1
|
Damman OC, van Strien-Knippenberg IS, Engelhardt EG, Determann D D, de Bruijne MC, Siesling S, Konings IR, Timmermans DR. Information and communication priorities of patients and healthcare professionals in shared decision making regarding adjuvant systemic breast cancer treatment: A survey study. Eur J Oncol Nurs 2024; 70:102574. [PMID: 38643680 DOI: 10.1016/j.ejon.2024.102574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/12/2024] [Accepted: 03/18/2024] [Indexed: 04/23/2024]
Abstract
PURPOSE To assess information and communication priorities of patients and healthcare professionals in Shared Decision Making about adjuvant systemic treatment of primary breast cancer and identify key decision-relevant information accordingly. METHODS Patients (N = 122) and professionals working with breast cancer patients (N = 118), of whom 38 were nurse practitioners and 32 nurses, were recruited using convenience sampling, and surveyed about information/communication aspects key to decision-making, using ranking assignments. We further posed a simple open question, questions about receiving population-based statistics versus personalized statistics concerning treatment outcomes, and their attitude and experience concerning Shared Decision Making. Data were analyzed using descriptive analysis and a qualitative analysis. RESULTS Both patients and professionals prioritized information about treatment outcomes (i.e., survival, recurrence) as key decision-relevant information for patients. Patients prioritized information about relatively severe treatment side-effects and late effects (e.g., blood clot, stroke), whilst professionals prioritized information about effects that occur relatively often (e.g., hair loss, fatigue). Patients specifically wanted to know if the benefit of treatment is worth the negative impact. Both groups prioritized personalized statistics over population-based statistics. CONCLUSIONS Some differences between patients and professionals were found in information and communication priorities, specifically related to the different side-effects. It seems worthwhile to precisely address these side-effects in Shared Decision Making concerning adjuvant systemic treatment. Furthermore, it seems important to deliberate together on the question if expected benefit of treatment is worth the potential negative impact for the individual patient.
Collapse
Affiliation(s)
- Olga C Damman
- Department of Public & Occupational Health and Amsterdam Public Health Research Institute, Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Netherlands.
| | - Inge S van Strien-Knippenberg
- Department of Public & Occupational Health and Amsterdam Public Health Research Institute, Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Netherlands
| | - Ellen G Engelhardt
- Division of Molecular Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Netherlands
| | | | - Martine C de Bruijne
- Department of Public & Occupational Health and Amsterdam Public Health Research Institute, Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Netherlands
| | - Sabine Siesling
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Netherlands; Department of Research and Development, Netherlands; Netherlands Comprehensive Cancer Organisation (IKNL), Netherlands
| | - Inge R Konings
- Department of Medical Oncology and Cancer Center Amsterdam, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Netherlands
| | - Danielle R Timmermans
- Department of Public & Occupational Health and Amsterdam Public Health Research Institute, Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Netherlands
| |
Collapse
|
2
|
Ankersmid JW, Engelhardt EG, Lansink Rotgerink FK, The R, Strobbe LJA, Drossaert CHC, Siesling S, van Uden-Kraan CF. Evaluation of the Implementation of the Dutch Breast Cancer Surveillance Decision Aid including Personalized Risk Estimates in the SHOUT-BC Study: A Mixed Methods Approach. Cancers (Basel) 2024; 16:1390. [PMID: 38611068 PMCID: PMC11010914 DOI: 10.3390/cancers16071390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND To improve Shared decision-making (SDM) regarding personalized post-treatment surveillance, the Breast Cancer Surveillance Decision Aid (BCS-PtDA), integrating personalized risk information, was developed and implemented in eight hospitals. The aim of this mixed-methods study was to (1) assess the implementation and participation rates, (2) identify facilitators and barriers for use by health care professionals (HCPs), (3) quantify the observed level of SDM, and (4) evaluate risk communication and SDM application in consultations. METHODS Implementation and participation rates and patients' BCS-PtDA use were calculated using hospital registry data and BCS-PtDA log data. HCPs' perspective on facilitators and barriers were collected using the MIDI framework. Observed SDM levels in consultation transcripts were quantified using the OPTION-5 scale. Thematic analysis was performed to assess consultation content. RESULTS The average PtDA implementation and participation rates were, respectively, 26% and 61%. HCPs reported that the PtDA supported choice awareness. Reported barriers for implementation were mainly increased workload and a lack of perceived benefits. The consultation analysis (n = 64) showed patients were offered a choice, but deliberation was lacking. Risk communication was generally adequate. DISCUSSION When the BCS-PtDA was used, patients were clearly given a choice regarding their post-treatment surveillance, but information provision and SDM application can be improved.
