Surgical resection remains the standard treatment in the management of rectal cancer. Omitting surgery in carefully selected patients who achieve a clinical complete response after neoadjuvant radiotherapy is stated to provide acceptable oncological outcomes. This survey aimed to understand the preference of patients with rectal cancer towards non-operative management (NOM).

A prospective cross-sectional study was conducted among patients diagnosed with locally advanced mid- or lower-third rectal cancer. A structured interview schedule was used to assess the willingness for the trial under various conditions associated with an imaginary scenario of NOM after a complete response to an intensive neoadjuvant treatment. Psychological parameters were collected using Fear of Progression (FOP)-12, Life Orientation Test-Revised, and Multidimensional Health Locus of Control-Form C (MHLC-C). The data was analyzed using descriptive statistics.

Of the 59 patients included, 37.3% expressed an overall willingness for NOM. While 91.5% expressed willingness for the NOM if there were no increased side effects of neoadjuvant treatment, 44.1% reported willingness with even 10% increased side effects, 54.2% with the suggested intensive follow-up schedule, and 10.2% if there was a 25% chance of tumour regrowth. In total, 74.6% and 16.9% consented if the cure rate with NOM was similar to and less than surgery, respectively. Overall, 50% had significant FOP, and 79.7% had low optimism. Comparatively higher MHLC-C score (M = 22.29; SD = 4.33) indicates that the majority of the patients attribute events to luck or fate.

We observed that only one-third of patients in this study preferred a NOM to radical surgery; the decision was mainly driven by FOP and fear of increased side effects of neoadjuvant treatment. Detailed counselling of the patients about the treatment modality and NOM strategy is essential before considering any patient for an intentional watch-and-wait approach.