J Gynecol Oncol | Volume 2, Issue 1 | Research Article | Open Access
Aarts JWM1*, Burg LC2, Kasius JC3, Groenewoud H4, Kraaijenbrink A2, Stalmeier P4 and Zusterzeel PLM1*
1Department of Obstetrics and Gynecology, Radboud University Medical Centre, Netherlands 2Department of Obstetrics and Gynecology, Rijnstate Hospital, Netherlands 3Department of Obstetrics and Gynecology, Amsterdam University Medical Centre, Netherlands 4Health Evidence, Radboud University Medical Centre, Netherlands
Fulltext PDFBackground: Over 200 articles about the Sentinel Lymph Node Procedure (SNP) in Endometrial Cancer (EC) have been published in the last decade, but none assesses patients’ and gynecologists’ views on this innovative technique. In this vignette study, we established which factors are important for both patients and gynecologists when considering SNP in EC. Methodology: Based on literature and interviews with patients and gynecologists a list of attributes regarding SNP was composed: 1) risk of complications of SNP, 2) chance of finding a metastasis, 3) survival gain, 4) risk of complications after radiotherapy, 5) additional operation time and 6) hospital of surgery (travel time). A questionnaire with eighteen hypothetical scenarios was developed, in which the levels of each attribute varied. Patients previously treated for low or intermediate-risk EC and gynecologists with interest in oncology were invited to participate. For each scenario, they were asked how strongly they would prefer SNP on a scale from 1 to 7. The strength of preference for each scenario was analyzed using a linear mixed effects model. Results: Both patients (41/108) and gynecologists (42/126) had a preference for SNP. On the 7 point scale, the mean preference for patients was 4.29 (95% CI 3.72-4.85) and 4.39 (95% CI 3.99-4.78) for gynecologists. Patients’ preferences increased from 3.4 in case of no survival gain to 4.9 in case of three years survival gain (P=0.000) and decreased when travel time increased to over 60 min (-0.4, P=0.024), or with an increased risk of complications after adjuvant radiotherapy (-0.6, P=0.002). The chance of finding a metastasis was not important to patients. For gynecologists, all attributes except travel time were significantly related to the SNP choice. Conclusion: This study is the first to describe which characteristics are important for patients and gynecologists when considering SNP in low and intermediate-risk EC management. There is a substantial variance in both patients' and clinicians' preferences. Individual patients make different choices highlighting the need for involving patients in decisions about adding SNP to standard EC treatment.
Aarts JWM, Burg LC, Kasius JC, Groenewoud H, Kraaijenbrink A, Stalmeier P, et al. Patients’ and Gynecologists’ Views on Sentinel Lymph Node Procedure in Low and Intermediate Endometrial Cancer Management: A Vignette Study. J Gynecol Oncol. 2019; 2(1): 1010.