Collapse
Affiliation(s)
- Jet W. Ankersmid
- Department of Health Technology and Services Research, University of Twente, 7522 NB Enschede, The Netherlands;
- Santeon, 3584 AA Utrecht, The Netherlands; (E.G.E.)
| | | | | | - Regina The
- ZorgKeuzeLab, 2611 BN Delft, The Netherlands
| | - Luc J. A. Strobbe
- Department of Surgery, Canisius Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands
| | - Constance H. C. Drossaert
- Department of Psychology, Health & Technology, University of Twente, 7522 NB Enschede, The Netherlands;
| | - Sabine Siesling
- Department of Health Technology and Services Research, University of Twente, 7522 NB Enschede, The Netherlands;
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, 3501 DB Utrecht, The Netherlands
| | | |
Collapse
|
3
|
Kruiswijk AA, van de Sande MAJ, Haas RL, van den Akker-van Marle EM, Engelhardt EG, Marang-van de Mheen P, van Bodegom-Vos L. (Cost-)effectiveness of an individualised risk prediction tool (PERSARC) on patient's knowledge and decisional conflict among soft-tissue sarcomas patients: protocol for a parallel cluster randomised trial (the VALUE-PERSARC study). BMJ Open 2023; 13:e074853. [PMID: 37918933 PMCID: PMC10626817 DOI: 10.1136/bmjopen-2023-074853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 10/09/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION Current treatment decision-making in high-grade soft-tissue sarcoma (STS) care is not informed by individualised risks for different treatment options and patients' preferences. Risk prediction tools may provide patients and professionals insight in personalised risks and benefits for different treatment options and thereby potentially increase patients' knowledge and reduce decisional conflict. The VALUE-PERSARC study aims to assess the (cost-)effectiveness of a personalised risk assessment tool (PERSARC) to increase patients' knowledge about risks and benefits of treatment options and to reduce decisional conflict in comparison with usual care in high-grade extremity STS patients. METHODS The VALUE-PERSARC study is a parallel cluster randomised control trial that aims to include at least 120 primarily diagnosed high-grade extremity STS patients in 6 Dutch hospitals. Eligible patients (≥18 years) are those without a treatment plan and treated with curative intent. Patients with sarcoma subtypes or treatment options not mentioned in PERSARC are unable to participate. Hospitals will be randomised between usual care (control) or care with the use of PERSARC (intervention). In the intervention condition, PERSARC will be used by STS professionals in multidisciplinary tumour boards to guide treatment advice and in patient consultations, where the oncological/orthopaedic surgeon informs the patient about his/her diagnosis and discusses benefits and harms of all relevant treatment options. The primary outcomes are patients' knowledge about risks and benefits of treatment options and decisional conflict (Decisional Conflict Scale) 1 week after the treatment decision has been made. Secondary outcomes will be evaluated using questionnaires, 1 week and 3, 6 and 12 months after the treatment decision. Data will be analysed following an intention-to-treat approach using a linear mixed model and taking into account clustering of patients within hospitals. ETHICS AND DISSEMINATION The Medical Ethical Committee Leiden-Den Haag-Delft (METC-LDD) approved this protocol (NL76563.058.21). The results of this study will be reported in a peer-review journal. TRIAL REGISTRATION NUMBER NL9160, NCT05741944.
