OBJECTIVES: Patients with rectal cancer with clinical complete response have two options: (i) further surgery or (ii) watch-and-wait which is an emerging strategy. This study aimed to generate a list of potentially relevant consequences to enable subsequent understanding of their relative value to inform decision-makers about the role of watch-and-wait or surgery.

METHODS:

Potential consequences relevant to rectal cancer were identified from existing Value-Based Assessment Frameworks (VBAFs) covering oncology. Relevant VBAFs were identified using comprehensive pearl growing with bidirectional searching. A bespoke data extraction tool was used to describe each VBAF and the consequences (benefits, harms and costs) mentioned. A thematic approach was taken to group similar consequences into a labelled category. These categories were then collated into core domains. Two reviewers (ST, KP) completed the analysis. A third reviewer (AR) was involved if there were differences of opinion.

RESULTS:

Six VBAFs relevant to oncology were identified and a total list of 86 individual consequences were defined. These 86 consequences were then grouped into 27 categories capturing similar themes and then collated into three domains: Clinical and Technology; Health and Boarder Well-being; Economic, Financial and Health System. Clinical and Technology included clinical outcomes (e.g. overall survival, adverse events) and outcomes related to the technical aspects of the intervention (e.g. time to treatment). Health and Broader Well-being included outcomes that are beyond clinical endpoints (e.g. health related quality of life). Economic, Financial and Health System domain included outcomes that have economic impact and impacts in organisational level (e.g. budget impact, implementation).

CONCLUSIONS:

A large number of disparate consequences relevant to oncology were identified.The relative value attached to these consequences is unknown. Subsequent studies could use a Delphi followed by multi-criteria decision-analysis to quantify the value weights of relevant consequences in the context of rectal cancer interventions.