Background and Objectives Increasing evidence suggests patient‐oriented benefits of nonoperative management (NOM) for rectal cancer. However, vigilant surveillance requires excellent access to care. We sought to examine patient, socioeconomic, and facility‐level factors associated with NOM over time. Methods Using the National Cancer Database (2006–2017), we examined patients with Stage II–III rectal adenocarcinoma, who received neoadjuvant chemoradiation and received NOM versus surgery. Factors associated with NOM were assessed using multivariable logistic regression with backward stepwise selection. Results There were 59,196 surgical and 8520 NOM patients identified. NOM use increased from 12.9% to 15.9% between 2006 and 2017. Patients who were Black (adjusted odds ratio [aOR]: 1.36, 95% confidence interval [CI]: 1.26–1.47), treated at community cancer centers (aOR: 1.22, 95% CI: 1.12–1.30), without insurance (aOR: 1.87, 95% CI: 1.68–2.09), and with less education (aOR: 1.53, 95% CI: 1.42–1.65) exhibited higher odds of NOM. Patients treated at high‐volume centers (aOR: 0.79, 95% CI: 0.74–0.84) and those who traveled >25.6 miles for care (aOR: 0.59, 95% CI: 0.55–0.64) had lower odds of NOM. Conclusions Vulnerable groups who traditionally have difficulty accessing comprehensive cancer care were more likely to receive NOM, suggesting that healthcare disparities may be driving utilization. More research is needed to understand NOM decision‐making in rectal cancer treatment.

Climate change, travel, and urbanization contribute to increasing exposure to Zika, Dengue and Chikungunya. Lab-based diagnostics are required because of overlapping clinical presentations. Here we review the current diagnostic methods, and find them poorly adapted to point of care use in resource-limited settings: generally, serologic assays are hindered by cross-reactivity while molecular assays require laboratory conditions. We conclude that a differential diagnostic device is critically needed, requiring a simpler molecular assay kit that maintains high sensitivity and specificity.

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INTRODUCTION:Increasing evidence suggests patient-oriented benefits of surveillance and non-operative management (NOM) for rectal cancer with complete clinical response after chemoradiation. However, vigilant surveillance requires excellent access to care. We hypothesize that NOM is increasingly common, especially in groups with higher access to care.