TY - JOUR
T1 - Patients' and clinicians' preferences in adjuvant treatment for high-risk endometrial cancer
T2 - Implications for shared decision making
AU - Post, Cathalijne C.B.
AU - Mens, Jan Willem M.
AU - Haverkort, Marie A.D.
AU - Koppe, Friederike
AU - Jürgenliemk-Schulz, Ina M.
AU - Snyers, An
AU - Roeloffzen, Ellen M.A.
AU - Schaake, Eva E.
AU - Slot, Annerie
AU - Stam, Tanja C.
AU - Beukema, Jannet C.
AU - van den Berg, Hetty A.
AU - Lutgens, Ludy C.H.W.
AU - Nijman, Hans W.
AU - de Kroon, Cornelis D.
AU - Kroep, Judith R.
AU - Stiggelbout, Anne M.
AU - Creutzberg, Carien L.
N1 - Funding Information:
We thank all participating patients and clinicians for their efforts. We also thank all participating centres. Furthermore, we thank Corine de Jong and Anne-Sophie van den Heerik for sending out paper questionnaires.
Publisher Copyright:
© 2021 The Authors
Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.
PY - 2021/6
Y1 - 2021/6
N2 - BACKGROUND: Decision making regarding adjuvant therapy for high-risk endometrial cancer is complex. The aim of this study was to determine patients' and clinicians' minimally desired survival benefit to choose chemoradiotherapy over radiotherapy alone. Moreover, influencing factors and importance of positive and negative treatment effects (i.e. attribute) were investigated.METHODS: Patients with high-risk endometrial cancer treated with adjuvant pelvic radiotherapy with or without chemotherapy and multidisciplinary gynaecologic oncology clinicians completed a trade-off questionnaire based on PORTEC-3 trial data.RESULTS: In total, 171 patients and 63 clinicians completed the questionnaire. Median minimally desired benefit to make chemoradiotherapy worthwhile was significantly higher for patients versus clinicians (10% vs 5%, p = 0.02). Both patients and clinicians rated survival benefit most important during decision making, followed by long-term symptoms. Older patients (OR 0.92 [95%CI 0.87-0.97]; p = 0.003) with comorbidity (OR 0.34 [95% CI 0.12-0.89]; p = 0.035) had lower preference for chemoradiotherapy, while patients with better numeracy skills (OR 1.2 [95%CI 1.05-1.36], p = 0.011) and chemoradiotherapy history (OR 25.0 [95%CI 8.8-91.7]; p < 0.001) had higher preference for chemoradiotherapy.CONCLUSIONS: There is a considerable difference in minimally desired survival benefit of chemoradiotherapy in high-risk endometrial cancer among and between patients and clinicians. Overall, endometrial cancer patients needed higher benefits than clinicians before preferring chemoradiotherapy.
AB - BACKGROUND: Decision making regarding adjuvant therapy for high-risk endometrial cancer is complex. The aim of this study was to determine patients' and clinicians' minimally desired survival benefit to choose chemoradiotherapy over radiotherapy alone. Moreover, influencing factors and importance of positive and negative treatment effects (i.e. attribute) were investigated.METHODS: Patients with high-risk endometrial cancer treated with adjuvant pelvic radiotherapy with or without chemotherapy and multidisciplinary gynaecologic oncology clinicians completed a trade-off questionnaire based on PORTEC-3 trial data.RESULTS: In total, 171 patients and 63 clinicians completed the questionnaire. Median minimally desired benefit to make chemoradiotherapy worthwhile was significantly higher for patients versus clinicians (10% vs 5%, p = 0.02). Both patients and clinicians rated survival benefit most important during decision making, followed by long-term symptoms. Older patients (OR 0.92 [95%CI 0.87-0.97]; p = 0.003) with comorbidity (OR 0.34 [95% CI 0.12-0.89]; p = 0.035) had lower preference for chemoradiotherapy, while patients with better numeracy skills (OR 1.2 [95%CI 1.05-1.36], p = 0.011) and chemoradiotherapy history (OR 25.0 [95%CI 8.8-91.7]; p < 0.001) had higher preference for chemoradiotherapy.CONCLUSIONS: There is a considerable difference in minimally desired survival benefit of chemoradiotherapy in high-risk endometrial cancer among and between patients and clinicians. Overall, endometrial cancer patients needed higher benefits than clinicians before preferring chemoradiotherapy.
KW - Adjuvant chemotherapy
KW - Chemoradiotherapy
KW - Clinician preferences
KW - Decision-making
KW - Endometrial cancer
KW - Patient preferences
KW - Humans
KW - Middle Aged
KW - Combined Modality Therapy
KW - Endometrial Neoplasms/mortality
KW - Survival
KW - Netherlands
KW - Adjuvants, Immunologic/therapeutic use
KW - Decision Making, Shared
KW - Female
KW - Surveys and Questionnaires
KW - Aged
UR - https://www.scopus.com/pages/publications/85102263520
U2 - 10.1016/j.ygyno.2021.03.004
DO - 10.1016/j.ygyno.2021.03.004
M3 - Article
C2 - 33712276
AN - SCOPUS:85102263520
SN - 0090-8258
VL - 161
SP - 727
EP - 733
JO - Gynecologic Oncology
JF - Gynecologic Oncology
IS - 3
ER -