Patients’ preferences regarding invasive mediastinal nodal staging of resectable lung cancer

Jelle E. Bousema; Fieke Hoeijmakers; Marcel G. W. Dijkgraaf; Jouke T. Annema; Frank J. C. van den Broek; M. Elske van den Akker-van Marle

doi:10.2147/PPA.S319790

Patients’ preferences regarding invasive mediastinal nodal staging of resectable lung cancer

Jelle E. Bousema
, Fieke Hoeijmakers
, Marcel G. W. Dijkgraaf
, Jouke T. Annema
, Frank J. C. van den Broek^*
, M. Elske van den Akker-van Marle

^*Corresponding author for this work

Department of Surgery, Máxima MC, Veldhoven, 5500 MB, the Netherlands;
Leiden University Medical Center

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background: Variability in practice and ongoing debate on optimal invasive mediastinal staging of patients with resectable non-small cell lung cancer (NSCLC) are widely described in the literature. Patients’ preferences on this topic have, however, been underexposed so far. Methods: An internet-based questionnaire was distributed among MEDIASTrial partici-pants (NTR6528, randomization of patients to mediastinoscopy or not in the case of negative endosonography). Literature, expert opinion and patient interviews resulted in five attributes: the risk of a futile lung resection (oncologically futile in case of unforeseen N2 disease), the length of the staging period, resection of the primary tumor, complications of staging procedures and the mediastinoscopy scar. The relative importance (RI) of each attribute was assessed by using adaptive conjoint analysis and hierarchical Bayes estimation. A treatment trade-off was used to examine the acceptable proportion of avoided futile lung resections to cover the burden of confirmatory mediastinoscopy. Results: Ninety-seven patients completed the questionnaire (57%). The length of the staging period was significantly the most important attribute (RI 26.24; 95% CI: 25.05–27.43), followed by the risk of a futile surgical lung resection (RI 23.44; 95% CI: 22.28–24.60) and resection of the primary tumor (RI 22.21; 95% CI: 21.09–23.33). Avoidance of 7% (IQR 1– >14%) futile lung resections would cover the burden of confirmatory mediastinoscopy, with a dichotomy among patients always (39%) or never (38%) willing to undergo confirmatory mediastinoscopy after N2 and N3-negative endosonography. Conclusion: Although a strong dichotomy among patients always or never willing to undergo confirmatory mediastinoscopy was found, the length of the staging period was the most important attribute in invasive mediastinal staging according to patients with resectable NSCLC. Trial Registration: Not applicable.

Original language	English
Pages (from-to)	2185-2196
Number of pages	12
Journal	Patient preference and adherence
Volume	15
DOIs	https://doi.org/10.2147/PPA.S319790
Publication status	Published - 2021

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Endosonography
Mediastinal nodal staging
Mediastinoscopy
Non-small cell lung cancer
Patients’ preferences
Thoracic surgery

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Cite this

@article{a2ec51322c5548c3b691f2456507f9ed,

title = "Patients{\textquoteright} preferences regarding invasive mediastinal nodal staging of resectable lung cancer",

abstract = "Background: Variability in practice and ongoing debate on optimal invasive mediastinal staging of patients with resectable non-small cell lung cancer (NSCLC) are widely described in the literature. Patients{\textquoteright} preferences on this topic have, however, been underexposed so far. Methods: An internet-based questionnaire was distributed among MEDIASTrial partici-pants (NTR6528, randomization of patients to mediastinoscopy or not in the case of negative endosonography). Literature, expert opinion and patient interviews resulted in five attributes: the risk of a futile lung resection (oncologically futile in case of unforeseen N2 disease), the length of the staging period, resection of the primary tumor, complications of staging procedures and the mediastinoscopy scar. The relative importance (RI) of each attribute was assessed by using adaptive conjoint analysis and hierarchical Bayes estimation. A treatment trade-off was used to examine the acceptable proportion of avoided futile lung resections to cover the burden of confirmatory mediastinoscopy. Results: Ninety-seven patients completed the questionnaire (57\%). The length of the staging period was significantly the most important attribute (RI 26.24; 95\% CI: 25.05–27.43), followed by the risk of a futile surgical lung resection (RI 23.44; 95\% CI: 22.28–24.60) and resection of the primary tumor (RI 22.21; 95\% CI: 21.09–23.33). Avoidance of 7\% (IQR 1– >14\%) futile lung resections would cover the burden of confirmatory mediastinoscopy, with a dichotomy among patients always (39\%) or never (38\%) willing to undergo confirmatory mediastinoscopy after N2 and N3-negative endosonography. Conclusion: Although a strong dichotomy among patients always or never willing to undergo confirmatory mediastinoscopy was found, the length of the staging period was the most important attribute in invasive mediastinal staging according to patients with resectable NSCLC. Trial Registration: Not applicable.",

keywords = "Endosonography, Mediastinal nodal staging, Mediastinoscopy, Non-small cell lung cancer, Patients{\textquoteright} preferences, Thoracic surgery",

author = "Bousema, \{Jelle E.\} and Fieke Hoeijmakers and Dijkgraaf, \{Marcel G. W.\} and Annema, \{Jouke T.\} and \{van den Broek\}, \{Frank J. C.\} and \{van den Akker-van Marle\}, \{M. Elske\}",

note = "Funding Information: Dr Bousema and Dr van den Broek report research grants from ZonMw and the Dutch Cancer Society, during the conduct of this study. Prof. Dr Annema reports nonfinancial support from Hitachi Medical systems and Pentax and a grant from Cook Medical, outside the submitted work. The authors report no other conflicts of interest in this work. Funding Information: This patients{\textquoteright} preferences study is part of the MEDIASTrial which is funded by ZonMw (project number 843004109) and The Dutch Cancer Society (project number 11313). The funding sources had no involvement in the study design, data analysis and interpretation and the decision to submit the article for publication. Publisher Copyright: {\textcopyright} 2021 Bousema et al.",

year = "2021",

doi = "10.2147/PPA.S319790",

language = "English",

volume = "15",

pages = "2185--2196",

journal = "Patient preference and adherence",

issn = "1177-889X",

publisher = "Dove Medical Press Ltd",

}

TY - JOUR

T1 - Patients’ preferences regarding invasive mediastinal nodal staging of resectable lung cancer

AU - Bousema, Jelle E.

