Survey results of US radiation oncology providers' contextual engagement of watch-and-wait beliefs after complete clinical response to chemoradiation in patients with local rectal cancer.

e22120 Background: Current multimodality treatment of locally advanced rectal cancer (RC) includes chemotherapy, chemoradiation (CRT) and surgery. Growing clinical data suggest omitting resection (watch-and-wait) for patients (pts) with complete clinical response (cCR) to CRT with salvage resection for local recurrence, may lead to improved quality of life without jeopardizing oncological outcomes. The current acceptance of watch-and-wait by practicing US radiation oncologists (ROs) is unknown. Methods: US ROs completed our IRB-approved anonymous online survey regarding non-surgical management of pts who achieved cCR to neoadjuvant CRT. Self-ranked knowledge of the OnCoRe Project – a large national UK prospective observational study of watch-and-wait – was tested for its correlation with ROs’ attitudes using Chi-squared test. Supporters of observation are those who self-claimed their belief in observation. Results: Of the 220 responses, 61% of respondents practiced for over 10 years since completing residency with 48% (n = 106) supporting the wait-and-watch approach. Forty percent claimed familiarity with the OnCoRe Project publication. Respondents supporting observation were more likely to be familiar with the OnCoRe Project (p-value = 0.029). Among supporters of observation, 59% (n = 62) felt comfortable discussing the watch-and-wait approach and 41% preferred the conversation be initiated by other specialists. There was no association between comfort level in discussing non-surgical management and familiarity with the OnCoRe project. Yet, ROs treating more than 10 RC pts annually felt more more comfortable leading this discussion (p-value = 0.015) compared to ROs seeing fewer patients. Conclusions: Almost half of surveyed US ROs support the watch-and-wait approach, though many do not feel comfortable discussing this treatment paradigm with pts. Knowledge of the OnCoRe Project is associated with support of watch-and-wait, yet not comfort level in leading the discussion. These results inform provider attitudes toward participation in future clinical studies and guidelines in local RC management.