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Clin Colon Rectal Surg
DOI: 10.1055/a-2771-7640
Review Article

Navigating Complex Choices in Locally Advanced Rectal Cancer: A Review of Patient Decision-Making, Shared Decision-Making Models, and Future Directions

Authors

  • Racquel S. Gaetani

    1   Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, United States

  • Jonathan S. Abelson

    1   Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, United States
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Abstract

Decision-making in oncology is uniquely challenging, requiring patients to interpret complex information, weigh uncertain outcomes, and balance survival with quality-of-life considerations. In locally advanced rectal cancer, evolving treatment options such as total neoadjuvant therapy, selective radiation, and nonoperative management via watch-and-wait have made decision-making increasingly nuanced. These choices are preference-sensitive, meaning the optimal approach depends not on a single clinical standard but on the patient's values, goals, and risk tolerance. This review explores how patients navigate key decision points in locally advanced rectal cancer management. We examine individual-level factors that shape decision-making and describe how patients process trade-offs between oncologic risk and functional outcomes. The review also discusses models that support patient decision-making and outlines future directions for research, clinical training, and the development of tools to better understand and meet patients' decisional needs.

Keywords

locally advanced rectal cancer - decision-making - shared decision-making - rectal cancer


Publication History

Article published online:
16 January 2026

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