinical research coordinator (CRC). An active-monitoring intervention was designed to address missed intervals by conducting a monthly audit. If a patient had a missed interval over the past month, the colorectal surgeon was notified by the CRC and the patient rescheduled.

Results/Outcomes: In the survey, 45% (11 of 24) of colorectal surgeons reported heterogeneity within their practice for how Watch and Wait patients were tracked. Within our institution, a total of 38 patients were added to the Watch and Wait database between August 2022 and September 2023. This database includes patients who had been enrolled in Watch and Wait since 2019. Among those, 8 (21.1%) patients had local regrowth and 30 (78.9%) are currently under active surveillance. The rates of missing an endoscopy or imaging interval were 22.4% and 16.8% respectively (p=0.222), with an overall miss rate of 19.6% (Table 1). A total of 20 patients (52.6%) missed at least one surveillance interval, and 8 (21.1%) missed two or more sequential intervals. Among the intervals within the first two years of surveillance, the 12-month colonoscopy and 15-month flexible sigmoidoscopy were the most missed, with completion rates of 21.1% and 35.3% respectively.

Conclusion/Discussion: This study revealed variation in practice among colorectal surgeons offering a Watch and Wait program for patients with rectal cancer. We also found a high rate of patients with missed intervals in surveillance. This highlights the need to examine and improve systems to assist patients and their health care teams in adhering to surveillance protocols, including after missed surveillance intervals. At the time of this presentation, we will have 12-month data on success of the active-monitoring intervention on rate of missed intervals.