Strategic efforts for optimal outcomes in patients with low anterior resection syndrome (LARS) at the Vanderbilt-Ingram Cancer Center (VICC).

Abstract

e15643 Background: Low anterior resection (LAR) involves surgical resection of the rectum while sparing the anal sphincter and is frequently performed for rectal cancer. Following surgery, many patients (pts) experience post-operative symptoms, including fecal urgency and incontinence. These symptoms and their impact on patient quality of life comprise Low Anterior Resection Syndrome (LARS). The reported prevalence of LARS varies widely (41-80%) and is likely underreported. Prior studies of LAR found that pts feel unprepared for symptoms associated with LARS, significantly impacting quality of life. Methods: A data search of the electronic medical record at the Vanderbilt-Ingram Cancer Center (VICC) was completed using the gastrointestinal database (GIDB) to estimate prevalence of LARS. Following the data review, a multidisciplinary team of healthcare providers assembled. A strategic plan was formed with the goals of better identifying patients impacted by LARS and offering resources to improve symptoms and quality of life. Results: 1017 pts consented to the VICC GIDB (9/20/2020- 6/1/2024). Of this group, 176 (17%) rectal cancer pts underwent an operation; 107 (61%) underwent LAR. Demographics of LAR pts: 51% female, 76% white, median age at LAR was 51. Only 15 (14%) pts who underwent a LAR had chart documentation of the presence or absence of LARS; at a median follow-up 7 months post-op. The unexpectedly low documentation rate of LARS led to the creation of a strategic initiative to better identify these pts and to offer additional services that may lead to improved quality of life. Objectives include: 1) Establish terminology to better identify existing pts with LARS; 2) Ensure LAR pts complete the LARS scoring survey; 3) Increasing education and offering preventative and treatment measures; 4) Increase awareness among pts, families, providers; 5) Utilize PRO’s and capture metrics pre- and post- operatively at designated time points to measure the pts’ symptoms over time. Conclusions: Among patients who underwent LAR at VICC, fewer patients relative to historical controls were documented to experience LARS, which suggests underdiagnosis. Multidisciplinary strategic efforts can maximize identification of patients and associated symptoms, with provision of outreach and educational programs to potentially improve quality of life for these pts.