Patient preferences for active surveillance vs standard surgery after neoadjuvant chemoradiotherapy in oesophageal cancer treatment: The NOSANO‐study

Abstract

Active surveillance may be a safe and effective treatment in oesophageal cancer patients with a clinically complete response after neoadjuvant chemoradiotherapy (nCRT). In the NOSANO-study we gained insight in patients' motive to opt for either an experimental treatment called active surveillance or for standard immediate surgery. Both qualitative and quantitative analyses methods were used. Forty patients were interviewed about their treatment preference, 3 months after completion of nCRT (T1). Data were recorded, transcribed verbatim and analysed according to the principles of grounded theory. In addition, at T1 and T2 (12 months after completion of nCRT) questionnaires on health-related quality of life, coping, anxiety and decisional regret (only T2) were administered. Interview data analyses resulted in a conceptual model with 'dealing with threat of cancer' as the central theme. Patients preferring active surveillance tend to cope with this threat by confiding in their bodies and good outcomes. Their mind-set is one of 'enjoy life now'. Patients preferring surgery tend to cope by minimizing uncertainty and eliminating the source of cancer.Their mind-set is one of 'don't give up, act now'. Furthermore, questionnaire results showed that patients with a preference for standard surgery had a lower quality of life. Patient preferences are individualized and thus difficult to predict. Our model can help healthcare professionals to determine patient preferences for treatment.Coping style and mind-set seem to be determining factors here.

Surgeon's steering behaviour towards patients to participate in a cluster randomised trial on active surveillance for oesophageal cancer: A qualitative study

“…A recently published study from our group suggests that the patients' interpretation of the doctor's advice can influence their treatment preferences. [33] It was found that if a doctor seems -according to the patiententhusiastic about one of both treatment options, the patient is tended to opt for that specific treatment, independent of whether that treatment is active surveillance or surgery. It should however be noted that the patients that participated in this study had a strong preferences for one of the two treatment options.…”

Esophageal cancer patients’ need for information and support in making a treatment decision between standard surgery and active surveillance

“…This was clearly demonstrated by another study from our group, where we found that several patients with a complete clinical response after nCRT worded their motivation for active surveillance treatment as “I feel all good right now, I trust my body, why would I undergo surgery“; and some patients opting for surgery motivated their choice with “I know it may not be necessary to undergo surgery, but I would not forgive myself if I did not do everything that may possibly help”, indicating anticipated regrets. 23 So, in short, the final outcome (i.e., treatment choice) then is the result of a subjective evaluation of multiple factors. As this can be quite complex, presuming that “just providing the facts” will lead to an well‐considered treatment choice is obsolete.…”