Collapse
Affiliation(s)
- Anouk A Kruiswijk
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Rick L Haas
- Department of Radiotherapy, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Ellen G Engelhardt
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Perla Marang-van de Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
4
|
Schmitz RSJM, Engelhardt EG, Gerritsma MA, Sondermeijer CMT, Verschuur E, Houtzager J, Griffioen R, Retèl V, Bijker N, Mann RM, van Duijnhoven F, Wesseling J, Bleiker EMA. Active surveillance versus treatment in low-risk DCIS: Women's preferences in the LORD-trial. Eur J Cancer 2023; 192:113276. [PMID: 37657228 PMCID: PMC10632767 DOI: 10.1016/j.ejca.2023.113276] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Ductal carcinoma in situ (DCIS) can progress to invasive breast cancer (IBC), but most DCIS lesions remain indolent. However, guidelines recommend surgery, often supplemented by radiotherapy. This implies overtreatment of indolent DCIS. The non-randomised patient preference LORD-trial tests whether active surveillance (AS) for low-risk DCIS is safe, by giving women with low-risk DCIS a choice between AS and conventional treatment (CT). Here, we aim to describe how participants are distributed among both trial arms, identify their motives for their preference, and assess factors associated with their choice. METHODS Data were extracted from baseline questionnaires. Descriptive statistics were used to assess the distribution and characteristics of participants; thematic analyses to extract self-reported reasons for the choice of trial arm, and multivariable logistic regression analyses to investigate associations between patient characteristics and chosen trial arm. RESULTS Of 377 women included, 76% chose AS and 24% CT. Most frequently cited reasons for AS were "treatment is not (yet) necessary" (59%) and trust in the AS-plan (39%). Reasons for CT were cancer worry (51%) and perceived certainty (29%). Women opting for AS more often had lower educational levels (OR 0.45; 95% confidence interval [CI], 0.22-0.93) and more often reported experiencing shared decision making (OR 2.71; 95% CI, 1.37-5.37) than women choosing CT. CONCLUSION The LORD-trial is the first to offer women with low-risk DCIS a choice between CT and AS. Most women opted for AS and reported high levels of trust in the safety of AS. Their preferences highlight the necessity to establish the safety of AS for low-risk DCIS.
Collapse
Affiliation(s)
- Renée S J M Schmitz
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ellen G Engelhardt
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Miranda A Gerritsma
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Ellen Verschuur
- Dutch Breast Cancer Society ('Borstkanker Vereniging Nederland'), Utrecht, the Netherlands
| | - Julia Houtzager
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Rosalie Griffioen
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Valesca Retèl
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Nina Bijker
- Department of Radiation Oncology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Ritse M Mann
- Department of Radiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Radiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Frederieke van Duijnhoven
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Jelle Wesseling
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Pathology, Leiden University Medical Center, Leiden, Netherlands.
| | - Eveline M A Bleiker
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Family Cancer Clinic, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Clinical Genetics, Leiden University Medical Center, Leiden, Netherlands.
| |
Collapse
|
5
|
van Hemert AKE, van Olmen JP, Boersma LJ, Maduro JH, Russell NS, Tol J, Engelhardt EG, Rutgers EJT, Vrancken Peeters MJTFD, van Duijnhoven FH. De-ESCAlating RadioTherapy in breast cancer patients with pathologic complete response to neoadjuvant systemic therapy: DESCARTES study. Breast Cancer Res Treat 2023; 199:81-89. [PMID: 36892723 DOI: 10.1007/s10549-023-06899-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/16/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE Neoadjuvant systemic therapy (NST) is increasingly used in breast cancer patients and depending on subtype, 10-89% of patients will attain pathologic complete response (pCR). In patients with pCR, risk of local recurrence (LR) after breast conserving therapy is low. Although adjuvant radiotherapy after breast conserving surgery (BCS) reduces LR further in these patients, it may not contribute to overall survival. However, radiotherapy may cause early and late toxicity. The aim of this study is to show that omission of adjuvant radiotherapy in patients with a pCR after NST will result in acceptable low LR rates and good quality of life. METHODS The DESCARTES study is a prospective, multicenter, single arm study. Radiotherapy will be omitted in cT1-2N0 patients (all subtypes) who achieve a pCR of the breast and lymph nodes after NST followed by BCS plus sentinel node procedure. A pCR is defined as ypT0N0 (i.e. no residual tumor cells detected). Primary endpoint is the 5-year LR rate, which is expected to be 4% and deemed acceptable if less than 6%. In total, 595 patients are needed to achieve a power of 80% (one-side alpha of 0.05). Secondary outcomes include quality of life, Cancer Worry Scale, disease specific and overall survival. Projected accrual is five years. CONCLUSION This study bridges the knowledge gap regarding LR rates when adjuvant radiotherapy is omitted in cT1-2N0 patients achieving pCR after NST. If the results are positive, radiotherapy may be safely omitted in selected breast cancer patients with a pCR after NST. TRIAL REGISTRATION This study is registered at ClinicalTrials.gov on June 13th 2022 (NCT05416164). Protocol version 5.1 (15-03-2022).
