{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T10:15:10Z","timestamp":1788430510262,"version":"build-2803163510"},"reference-count":12,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Locally advanced rectal cancer (LARC) treatment has shifted from the utilization of neoadjuvant chemoradiation (NACRT), followed by total mesorectal excision (TME) and adjuvant chemotherapy (AC) to the implementation of total neoadjuvant therapy (TNT). This transition was influenced by data from multiple studies reporting suboptimal compliance rates to adjuvant chemotherapy. As a result, a paradigm shift to TNT occurred, consisting of chemoradiation with chemotherapy, based on the RAPIDO and PRODIGE-23 studies. Methods: Following IRB approval, a single-institution retrospective chart review was conducted at a tertiary care academic institution for patients with LARC. Demographic, clinical, and treatment data were collected using REDCap. Patients were excluded if under 18 years of age, pregnant, or had stage 1 or metastatic rectal cancer. The primary objective was to evaluate TNT adherence; secondary objectives assessed adherence associations with demographic and clinical variables. Results: Two hundred twenty-nine patients with rectal cancer were initially included in the database, including 153 patients with LARC from 2019 to 2024. One hundred twenty-seven patients underwent TNT with an adherence rate of 87.5%. Statistically significant variables that contributed to adherence include male gender (p = 0.04) and non-use of recreational drugs (p = 0.04). Conclusions: This is the first real-world study assessing TNT adherence. The observed 87.5% adherence rate represents a significant improvement over historical data in which patients were treated with NACRT\/TME\/AC. Statistically significant variables that contributed to TNT adherence included male gender and non-use of recreational drugs. These factors may provide insight into gender differences and behavioral patterns that put patients in an at-risk category for non-adherence.<\/jats:p>","DOI":"10.3390\/cancers18172853","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T09:20:43Z","timestamp":1788427243000},"page":"2853","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Identification of Factors That Determine Adherence for Total Neoadjuvant Therapy in Locally Advanced Rectal Cancer"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-3986-6329","authenticated-orcid":false,"given":"Cynthia","family":"Araradian","sequence":"first","affiliation":[{"name":"Department of Surgery, Oregon Health & Science University, Portland, OR 97239, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]},{"given":"Emmett","family":"Hunnicutt","sequence":"additional","affiliation":[{"name":"School of Medicine, Oregon Health & Science University, Portland, OR 97239, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Siting","family":"Chen","sequence":"additional","affiliation":[{"name":"Biostatistics and Design Program, Oregon Health & Science University, Portland, OR 97239, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Shawna","family":"Rivedal","sequence":"additional","affiliation":[{"name":"Department of Surgery, Oregon Health & Science University, Portland, OR 97239, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"validation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Shelby","family":"Willis","sequence":"additional","affiliation":[{"name":"Department of Surgery, Oregon Health & Science University, Portland, OR 97239, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"validation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0736-1311","authenticated-orcid":false,"given":"Maura","family":"Walsh","sequence":"additional","affiliation":[{"name":"Department of Surgery, Oregon Health & Science University, Portland, OR 97239, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"validation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5216-2971","authenticated-orcid":false,"given":"Vassiliki Liana","family":"Tsikitis","sequence":"additional","affiliation":[{"name":"Department of Surgery, Oregon Health & Science University, Portland, OR 97239, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9097-6968","authenticated-orcid":false,"given":"Sandy Hwang","family":"Fang","sequence":"additional","affiliation":[{"name":"Department of Surgery, Oregon Health & Science University, Portland, OR 97239, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.1056\/NEJMoa060829","article-title":"Chemotherapy with preoperative radiotherapy in rectal cancer","volume":"355","author":"Bosset","year":"2006","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1356","DOI":"10.1093\/annonc\/mdu147","article-title":"Chronicle: Results of a randomised phase III trial in locally advanced rectal cancer after neoadjuvant chemoradiation randomising postoperative adjuvant capecitabine plus oxaliplatin (XELOX) versus control","volume":"25","author":"Counsell","year":"2014","journal-title":"Ann. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1016\/S1470-2045(13)70599-0","article-title":"Fluorouracil-based adjuvant chemotherapy after preoperative chemoradiotherapy in rectal cancer: Long-term results of the EORTC 22921 randomised study","volume":"15","author":"Bosset","year":"2014","journal-title":"Lancet Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2544","DOI":"10.1007\/s00268-019-05060-5","article-title":"Compliance to Adjuvant Chemotherapy of Patients Who Underwent Surgery for Rectal Cancer: Report from a Multi-institutional Research Network","volume":"43","author":"Mari","year":"2019","journal-title":"World J. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1016\/S1470-2045(15)00004-2","article-title":"Effect of adding mFOLFOX6 after neoadjuvant chemoradiation in locally advanced rectal cancer: A multicentre, phase 2 trial","volume":"16","author":"Chow","year":"2015","journal-title":"Lancet Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/S1470-2045(20)30555-6","article-title":"Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): A randomised, open-label, phase 3 trial","volume":"22","author":"Bahadoer","year":"2021","journal-title":"Lancet Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1016\/S1470-2045(21)00079-6","article-title":"Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23): A multicentre, randomised, open-label, phase 3 trial","volume":"22","author":"Conroy","year":"2021","journal-title":"Lancet Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2546","DOI":"10.1200\/JCO.22.00032","article-title":"Organ Preservation in Patients With Rectal Adenocarcinoma Treated With Total Neoadjuvant Therapy","volume":"40","author":"Patil","year":"2022","journal-title":"J. Clin. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)\u2013A metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","year":"2009","journal-title":"J. Biomed. Inform."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1097\/DCR.0b013e3182a857eb","article-title":"Postoperative complications in patients with rectal cancer are associated with delays in chemotherapy that lead to worse disease-free and overall survival","volume":"56","author":"Tevis","year":"2013","journal-title":"Dis. Colon. Rectum."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"220","DOI":"10.3892\/mco.2021.2382","article-title":"Total neoadjuvant therapy in patients with locally advanced rectal cancer: A tertiary medical center experience","volume":"15","author":"Husseini","year":"2021","journal-title":"Mol. Clin. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.ijrobp.2023.07.043","article-title":"Compliance and Toxicity of Total Neoadjuvant Therapy for Rectal Cancer: A Secondary Analysis of the OPRA Trial","volume":"118","author":"Verheij","year":"2024","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/17\/2853\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T09:27:40Z","timestamp":1788427660000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/17\/2853"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,3]]},"references-count":12,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["cancers18172853"],"URL":"https:\/\/doi.org\/10.3390\/cancers18172853","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,3]]}}}