Authors: Esther W de BekkerGrob Eva J Niers J Jan B van Lanschot Ewout W Steyerberg Bas P L Wijnhoven
Publish Date: 2015/07/14
Volume: 39, Issue: 10, Pages: 2492-2499
Abstract
We conducted a discrete choice experiment among adult patients who had undergone esophagectomy for adenocarcinoma or squamous cell cancer of the esophagus Patients’ preferences were quantified with regression analysis using scenarios based on five aspects risk of inhospital mortality risk of persistent symptoms chance of 5year survival risk of surgical and nonsurgical complications and hospital volume of esophageal cancer surgeryThe response rate was 68 104/142 All aspects proved to influence patients’ preferences p 005 Persisting gastrointestinal symptoms and 5year survival were the most important attributes but preferences varied between patients On average patients were willing to tradeoff 95 CI 24–166 5year survival chance to obtain a surgical treatment with 30 lower risk of gastrointestinal symptoms or 81 CI 40–122 5year survival chance for being treated in a high instead of a lowvolume hospitalPatients are willing to tradeoff some 5year survival chance to achieve an improvement in early outcomes Given the preference heterogeneity among participants the present study underlines the importance of a patienttailored approach when discussing prognosis and treatmentEsophageal cancer is an aggressive disease with a 15 overall 5year survival rate 1 Surgery ie esophagectomy combined with neoadjuvant therapy offers the best chances for cure but is associated with significant mortality and morbidity rates 2 Esophagectomy can cause troublesome and persistent gastrointestinal problems and is associated with diminished healthrelated quality of life 3 4From the patients’ perspective optimal surgical management of esophageal cancer weights aspects such as survival chance and nonsurgical complications and the experience of the hospital to conduct esophagectomies To optimize cancer care it is important for health care providers and policy makers to obtain insight into patients’ preferences towards surgical management for esophageal cancer and to elicit the tradeoffs that patients make This insight is not only relevant to meet patients’ expectations but also to provide high quality and responsive care 5 However quantitative studies investigating patients’ preferences for surgical management of esophageal cancer are lackingThis study investigated patients’ preferences for surgical management of esophageal cancer and elicited the tradeoffs that patients make We hereto performed a discrete choice experiment DCE a quantitative approach that is increasingly used in healthcare 6We identified patients who had undergone an esophagectomy for adenocarcinoma or squamous cell cancer of the esophagus at the Erasmus MC University Medical Centre Rotterdam The Netherlands Patients who were alive and did not have difficulties in understanding the Dutch language were invited to participate in the study The questionnaire and a prepaid return envelope were mailed to the patients After 3 weeks nonresponders were sent a reminder Written informed consent was obtained from all patients The study was approved by the Medical Ethical Committee of the Erasmus MC—University Medical Centre Rotterdam MEC2011217
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