Collapse
Affiliation(s)
- Annemiek K E van Hemert
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Josefien P van Olmen
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Liesbeth J Boersma
- Department of Radiation Oncology (Maastro), Maastricht University Medical Centre+ - GROW School for Oncology and Reproduction, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
| | - John H Maduro
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Nicola S Russell
- Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Jolien Tol
- Department of Medical Oncology, Jeroen Bosch Ziekenhuis, Henri Dunantstraat 1, 5223 GZ, 'S-Hertogenbosch, The Netherlands
| | - Ellen G Engelhardt
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Emiel J Th Rutgers
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | | | - Frederieke H van Duijnhoven
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| |
Collapse
|
6
|
Schmitz RS, Engelhardt EG, Gerritsma MA, Sondermeijer CM, Alaeikhanehshir S, Verschuur E, van Oirsouw M, Houtzager J, Griffioen R, Bijker N, Mann RM, van Duijnhoven F, Wesseling J, Bleiker E. Abstract P6-05-11: Active surveillance versus conventional treatment in low-risk DCIS; women’s preferences in the LORD trial. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p6-05-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: Ductal carcinoma in situ (DCIS) is a potential precursor to breast cancer. Its incidence has increased multifold with the introduction of breast cancer screening and makes for 20% of all malignant breast lesions in women. DCIS has the potential to progress into invasive breast cancer. However, the majority of DCIS lesions are indolent and will never progress during the patient’s lifetime. Consequently, there is a growing concern of overdiagnosis and overtreatment for women with DCIS. The LORD trial is a non-randomized, patient preference trial comparing active surveillance to conventional treatment (i.e., breast conserving surgery with or without radiotherapy or mastectomy). The primary outcome of this trial is the percentage of women without an occurrence of ipsilateral invasive breast cancer after 10 years of follow up. Within the patient preference design, women are free to opt for either treatment arm. In addition to active surveillance of the DCIS, quality of life (QOL) of women included in the LORD trial is also actively monitored. The aims of this study were to: a) describe the distribution of participants within the treatment arms, b) identify women’s motives to opt for their preferred treatment arm, and c) assess factors associated with a preference for either treatment arm. Methods: Data from the baseline patient QOL questionnaire was collected. This questionnaire was completed after the women’s diagnosis and first consultation with their physician. Descriptive statistics were used to assess the distribution in both treatment arms. Thematic analyses were used to describe self-reported reasons for treatment selection derived from the open-ended question about treatment preference. Multivariable logistic regression analyses were used to assess associations between the patient characteristics and their preferred treatment arm. Results: In total 384 women completed the baseline questionnaire, of which 376 entered their final treatment decision. Of these women, 287 (76%) opted for active surveillance and 89 (24%) for conventional treatment. Most frequently cited reason for opting for active surveillance was that treatment was not yet necessary (55%). Also, patients’ reasons for preferring active surveillance alluded to a high level of trust in the active surveillance plan (24%) and that disease progression could be picked up and treated in a timely manner (14%). Furthermore, 11% of patients cited the advice of their healthcare professional as a reason for opting for active surveillance and 8% cited reasons relating to altruism. Most reported reasons for opting for the conventional treatment arm were avoiding unnecessary risks (26%), avoiding cancer worry (18%), the notion that what doesn’t belong, should be removed from the body (18%) and a need for closure (13%). In multivariable logistic regression analyses, high level of education (OR 2.17; 95%CI 1.09-4.38) and higher knowledge score (OR 1.8; 95%CI 1.07-3.02) were associated with a preference for conventional treatment. Furthermore, women opting for active surveillance more often reported the decision to be a shared decision between them and their healthcare professional (OR 2.30; 95%CI 1.18-4.47) compared to women who chose conventional treatment, who more often reported decision-making to be patient-driven. Age and tolerance of uncertainty were not significantly associated with treatment preference. Conclusion: The LORD trial is the first to actively offer women with low-risk DCIS a choice between conventional treatment and active surveillance. Within this trial, most women opt for active surveillance, even though clinical guidelines still recommend treatment for all women with DCIS. Women with low-risk DCIS report high levels of trust in their physicians and the safety of active surveillance. Their preferences also highlight the necessity to proof that de-escalating treatment of low-risk DCIS is safe.
