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Multicenter Study
. 2024 Dec;12(10):1367-1377.
doi: 10.1002/ueg2.12628. Epub 2024 Jul 19.

T1 colorectal cancer patients' perspective on information provision and therapeutic decision-making after local resection

Nik Dekkers  1 , Hao Dang  1 , Manon de Graaf  1 , Kate Nobbenhuis  1 , Daan A Verhoeven  1 , Jolein van der Kraan  1 , Wouter H de Vos Tot Nederveen Cappel  2 , Alaa Alkhalaf  2 , Henderik L van Westreenen  3 , Kirill Basiliya  1 , Koen C M J Peeters  4 , Marinke Westerterp  5 , Pascal G Doornebosch  6 , James C H Hardwick  1 , Alexandra M J Langers  1 , Jurjen J Boonstra  1
Affiliations
Multicenter Study

T1 colorectal cancer patients' perspective on information provision and therapeutic decision-making after local resection

Nik Dekkers et al. United European Gastroenterol J. 2024 Dec.

Abstract

Background: Decision-making after local resection of T1 colorectal cancer (T1CRC) is often complex and calls for optimal information provision as well as active patient involvement.

Objective: The aim was to evaluate the perceptions of patients with T1CRC on information provision and therapeutic decision-making.

Methods: This multicenter cross-sectional study included patients who underwent endoscopic or local surgical resection as initial treatment. Information provision was assessed using the EORTC QLQ-INFO25 questionnaire. In patients with high-risk T1CRC, we evaluated decisional involvement and satisfaction regarding the choice as to whether to undergo additional treatment after local resection, and the level of decisional conflict using the Decisional Conflict Scale.

Results: Ninety-eight patients with T1CRC were included (72% response rate; 79/98 endoscopic and 19/98 local surgical resection; 45/98 high-risk T1CRC). Median time since local resection was 28 months (IQR 18); none had developed recurrence. Unmet information needs were reported by 29 patients (30%; 18 low-risk, 11 high-risk), mostly on post-treatment related topics (follow-up visits, recovery time, recurrence prevention). After local resection, 24 of the 45 high-risk patients (53%) underwent additional treatment, while others were subjected to surveillance. Higher-educated patients were more often actively involved in decision-making (93% vs. 43%, p = 0.002) and more frequently underwent additional treatment (79% vs. 40%, p = 0.02). Decisional conflict (p = 0.19) and satisfaction (p = 0.78) were comparable between higher- and lower-educated high-risk patients.

Conclusion: Greater attention should be given to the post-treatment course during consultations following local T1CRC resection. The differences in decisional involvement and selected management strategies between higher- and lower-educated high-risk patients warrant further investigation.

Keywords: colorectal cancer; endoscopic resection; endoscopic submucosal dissection; local resection.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

FIGURE 1
FIGURE 1
Flow‐chart of patient selection. CRC, colorectal cancer; DCS, Decision conflict scale; INFO25 EORTC QLQ‐INFO25.
FIGURE 2
FIGURE 2
Visual representation of the amount of information that was provided on the various disease topics of the INFO25 questionnaire. Comparisons were made by (a) Overall; (b) Grouped by histological risk‐status; (c) Grouped by sex. Scale 0–100: ranging from ‘not at all’ to ‘very much’.
FIGURE 3
FIGURE 3
Topics with unmet information needs in 23 patients who specified on what topics they wished to have received more information on. The category ‘other’ was utilized to categorize responses that were provided only once and did not fit into the other predefined categories.
FIGURE 4
FIGURE 4
Overview of the therapeutic decision‐making in patients with high‐risk T1 colorectal cancer. CRC, colorectal cancer; CRT, chemoradiotherapy.
See this image and copyright information in PMC

References

    1. Dekker E, Tanis PJ, Vleugels JLA, Kasi PM, Wallace MB. Colorectal cancer. Lancet. 2019;394(10207):1467–1480. 10.1016/s0140-6736(19)32319-0 - DOI - PubMed
    1. Rex DK, Shaukat A, Wallace MB. Optimal management of malignant polyps, from endoscopic assessment and resection to decisions about surgery. Clin Gastroenterol Hepatol. 2019;17(8):1428–1437. 10.1016/j.cgh.2018.09.040 - DOI - PubMed
    1. Dekkers N, Dang H, van der Kraan J, Hardwick JCH, Langers AMJ, Boonstra JJ. Patient educational videos on T1 colorectal cancer. VideoGIE. 2023;8(12):527–528. 10.1016/j.vgie.2023.08.009 - DOI - PMC - PubMed
    1. Mulcare H, Schofield P, Kashima Y, Milgrom J, Wirth A, Bishop M, et al. Adjustment to cancer and the information needs of people with lung cancer. Psycho Oncol. 2011;20(5):488–496. 10.1002/pon.1752 - DOI - PubMed
    1. Mesters I, van den Borne B, De Boer M, Pruyn J. Measuring information needs among cancer patients. Patient Educ Couns. 2001;43(3):253–262. - PubMed

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