Patient preferences for active surveillance versus standard surgery after neoadjuvant chemoradiotherapy in esophageal cancer treatment: the NOSANO-study

Menée par questionnaire auprès de 40 patients atteints d'un cancer de l'oesophage et ayant obtenu une réponse clinique complète après une chimioradiothérapie néoadjuvante, cette étude analyse les facteurs déterminant le choix des patients entre une surveillance active ou une chirurgie standard

Résumé en anglais

Active surveillance may be a safe and effective treatment in esophageal 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. 40 patients were interviewed about their treatment preference, three months after completion of nCRT (T1). Data were recorded, transcribed verbatim and analyzed 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.