E96: Current Status of Organ Preservation for Locally Advanced Rectal Cancer in Canada: A Survey of Real-World Clinical Practice

Between May and August 2023, we created and piloted a survey to collect information on real-world clinical practice related to primary organ preservation in locally advanced rectal cancer. We invited surgeons, radiation and medical oncologists involved in managing locally advanced rectal cancer in Canada to complete an electronic survey. We used a non-probabilistic convenience sampling strategy, where we identified a single champion from each of the 44 centers in Canada where locally advanced rectal cancer is treated using tri-modality treatment (i.e., radiotherapy, systemic treatment and surgery).

Results:

Responses were received from 40 centers (response rate 91%). The sample included three (8%) medical oncologists, 24 (60%) radiation oncologists and 13 (33%) surgeons from all 10 Canadian provinces. A total of 20 (51%) respondents reported their center offered organ preservation. Organ preservation was offered in all but three provinces. Organ preservation was integrated it into routine clinical practice in seven (35%) centers, whereas some offered it when patients requested it (6, 15%) or refused surgery (8, 20%). Organ preservation was reported to be offered as early as 2010 in one center, whereas 13 (65%) reported offering it only after 2019. Among respondents from centers where organ preservation was not offered, plans for future implementation were noted by six (33.3%) respondents. Among respondents who offered organ preservation, several different treatment strategies were used when planning for organ preservation (Table). The most common challenges to implementing organ preservation were access to MRI (19, 51%), clinic time (17, 46%), timely surgery (15, 41%) and lack of comfort/familiarity with strength of supporting evidence (14, 39%).

Conclusions:

Significant variations in the uptake of organ preservation exist in Canada. The reasons for these variations need to be examined to ensure equitable access to organ preservation. Understanding the challenges can help us to develop solutions that will improve the uptake of organ preservation in the future.