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Session: ePoster: Rectal Cancer 8 (Mon1015)

EP756 - Watch and Wait – Can Watchers Watch Better? Database System Monitoring and Notifications for Missed Surveillance

Monday, May 12, 2025
10:53 AM – 10:58 AM PT

    ePoster Presenter(s)

  • Alexander J. Rossi, MD

    Fellow - Colon and Rectal Surgery
    Ochsner Clinic
    New Orleans, LA, United States

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

    • Author(s)

  • Koby Herman, MD

    Research Fellow
    Ochsner Medical Center
    New Orleans, LA, United States

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

  • Renee M. Cholyway, MD (she/her/hers)

    Colon & Rectal Surgery Fellow
    Ochsner Medical Cetner
    New Orleans, LA, United States

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

  • DK

    Danielle Kay, MD

    Surgeon
    Ochsner Medical Center
    New Orleans, Louisiana, United States

    Disclosure information not submitted.

  • William C. Kethman, MD

    Surgeon
    Ochsner Medical Center
    New Orleans, Louisiana, United States

    Disclosure information not submitted.

  • W. Forrest Johnston, MD

    Ochsner Health
    University of Queensland
    New Orleans, LA, US

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

  • BK

    Brian R. Kann, MD

    Chair, Dept of Colon & Rectal Surgery
    Ochsner Medical Center
    University of Queensland/Ochsner Clinical School
    New Orleans, Louisiana, United States

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

    • Senior Author(s)

  • Jennifer L. Paruch, MD (she/her/hers)

    Surgeon, Principal Investigator
    Ochsner Medical Center
    Ochsner Medical Center
    New Orleans, Louisiana, United States

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

All of the relevant financial relationships listed below have been mitigated.
Alexander J. Rossi, MD: This individual has no financial relationships with ineligible companies.
Koby Herman, MD: This individual has no financial relationships with ineligible companies.
Renee M. Cholyway, MD: This individual has no financial relationships with ineligible companies.
W. Forrest Johnston, MD: This individual has no financial relationships with ineligible companies.
Brian R. Kann, MD: This individual has no relevant relationships with ineligible companies.
Jennifer L. Paruch, MD: This individual has no relevant relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Patients with a complete or near complete response to total neoadjuvant therapy (TNT) have an opportunity to preserve their rectum through a Watch & Wait (W&W) surveillance pathway. However, Watch & Wait requires frequent surveillance, and studies suggests that up to 50% of patients miss surveillance intervals. There is currently no standardized or recommended method to track W&W patients. Here, we analyze the impact of a prospective tracking and notification system on completeness of W&W surveillance.

Methods/Interventions: A prospective Redcap database was created to monitor W&W patients. An audit of the database is performed monthly by a research coordinator. When a patient is >30 days late for surveillance, an email is sent to the patient’s surgeon and nurse. The intervention was implemented in April 2023. Patients were grouped as pre- or post-intervention based their date of enrollment in W&W. Patients were categorized as: having never missed, missed a single interval, missed ≥2 consecutive intervals, or missed ≥2 non-consecutive intervals. A sensitivity analysis was completed for the first 12 months of surveillance alone to address the lead-time of the pre-intervention group. Pearson chi square and Fisher’s exact testing were utilized to test for statistical significance.

Results/Outcomes: A total of 53 patients were included in the W&W program between April 2020 and September 2024. There were 34 patients in the pre-intervention and 19 patients in the post-intervention groups. Of the entire cohort, 38 (70.4%) patients missed at least one surveillance interval. On primary analysis, 30(88.2%) of patients in the pre-intervention group and 8(42.1%) in the post-intervention group missed at least 1 interval (p=0.019). In the pre-intervention group, 18(52.9%) of patients missed 2 or more consecutive intervals versus 4(21.2%) post-intervention (p=0.023). On secondary analysis, looking at only the first 12 months of follow-up for each group, 8(42.1%) missed at least 1 interval in the post-intervention group vs. 24(70.6%) in the pre-intervention group (p=0.042). The post-intervention group was also less likely to miss ≥2 consecutive intervals (4(21.1%) vs. 11(32.4%)).

Conclusion/Discussion: Close adherence to Watch & Wait surveillance is critical to identify and treat patients with tumor regrowth. We report the successful implementation of a low-cost system for tracking surveillance intervals and intervening when patients miss an interval. This system was associated with a significant decrease in the number of patients who missed surveillance intervals.