Nonoperative Management of Rectal Cancer Shows Cost-Effectiveness, but Can Comparative Effectiveness Be Established?
A partir d'un modèle de décision analytique, cette étude estime la survie ajustée sur la qualité de vie ainsi que le rapport coût-efficacité d'une surveillance médicale post-traitement chez les patients avec réponse pathologique complète après une chimioradiothérapie pour traiter un cancer rectal
Locally advanced rectal cancer (LARC) treatment traditionally includes pre-operative chemoradiation, radical surgery, and post-operative chemotherapy.1While highly effective, this standard leads substantialrates of long term morbidity including permanent colostomy, low anterior resection syndrome, urinary dysfunction, and sexual dysfunction.1-3Patients with mid and low rectal cancers who achieve a clinical complete response (cCR) presenta dilemma tothe thoughtful surgeon because thepre-operative discussionmustincludethe very real possibility that the specimen would not contain cancer.Patients’refusal ofradical surgery and surgeon’s desire to balance oncologic outcomes with quality of life have ledinvestigators to embark on organ preservation strategiesin complete responders. While the non-operative management (NOM, also known aswatch-and-wait)strategy has beenincreasinglyaccepted, radical surgery is still considered the standardand randomized evidencedetermining the comparative effectiveness of NOM remainsto be established.In this issue of JNCI, Miller and colleagues evaluate other important considerations of effectiveness, specifically the cost effectiveness and quality-adjusted survival of NOM.