Exploring the Patient Voice in Decisions Around Organ-Preserving Rectal Cancer Treatment

Abstract The patient's decision to pursue organ-sparing treatment for rectal cancer is nuanced and profoundly personal. As organ-sparing approaches like Watch-and-Wait become more widely adopted, it is increasingly important to understand how patients experience and navigate these complex decisions. Patients and providers may weigh treatment outcomes differently, reflecting varied priorities around survival, bowel function, and quality of life. This commentary draws on patient quotes to explore three key stages of decision-making: learning about treatment options, aligning values with choices, and coping with the aftermath of the decision. We highlight that patients often need tailored communication and educational resources to support understanding, that for some, avoiding an ostomy carries as much weight as oncologic outcomes like recurrence and survival, and that coping with intensive surveillance after treatment involves both emotional and logistical challenges that require ongoing support. These reflections underscore the need for accessible, patient-centered educational resources, communication strategies, and decision-support tools as organ-sparing treatments for rectal cancer become more widely implemented.