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Article

Preferences of Treatment Strategies among Women with Low-Risk DCIS and Oncologists

1
Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands
2
Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands
3
Division of Molecular Pathology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands
4
Division of Surgical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands
5
Department of Pathology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
6
Department of Clinical Genetics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
*
Author to whom correspondence should be addressed.
Membership of the Grand Challenge Precision Consortium is provided in the Acknowledgments section of the manuscript.
Academic Editor: Thaer Khoury
Cancers 2021, 13(16), 3962; https://doi.org/10.3390/cancers13163962
Received: 10 July 2021 / Revised: 29 July 2021 / Accepted: 2 August 2021 / Published: 6 August 2021
Preferences for treatment strategies for low-risk ductal carcinoma in situ (DCIS), a potential precursor of invasive breast cancer (IBC) including a new active surveillance strategy, were elicited with a discrete choice experiment among recently-diagnosed women and oncologists involved in the care of women with DCIS. Patients exhibited strong preferences for active surveillance and seemed prepared to accept much higher levels of 10-year risk of developing ipsilateral invasive breast cancer than oncologists. Both patients and oncologists showed a strong aversion toward more extensive locoregional treatments (i.e., breast conserving surgery followed by radiotherapy, and mastectomy), while both groups demonstrated a strong preference toward shorter follow-up intervals.
As ongoing trials study the safety of an active surveillance strategy for low-risk ductal carcinoma in situ (DCIS), there is a need to explain why particular choices regarding treatment strategies are made by eligible women as well as their oncologists, what factors enter the decision process, and how much each factor affects their choice. To measure preferences for treatment and surveillance strategies, women with newly-diagnosed, primary low-risk DCIS enrolled in the Dutch CONTROL DCIS Registration and LORD trial, and oncologists participating in the Dutch Health Professionals Study were invited to complete a discrete choice experiment (DCE). The relative importance of treatment strategy-related attributes (locoregional intervention, 10-year risk of ipsilateral invasive breast cancer (iIBC), and follow-up interval) were discerned using conditional logit models. A total of n = 172 patients and n = 30 oncologists completed the DCE. Patient respondents had very strong preferences for an active surveillance strategy with no surgery, irrespective of the 10-year risk of iIBC. Extensiveness of the locoregional treatment was consistently shown to be an important factor for patients and oncologists in deciding upon treatment strategies. Risk of iIBC was least important to patients and most important to oncologists. There was a stronger inclination toward a twice-yearly follow-up for both groups compared to annual follow-up. View Full-Text
Keywords: active surveillance; de-escalating; discrete choice experiment; ductal carcinoma in situ; patient preference active surveillance; de-escalating; discrete choice experiment; ductal carcinoma in situ; patient preference
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MDPI and ACS Style

Byng, D.; Retèl, V.P.; Engelhardt, E.G.; Groothuis-Oudshoorn, C.G.M.; van Til, J.A.; Schmitz, R.S.J.M.; van Duijnhoven, F.; Wesseling, J.; Bleiker, E.; van Harten, W.H.; on behalf of the Grand Challenge Precision Consortium. Preferences of Treatment Strategies among Women with Low-Risk DCIS and Oncologists. Cancers 2021, 13, 3962. https://doi.org/10.3390/cancers13163962

AMA Style

Byng D, Retèl VP, Engelhardt EG, Groothuis-Oudshoorn CGM, van Til JA, Schmitz RSJM, van Duijnhoven F, Wesseling J, Bleiker E, van Harten WH, on behalf of the Grand Challenge Precision Consortium. Preferences of Treatment Strategies among Women with Low-Risk DCIS and Oncologists. Cancers. 2021; 13(16):3962. https://doi.org/10.3390/cancers13163962

Chicago/Turabian Style

Byng, Danalyn, Valesca P. Retèl, Ellen G. Engelhardt, Catharina G. M. Groothuis-Oudshoorn, Janine A. van Til, Renée S. J. M. Schmitz, Frederieke van Duijnhoven, Jelle Wesseling, Eveline Bleiker, Wim H. van Harten, and on behalf of the Grand Challenge Precision Consortium. 2021. "Preferences of Treatment Strategies among Women with Low-Risk DCIS and Oncologists" Cancers 13, no. 16: 3962. https://doi.org/10.3390/cancers13163962

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