Department of Radiation-Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands.
Dis Colon Rectum. 2018 Aug;61(8):911-919. doi: 10.1097/DCR.0000000000001029.
Organ-sparing approaches, including wait-and-see and local excision, are increasingly being offered to patients with rectal cancer following a good response to neoadjuvant therapy. Preferences regarding these treatment strategies are yet unknown.
This study aimed to determine the preferences and utility scores for rectal cancer treatment approaches.
This is a cross-sectional study.
This study was conducted at the Radiation-Oncology Department of the University Medical Center Utrecht.
Fifty-seven patients with a history of rectal cancer and 38 volunteers were included.
Participants assessed 6 hypothetical treatment-outcome scenarios, including short-course radiotherapy or chemoradiation followed by abdominoperineal resection, low anterior resection, local excision, or a wait-and-see approach. The hierarchy in preferences between scenarios was assessed by using ranking. Utilities were estimated with a visual analog scale and time trade-off.
Organ-sparing approaches were ranked as the first preferred treatment option by 51% of the participants. Among all scenarios, wait-and-see was most often ranked highest by patients and volunteers (36% and 50%). Meanwhile, a substantial proportion ranked wait-and-see as their lowest preference (38% in patients and 35% in volunteers). Utility scores differed significantly between scenarios. Wait-and-see received a significantly higher score on the visual analog scale than the scenarios including abdominoperineal resection and the scenario including chemoradiation with low anterior resection, and a score similar to the scenarios including local excision and short-course radiotherapy with low anterior resection.
The study population consisted of patients with a history of rectal cancer treatment and volunteers related to patients. This may have influenced preferences.
This study suggests that there is a wide disparity in preferences concerning organ-sparing approaches for rectal cancer in both patients with a history of rectal cancer and volunteers. Wait-and-see is often the highest preferred treatment, but it is also among the least preferred treatment options. These findings give insights into how patients may value the current rectal cancer treatment options. See Video Abstract at http://links.lww.com/DCR/A521.
新辅助治疗后反应良好的直肠癌患者，越来越多地选择保器官治疗方法，包括观察等待和局部切除。但这些治疗策略的偏好尚不清楚。
本研究旨在确定直肠癌治疗方法的偏好和效用评分。
这是一项横断面研究。
乌得勒支大学医学中心放射肿瘤科。
57 例直肠癌病史患者和 38 名志愿者纳入研究。
参与者评估了 6 种假设的治疗结果情景，包括短程放疗或放化疗后腹会阴切除术、低位前切除术、局部切除或观察等待。通过排序评估方案间偏好的等级顺序。采用视觉模拟评分和时间权衡法评估效用。
51%的参与者将保器官治疗方法列为首选治疗方案。在所有情景中，观察等待策略最常被患者和志愿者列为首选（36%和 50%）。同时，相当一部分患者和志愿者将观察等待策略列为最低偏好（38%和 35%）。各情景间的效用评分存在显著差异。在视觉模拟评分上，观察等待显著高于包括腹会阴切除术的情景和包括放化疗+低位前切除术的情景，与包括局部切除术和短程放疗+低位前切除术的情景相似。
研究人群包括直肠癌治疗史患者和与患者相关的志愿者。这可能影响了偏好。
本研究表明，在直肠癌病史患者和志愿者中，对直肠癌保器官治疗方法的偏好存在广泛差异。观察等待通常是首选治疗方法，但也是最不受欢迎的治疗方法之一。这些发现深入了解了患者如何看待当前的直肠癌治疗选择。[观看视频摘要，网址：http://links.lww.com/DCR/A521。]
