Patient's Preferences for Adjuvant Postoperative Chemoradiation Therapy in Rectal Cancer

Couture, Jean; Chan, Ron; Bouharaoui, Fatima

doi:10.1007/s10350-005-0174-x

Cited by 14 publications

(20 citation statements)

References 16 publications

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“…The preferences of choosing an adjuvant post-or preoperative therapy have also been the focus of CRC-specific preference studies. Couture et al (2005) found a median point of 5% likelihood of recurrence to choose adjuvant post-operative chemoradiation while Pieterse et al (2007) showed a mean minimum benefit of 4% to undergo PRT. However, the latter authors also found 17% of patients refusing the adjuvant treatment in general; however, subgroup results were not reported.…”

Section: Discussionmentioning

confidence: 99%

“…Couture et al . () found a median point of 5% likelihood of recurrence to choose adjuvant post‐operative chemoradiation while Pieterse et al . () showed a mean minimum benefit of 4% to undergo PRT.…”

Section: Discussionmentioning

confidence: 99%

“…Couture et al . () showed that older patients and those with bad experiences of radiotherapy were less likely to choose this adjuvant therapy form. These results are in line with Dunn et al .…”

Section: Discussionmentioning

confidence: 99%

“…More than 50% would give up a mean of almost 25% of their life to avoid chemoradiotherapy. Couture et al (2005) used the Treatment Trade-Off method to measure rectal cancer patients' preferences with regard to adjuvant post-operative chemoradiation. Thresholds were found out by varying the likelihood of recurrence.…”

Section: Treatment Preferencesmentioning

confidence: 99%

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Preferences of colorectal cancer patients for treatment and decision-making: a systematic literature review

Damm

Vogel

Prenzler

2014

Eur J Cancer Care (Engl)

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Treatment decisions in life-threatening diseases, like colorectal cancer (CRC), are crucial, since they have a great impact on patient's survival and health-related quality of life. Thereby, the inclusion of patient's preferences becomes more and more important; however, these first need to be identified. Therefore, we conducted a systematic literature review in 12 electronic databases, published between 2000 and 2012, in order to identify patient's preferences concerning treatment preferences and involvement in the decision-making process. Nineteen studies were included and thoroughly analysed. This review shows that CRC patients do have preferences regarding different treatment options and outcomes; however, these preferences are not homogenous and seem to depend on personal factors like age and gender. Despite the existence of these preferences, the majority of patients prefer a passive role in the decision-making process, which in part may be explained by the severity of the disease. Again, subgroup analyses reveal the impact of personal factors like gender and education on the preference. Due to the importance of personal factors in the analysis of patient preferences, we identified an urgent need for larger studies that are suitable for subgroup analyses and incorporate multi-attributive measurement techniques, like discrete choice methods.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Treatment Preferencesmentioning

confidence: 99%

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Preferences of colorectal cancer patients for treatment and decision-making: a systematic literature review

Damm

Vogel

Prenzler

2014

Eur J Cancer Care (Engl)

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“…Patients’ preferences for chemotherapy in CRC have previously been examined by determining the amount of life cancer patients are willing to forgo to avoid treatment,13 the survival benefit needed to make chemotherapy worthwhile,14 and the recurrence rate at which patients will change their preference from surgery alone to surgery plus chemoradiation 15. Although the strength of patients’ preferences has been explored, less is known about the processes that influence these preferences.…”

Section: Introductionmentioning

confidence: 99%

Adjuvant chemotherapy for colorectal cancer: age differences in factors influencing patients' treatment decisions

Jorgensen¹,

Young²,

Solomon³

2013

PPA

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PurposeOlder colorectal cancer patients are significantly less likely than younger patients to receive guideline-recommended adjuvant chemotherapy. Previous research has indicated that patient refusal of treatment is a contributing factor. This study aimed to identify potential barriers to adjuvant chemotherapy use in older patients by examining the associations between patient age, factors influencing chemotherapy treatment decisions, and preferences for information and decision-making involvement.Patients and methodsSixty-eight patients who underwent surgery for colorectal cancer in Sydney, Australia, within the previous 24 months completed a self-administered survey.ResultsFear of dying, health status, age, quality of life, and understanding treatment procedures and effects were significantly more important to older patients (aged ≥65 years) than younger patients in deciding whether to accept chemotherapy (all P < 0.05). Reducing the risk of cancer returning and physician trust were important factors for all patients. Practical barriers such as traveling for treatment and cost were rated lowest. Older patients preferred less information and involvement in treatment decision making than younger patients. However, 60% of the older group wanted detailed information about chemotherapy, and 83% wanted some involvement in decision making. Those preferring less information and involvement still rated many factors as important in their decision making, including understanding treatment procedures and effects.ConclusionA range of factors appears to influence patients’ chemotherapy decision making, including, but not limited to, survival benefits and treatment toxicity. For older patients, balancing the risks and benefits of treatment may be made more complex by the impact of emotional motivators, greater health concerns, and conflicts between their need for understanding and their information and decision-making preferences. Through greater understanding of perceived barriers to treatment and unique motivators for treatment choice, physicians may be better able to support older patients to make informed decisions about their care.

