Abstract
BackgroundDecision 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. MethodsPatients 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. ResultsIn 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. ConclusionsThere 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.
Highlights
Endometrial cancer is the most common gynaecological malignancy in developed countries
There is a considerable difference in minimally desired survival benefit of chemoradiotherapy in high-risk endometrial cancer among and between patients and clinicians
Patients received CTRT Patients received RT Radiation Oncologists Gynaecologic Oncologists Medical Oncologists. This patient preference study for high-risk endometrial cancer showed that patients desired higher survival benefits than clinicians before preferring adjuvant chemoradiotherapy over radiotherapy alone
Summary
Endometrial cancer is the most common gynaecological malignancy in developed countries. Adding chemotherapy leads to additional symptoms that may persist (e.g. persisting tingling or numbness of hands or feet reported by 25% of the patients at 3 and 5 years after treatment, and a small deterioration in physical and role functioning during the first 3 years after treatment) [4]. Weighing these pros and cons reflects the complexity of shared decision-making on adjuvant treatment for patients with high-risk endometrial cancer. Influencing factors and importance of positive and negative treatment effects (i.e. attribute) were investigated
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