Patients' preferences for treatment after neoadjuvant chemoradiotherapy for oesophageal cancer

Noordman, Bo Jan; Bekker‐Grob, Esther W. de; Coene, Peter-Paul; Harst, Erwin van der; Lagarde, Sjoerd M.; Shapiro, Joël; Wijnhoven, Bas P. L.; Lanschot, J. Jan B. van

doi:10.1002/bjs.10897

Cited by 41 publications

(31 citation statements)

References 39 publications

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“…We also found that some participants reported difficulty separating their own recent personal experience of revision surgery from the hypothetical scenarios presented in the questionnaire, as they found it hard to imagine receiving a treatment option that differed from the one that they had received. In terms of methodology, many DCEs are conducted with participants who already have some experience of the treatment attributes under investigation 12 19 20 24. In our study previous experience meant that participants had some appreciation of the attributes being tested.…”

Section: Discussionmentioning

confidence: 99%

“…Previous research using discrete choice approaches has explored patient preferences in a surgical context. This has included examination of preferences for surgical versus non-surgical interventions in a range of conditions, such as oesophageal cancer and ulcerative colitis 24 25. Some research has explored preferences for conditions in which there are two surgical options, including for ectopic pregnancy, vaginal wall prolapse and osteoarthritis 26 27.…”

Section: Discussionmentioning

confidence: 99%

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What are patients’ preferences for revision surgery after periprosthetic joint infection? A discrete choice experiment

et al. 2020

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ObjectivesUnderstanding patients’ preferences for treatment is crucial to provision of good care and shared decisions, especially when more than one treatment option exists for a given condition. One such condition is infection of the area around the prosthesis after hip replacement, which affects between 0.4% and 3% of patients. There is more than one treatment option for this major complication, and our study aimed to assess the value that patients place on aspects of revision surgery for periprosthetic hip infection.DesignWe identified four attributes of revision surgery for periprosthetic hip infection. Using a discrete choice experiment (DCE), we measured the value placed on each attribute by 57 people who had undergone either one-stage or two-stage revision surgery for infection.SettingThe DCE was conducted with participants from nine National Health Service hospitals in the UK.ParticipantsAdults who had undergone revision surgery for periprosthetic hip infection (N=57).ResultsOverall, the strongest preference was for a surgical option that resulted in no restrictions on engaging in valued activities after a new hip is fitted (β=0.7). Less valued but still important attributes included a shorter time taken from the start of treatment to return to normal activities (6 months; β=0.3), few or no side effects from antibiotics (β=0.2), and having only one operation (β=0.2).ConclusionsThe results highlight that people who have had revision surgery for periprosthetic hip infection most value aspects of care that affect their ability to engage in normal everyday activities. These were the most important characteristics in decisions about revision surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

What are patients’ preferences for revision surgery after periprosthetic joint infection? A discrete choice experiment

et al. 2020

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“…9 What to do after complete response is still under debate 19 but patients seem to be willing to trade a substantial 5-year survival for a reduction in the risk of a possible esophagectomy. 25 Thus, it appears essential to have precise prognostic markers to satisfy the patients' need of avoiding overtreatment. Several studies have focused on this topic.…”

Section: Discussionmentioning

confidence: 99%

Immune surveillance activation after neoadjuvant therapy for esophageal adenocarcinoma and complete response

et al. 2020

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After neoadjuvant chemoradiotherapy for esophageal adenocarcinoma, up to 29% of patients have a pathological complete response (pCR). What to do afterward is still under debate. The aim of this prospective study was to define which local markers of immune response might act as predictors of pCR and of recurrence after pCR. The peritumoral healthy mucosa of the surgical specimen was sampled at esophagectomy and analyzed by immunohistochemistry, flow cytometry and Real-Time PCR. One hundred and twenty-three patients received neoadjuvant therapy for esophageal adenocarcinoma and were included in the study. Significantly higher rate of natural killer (NK) cells (CD57+), intraepithelial CD8 + T lymphocytes and degranulating T-and NK-cells (CD107+) were observed in the healthy mucosa of patients with pCR. Moreover, pCR was characterized by a lower immune-check points gene expression level. T-cell activation markers mRNA levels were significantly lower in patients with pCR and recurrent disease, showing an excellent accuracy in the prediction of the postoperative recurrence. Costimulatory molecules mRNA relative levels tended to be lower in patients with pCR and recurrent disease, showing a good accuracy in the prediction of postoperative recurrence in patients with pCR. The immune profile identified in this study might further be tested in large prospective trials as marker of pCR after neoadjuvant therapy and as predictor of recurrence after pCR.

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“…Interestingly, they found that many patients were willing to trade off substantial 5-years survival to achieve a reduction in the risk of esophagectomy. 16…”

Section: Wait and See Vs Surgerymentioning

confidence: 99%

New Trend of Surgery in Locally Advanced Esophageal Squamous Cell Carcinoma Patients

Rerkrak

Sunpaweravong

2021

J Health Sci Med Res

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The treatment of locally advanced esophageal squamous cell carcinoma is still controversial. Although, preoperative chemoradiation, followed by esophagectomy is the standard treatment, morbidity and patients’ quality of life problems after an esophagectomy are still considerable. Since a good pathologic complete response rate in patients after preoperative chemoradiation, a wait and see policy (with active surveillance) has been introduced as a new alternative approach after chemoradiation. Active surveillance involves imaging and biopsy evaluations in patients after chemoradiation to detect residual or recurrent tumors. If there are no residual tumors, observation is considered. Surgery is reserved for patients who present with residual tumors or locoregional recurrence after surveillance to achieve complete resection (salvage esophagectomy). Based on evidence from recent studies, surveillance with salvage esophagectomy is a treatment option for locally advanced esophageal squamous cell carcinoma patients achieving a clinical complete response after chemoradiation.

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Patients' preferences for treatment after neoadjuvant chemoradiotherapy for oesophageal cancer

Abstract: Patients are willing to trade off substantial 5-year survival to achieve a reduction in the risk that oesophagectomy is necessary.

Cited by 41 publications

References 39 publications

What are patients’ preferences for revision surgery after periprosthetic joint infection? A discrete choice experiment

What are patients’ preferences for revision surgery after periprosthetic joint infection? A discrete choice experiment

Immune surveillance activation after neoadjuvant therapy for esophageal adenocarcinoma and complete response

New Trend of Surgery in Locally Advanced Esophageal Squamous Cell Carcinoma Patients

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