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. 2023 Mar 15;152(6):1183-1190.
doi: 10.1002/ijc.34327. Epub 2022 Oct 27.

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

Merel Hermus  1 , Berend J van der Wilk  2 , Rebecca T H Chang  1 , Gerlise Collee  1 , Bo J Noordman  2 , Peter-Paul L O Coene  3 , Jan Willem T Dekker  4 , Henk H Hartgrink  5 , Joos Heisterkamp  6 , Grard A P Nieuwenhuijzen  7 , Camiel Rosman  8 , Liesbeth Timmermans  9 , Bas P L Wijnhoven  2 , Charlène J van der Zijden  2 , Jan J Busschbach  1 , J Jan B van Lanschot  2 , Sjoerd M Lagarde  2 , Leonieke W Kranenburg  1
Affiliations

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

Merel Hermus et al. Int J Cancer. .

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.

Keywords: active surveillance; oesophageal cancer; patient preferences; treatment decision-making.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flowchart of patient dropout and reasons
FIGURE 2
FIGURE 2
Conceptual model of the main results. Central is the strive for safety in a situation where patients are threatened by cancer and death. Patients differ in how they cope with this threat
See this image and copyright information in PMC

References

    1. Shapiro J, Van Lanschot JJB, Hulshof MCCM, et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long‐term results of a randomised controlled trial. Lancet Oncol. 2015;16(9):1090‐1098. - PubMed
    1. van Hagen P, Hulshof M, Van Lanschot JJB, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366(22):2074‐2084. - PubMed
    1. Noordman BJ, Wijnhoven BPL, Lagarde SM, et al. Neoadjuvant chemoradiotherapy plus surgery versus active surveillance for oesophageal cancer: a stepped‐wedge cluster randomised trial. BMC Cancer. 2018;18(1):1‐12. - PMC - PubMed
    1. Eyck BM, Onstenk BD, Noordman BJ, et al. Accuracy of detecting residual disease after neoadjuvant chemoradiotherapy for esophageal cancer: a systematic review and meta‐analysis. Ann Surg. 2020;271(2):245‐256. - PubMed
    1. Bedenne L, Mariette C. Comparison of systematic surgery versus surveillance and rescue surgery in operable oesophageal cancer with a complete clinical response to radiochemotherapy (Esostrate). Available at: ClinicalTrials.gov Identifier: NCT02551458; 2015.

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