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- Title
Patient preferences for attributes of primary surgical debulking versus neoadjuvant chemotherapy for treatment of newly diagnosed ovarian cancer.
- Authors
Havrilesky, Laura J.; Yang, Jui‐Chen; Lee, Paula S.; Secord, Angeles Alvarez; Ehrisman, Jessie A.; Davidson, Brittany; Berchuck, Andrew; Darcy, Kathleen M.; Maxwell, G. Larry; Reed, Shelby D.; Yang, Jui-Chen
- Abstract
<bold>Background: </bold>Randomized trials have reported conflicting findings on survival for advanced-stage ovarian cancer treated with primary debulking surgery (PDS) versus neoadjuvant chemotherapy with interval debulking; surgical complications and mortality are higher with PDS. We assessed women's preferences for tradeoffs related to this important clinical decision.<bold>Methods: </bold>Ovarian cancer patients were recruited to complete a discrete-choice experiment (DCE) consisting of 8 choice tasks presenting experimentally designed treatment alternatives in terms of treatment order, extent of surgery including risk of ostomy, chance of death from surgical complications (1%-10%), readmission for surgical complications (5%-50%), progression-free survival (1-3 years), and overall survival (3-5 years). Random-parameters logit regression was applied to model participants' choices as a function of attribute levels.<bold>Results: </bold>A total of 101 ovarian cancer survivors completed the DCE survey; of these participants, 30% were receiving chemotherapy at the time, and 33% had prior recurrence. Overall survival was of greatest importance to participants (36/100), followed by risk of readmission due to complications (23/100), progression-free survival (19/100), surgical mortality (16/100), extent of surgery (4/100), and order of surgery and chemotherapy (2/100). Overall, the participants would tolerate a 15-percentage point increase in risk of major complications (95% confidence interval [CI], 3%-29%) or a 4-percentage point increase in the risk of surgical mortality (95% CI, 2%-13%) in order to increase their expected overall survival from 3 to 3.5 years.<bold>Conclusions: </bold>Patients would accept a moderately higher risk of perioperative complications and surgical mortality in exchange for substantial gains in survival. These quantitative findings provide clinicians with a framework to discuss preferences with patients and to incorporate preferences into clinical trial design.
- Subjects
OVARIAN cancer; SURGICAL complications; EXPERIMENTAL design; OSTOMY; DO-not-resuscitate orders; CANCER chemotherapy; PROGRESSION-free survival
- Publication
Cancer (0008543X), 2019, Vol 125, Issue 24, p4399
- ISSN
0008-543X
- Publication type
journal article
- DOI
10.1002/cncr.32447