Patients' preferences for treatment after neoadjuvant chemoradiotherapy for oesophageal cancer

作者：Bo Jan Noordman, Esther Wilhelmina de Bekker-Grob, Peter‐Paul L. O. Coene, Erwin van der Harst, Sjoerd M. Lagarde, Joël Shapiro, Bas P. L. Wijnhoven, J. Jan B. van Lanschot · 发表于：British journal of surgery · 年份：2018 · DOI：10.1002/bjs.10897 · 被引用次数：65 · 研究领域：Esophageal Cancer Research and Treatment、Gastroesophageal reflux and treatments、Esophageal and GI Pathology

BACKGROUND: After neoadjuvant chemoradiotherapy (nCRT) plus surgery for oesophageal cancer, 29 per cent of patients have a pathologically complete response in the resection specimen. Active surveillance after nCRT (instead of standard oesophagectomy) may improve health-related quality of life (HRQoL), but patients need to undergo frequent diagnostic tests and it is unknown whether survival is worse than that after standard oesophagectomy. Factors that influence patients' preferences, and trade-offs that patients are willing to make in their choice between surgery and active surveillance were investigated here. METHODS: A prospective discrete-choice experiment was conducted. Patients with oesophageal cancer completed questionnaires 4-6 weeks after nCRT, before surgery. Patients' preferences were quantified using scenarios based on five aspects: 5-year overall survival, short-term HRQoL, long-term HRQoL, the risk that oesophagectomy is still necessary, and the frequency of clinical examinations using endoscopy and PET-CT. Panel latent class analysis was used. RESULTS: Some 100 of 104 patients (96·2 per cent) responded. All aspects, except the frequency of clinical examinations, influenced patients' preferences. Five-year overall survival, the chance that oesophagectomy is still necessary and long-term HRQoL were the most important attributes. On average, based on calculation of the indifference point between standard surgery and active surveillance, patients were willing to tra...