The OSCoRe Project: One-Stop Rectal Cancer Surveilance

Introduction

For patients with locally advanced rectal cancer (LARC), standard care typically involves neoadjuvant chemoradiotherapy (nCRT) followed by major surgery. However, at the 8–10 week post-nCRT assessment, approximately 15% of patients achieve a clinical complete response (cCR).

These patients can be offered a “Watch and Wait” (W&W) surveillance strategy, allowing them the potential to avoid major surgery entirely. But to remain safe, W&W demands intensive, precise follow-up to ensure any local regrowth (LR) is caught early enough for salvage therapy.

The Challenge with Traditional Follow-Up

⚠️ Service Capacity: The number of surveillance tests jumps from ~16 to ~40 over five years. Tests are frequently uncoordinated, and as new therapies push cCR rates past 30%, the surveillance service risks being completely overwhelmed.

🔒 Patient Safety: NHS resource inefficiencies mean tests are currently performed “whenever slots are available,” creating a real risk for delayed local regrowth (LR) detection.

👥 Patients’ Preferences: The sheer number of separate hospital visits is a major factor in patient decision-making, often translating to high transport costs and lost earnings.

🌱 Environmental Impact: Conducting multiple, uncoordinated individual appointments creates a significant, unquantified increase in the service’s carbon footprint (CF

Our Solution: The ‘One-Stop (OS)’ Clinic

The OSCORE Proposal: We propose establishing One-Stop (OS) follow-up clinics that bundle all required surveillance tests into a single visit at strictly scheduled timepoints, backed by “ring-fenced” radiology and endoscopy slots.

Anticipated Impact:

Maximizing Efficiency: Optimises the use of hard-pressed NHS clinical resources.

Enhancing Safety: Eliminates scheduling delays, ensuring early detection of local regrowth.

Lowering the Carbon Footprint: Drastically cuts down on patient and staff travel emissions.

Reducing Inequalities: Eases the financial burden of transport costs and lost wages for patients