Lof Pien, van Soolingen Neeltje J, Piek Jurgen M J, Aarts Johanna W M, Retèl Valesca P, Bukman Maarten, Smorenburg Carolina H, van Driel Willemien J, Amant Frédéric, Trum Johannes W, Lok Christianne A R
Department of Gynecologic Oncology, Center for Gynecologic Oncology Amsterdam, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
Department of Obstetrics and Gynecology, Catharina Hospital, Catharina Cancer Institute, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands.
Gynecol Oncol. 2024 Aug;187:227-234. doi: 10.1016/j.ygyno.2024.05.018. Epub 2024 May 31.
Treatment of advanced-stage ovarian cancer contains cytoreductive surgery (CRS) and chemotherapy. Achieving successful CRS (≤ 1 cm residual disease) is prognostically important, but may not be feasible peri-operatively while still risking complications. Therefore, patients' treatment expectations are important to discuss. We investigated patient considerations for interval CRS.
Patients with advanced-stage ovarian cancer planned for interval CRS completed a questionnaire about the impact of chance of successful CRS, survival benefit and becoming care-dependent on decision-making regarding CRS. The questionnaire included a vignette study, in which patients repeatedly chose between two treatment scenarios with varying levels for chance of successful CRS, survival benefit and risk of complications including stoma. Patient preferences were analyzed, including differences between patients aged < 70 and ≥ 70 years.
Among 85 included patients, 31 (37%) patients considered interval CRS worthwhile irrespective of survival benefit and 33 (39%) irrespective of chance of successful surgery. However, 34 patients (41%) considered interval CRS only worthwhile if survival benefit was > 12 months, while 41 (49%) thought so if chance of successful surgery was ≥ 25%. Older patients considered these factors more important. Overall, 27% considered becoming permanently dependent of home care unacceptable. In the vignette study (n = 72) risk of complications and stoma were considered less important than chance of successful CRS and survival benefit.
Survival benefit, chance of successful surgery and becoming care-dependent are important factors in patient's decision for interval CRS, while risk of complications and stoma are less important. Our results are useful in shared decision-making for interval CRS in ovarian cancer.