AU - Hoeijmakers, Fieke

AU - Dijkgraaf, Marcel G. W.

AU - Annema, Jouke T.

AU - van den Broek, Frank J. C.

AU - van den Akker-van Marle, M. Elske

N1 - Funding Information: Dr Bousema and Dr van den Broek report research grants from ZonMw and the Dutch Cancer Society, during the conduct of this study. Prof. Dr Annema reports nonfinancial support from Hitachi Medical systems and Pentax and a grant from Cook Medical, outside the submitted work. The authors report no other conflicts of interest in this work. Funding Information: This patients’ preferences study is part of the MEDIASTrial which is funded by ZonMw (project number 843004109) and The Dutch Cancer Society (project number 11313). The funding sources had no involvement in the study design, data analysis and interpretation and the decision to submit the article for publication. Publisher Copyright: © 2021 Bousema et al.

PY - 2021

Y1 - 2021

N2 - Background: Variability in practice and ongoing debate on optimal invasive mediastinal staging of patients with resectable non-small cell lung cancer (NSCLC) are widely described in the literature. Patients’ preferences on this topic have, however, been underexposed so far. Methods: An internet-based questionnaire was distributed among MEDIASTrial partici-pants (NTR6528, randomization of patients to mediastinoscopy or not in the case of negative endosonography). Literature, expert opinion and patient interviews resulted in five attributes: the risk of a futile lung resection (oncologically futile in case of unforeseen N2 disease), the length of the staging period, resection of the primary tumor, complications of staging procedures and the mediastinoscopy scar. The relative importance (RI) of each attribute was assessed by using adaptive conjoint analysis and hierarchical Bayes estimation. A treatment trade-off was used to examine the acceptable proportion of avoided futile lung resections to cover the burden of confirmatory mediastinoscopy. Results: Ninety-seven patients completed the questionnaire (57%). The length of the staging period was significantly the most important attribute (RI 26.24; 95% CI: 25.05–27.43), followed by the risk of a futile surgical lung resection (RI 23.44; 95% CI: 22.28–24.60) and resection of the primary tumor (RI 22.21; 95% CI: 21.09–23.33). Avoidance of 7% (IQR 1– >14%) futile lung resections would cover the burden of confirmatory mediastinoscopy, with a dichotomy among patients always (39%) or never (38%) willing to undergo confirmatory mediastinoscopy after N2 and N3-negative endosonography. Conclusion: Although a strong dichotomy among patients always or never willing to undergo confirmatory mediastinoscopy was found, the length of the staging period was the most important attribute in invasive mediastinal staging according to patients with resectable NSCLC. Trial Registration: Not applicable.

AB - Background: Variability in practice and ongoing debate on optimal invasive mediastinal staging of patients with resectable non-small cell lung cancer (NSCLC) are widely described in the literature. Patients’ preferences on this topic have, however, been underexposed so far. Methods: An internet-based questionnaire was distributed among MEDIASTrial partici-pants (NTR6528, randomization of patients to mediastinoscopy or not in the case of negative endosonography). Literature, expert opinion and patient interviews resulted in five attributes: the risk of a futile lung resection (oncologically futile in case of unforeseen N2 disease), the length of the staging period, resection of the primary tumor, complications of staging procedures and the mediastinoscopy scar. The relative importance (RI) of each attribute was assessed by using adaptive conjoint analysis and hierarchical Bayes estimation. A treatment trade-off was used to examine the acceptable proportion of avoided futile lung resections to cover the burden of confirmatory mediastinoscopy. Results: Ninety-seven patients completed the questionnaire (57%). The length of the staging period was significantly the most important attribute (RI 26.24; 95% CI: 25.05–27.43), followed by the risk of a futile surgical lung resection (RI 23.44; 95% CI: 22.28–24.60) and resection of the primary tumor (RI 22.21; 95% CI: 21.09–23.33). Avoidance of 7% (IQR 1– >14%) futile lung resections would cover the burden of confirmatory mediastinoscopy, with a dichotomy among patients always (39%) or never (38%) willing to undergo confirmatory mediastinoscopy after N2 and N3-negative endosonography. Conclusion: Although a strong dichotomy among patients always or never willing to undergo confirmatory mediastinoscopy was found, the length of the staging period was the most important attribute in invasive mediastinal staging according to patients with resectable NSCLC. Trial Registration: Not applicable.

KW - Endosonography

KW - Mediastinal nodal staging

KW - Mediastinoscopy

KW - Non-small cell lung cancer

KW - Patients’ preferences

KW - Thoracic surgery

UR - https://www.scopus.com/pages/publications/85115847274

U2 - 10.2147/PPA.S319790

DO - 10.2147/PPA.S319790

M3 - Article

C2 - 34588768

SN - 1177-889X

VL - 15

SP - 2185

EP - 2196

JO - Patient preference and adherence

JF - Patient preference and adherence

ER -

Patients’ preferences regarding invasive mediastinal nodal staging of resectable lung cancer

Abstract

UN SDGs

Keywords

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