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Safety and Feasibility of Using Magnetic Resonance Imaging Criteria to Identify Patients With “Good Prognosis” Rectal Cancer Eligible for Primary Surgery

et al. 2019

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IMPORTANCE Chemoradiotherapy (CRT), followed by surgery, is the recommended approach for stage II and III rectal cancer. While CRT decreases the risk of local recurrence, it does not improve survival and leads to poorer functional outcomes than surgery alone. Therefore, new approaches to better select patients for CRT are important. OBJECTIVE To conduct a phase 2 study to evaluate the safety and feasibility of using magnetic resonance imaging (MRI) criteria to select patients with "good prognosis" rectal tumors for primary surgery. DESIGN, SETTING, AND PARTICIPANTS Prospective nonrandomized phase 2 study at 12 high-volume colorectal surgery centers across Canada. From September 30, 2014, to October 21, 2016, a total of 82 patients were recruited for the study. Participants were patients newly diagnosed as having rectal cancer with MRI-predicted good prognosis rectal cancer. The MRI criteria for good prognosis tumors included distance to the mesorectal fascia greater than 1 mm; definite T2, T2/early T3, or definite T3 with less than 5 mm of extramural depth of invasion; and absent or equivocal extramural venous invasion. INTERVENTIONS Patients with rectal cancer with MRI-predicted good prognosis tumors underwent primary surgery. MAIN OUTCOMES AND MEASURES The primary outcome was the proportion of patients with a positive circumferential resection margin (CRM) rate. Assuming a 10% baseline probability of a positive CRM, a sample size of 75 was estimated to yield a 95% CI of ±6.7%. RESULTS Eighty-two patients (74% male) participated in the study. The median age at the time of surgery was 66 years (range, 37-89 years). Based on MRI, most tumors were midrectal (65% [n = 53]), T2/early T3 (60% [n = 49]), with no suspicious lymph nodes (63% [n = 52]). On final pathology, 91% (n = 75) of tumors were T2 or greater, 29% (n = 24) were node positive, and 59% (n = 48) were stage II or III. The positive CRM rate was 4 of 82 (4.9%; 95% CI, 0.2%-9.6%). CONCLUSIONS AND RELEVANCE The use of MRI criteria to select patients with good prognosis rectal cancer for primary surgery results in a low rate of positive CRM and suggests that CRT may not be necessary for all patients with stage II and III rectal cancer.

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Patient's Preferences for Adjuvant Postoperative Chemoradiation Therapy in Rectal Cancer

Abstract: This small study demonstrates a substantial variation in patient's preferences with regard to postoperative chemoradiation for rectal cancer. Further studies in the preoperative setting are warranted.

Cited by 14 publications

References 16 publications

Preferences of colorectal cancer patients for treatment and decision-making: a systematic literature review

Preferences of colorectal cancer patients for treatment and decision-making: a systematic literature review

Adjuvant chemotherapy for colorectal cancer: age differences in factors influencing patients' treatment decisions

Safety and Feasibility of Using Magnetic Resonance Imaging Criteria to Identify Patients With “Good Prognosis” Rectal Cancer Eligible for Primary Surgery

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Patient's Preferences for Adjuvant Postoperative Chemoradiation Therapy in Rectal Cancer

Abstract: This small study demonstrates a substantial variation in patient's preferences with regard to postoperative chemoradiation for rectal cancer. Further studies in the preoperative setting are warranted.

Cited by 14 publications

References 16 publications

Preferences of colorectal cancer patients for treatment and decision-making: a systematic literature review

Preferences of colorectal cancer patients for treatment and decision-making: a systematic literature review

Adjuvant chemotherapy for colorectal cancer: age differences in factors influencing patients&#39; treatment decisions

Safety and Feasibility of Using Magnetic Resonance Imaging Criteria to Identify Patients With “Good Prognosis” Rectal Cancer Eligible for Primary Surgery

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Adjuvant chemotherapy for colorectal cancer: age differences in factors influencing patients' treatment decisions