Citation Format: Renée S. Schmitz, Ellen G. Engelhardt, Miranda A. Gerritsma, Carine M. Sondermeijer, Sena Alaeikhanehshir, Ellen Verschuur, Marja van Oirsouw, Julia Houtzager, Rosalie Griffioen, Nina Bijker, Ritse M. Mann, Frederieke van Duijnhoven, Jelle Wesseling, Eveline Bleiker. Active surveillance versus conventional treatment in low-risk DCIS; women’s preferences in the LORD trial [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-11.
Collapse
Affiliation(s)
- Renée S. Schmitz
- 1Netherlands Cancer Institute, Amsterdam, Noord-Holland, Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Lof P, Engelhardt EG, van Gent MDJM, Mom CH, Rosier-van Dunné FMF, van Baal WM, Verhoeve HR, Hermsen BBJ, Verbruggen MB, Hemelaar M, van de Swaluw JMG, Knipscheer HC, Huirne JAF, Westenberg SM, van Driel WJ, Bleiker EMA, Amant F, Lok CAR. Psychological impact of referral to an oncology hospital on patients with an ovarian mass. Int J Gynecol Cancer 2022; 33:ijgc-2022-003753. [PMID: 36600495 DOI: 10.1136/ijgc-2022-003753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES In patients with an ovarian mass, a risk of malignancy assessment is used to decide whether referral to an oncology hospital is indicated. Risk assessment strategies do not perform optimally, resulting in either referral of patients with a benign mass or patients with a malignant mass not being referred. This process may affect the psychological well-being of patients. We evaluated cancer-specific distress during work-up for an ovarian mass, and patients' perceptions during work-up, referral, and treatment. METHODS Patients with an ovarian mass scheduled for surgery were enrolled. Using questionnaires we measured (1) cancer-specific distress using the cancer worry scale, (2) patients' preferences regarding referral (evaluated pre-operatively), and (3) patients' experiences with work-up and treatment (evaluated post-operatively). A cancer worry scale score of ≥14 was considered as clinically significant cancer-specific distress. RESULTS A total of 417 patients were included, of whom 220 (53%) were treated at a general hospital and 197 (47%) at an oncology hospital. Overall, 57% had a cancer worry scale score of ≥14 and this was higher in referred patients (69%) than in patients treated at a general hospital (43%). 53% of the patients stated that the cancer risk should not be higher than 25% to undergo surgery at a general hospital. 96% of all patients were satisfied with the overall work-up and treatment. No difference in satisfaction was observed between patients correctly (not) referred and patients incorrectly (not) referred. CONCLUSIONS Relatively many patients with an ovarian mass experienced high cancer-specific distress during work-up. Nevertheless, patients were satisfied with the treatment, regardless of the final diagnosis and the location of treatment. Moreover, patients preferred to be referred even if there was only a relatively low probability of having ovarian cancer. Patients' preferences should be taken into account when deciding on optimal cut-offs for risk assessment strategies.
Collapse
Affiliation(s)
- Pien Lof
- Department of Gynecologic Oncology, Netherlands Cancer Institute, Center for Gynecologic Oncology Amsterdam, Amsterdam, The Netherlands
| | - Ellen G Engelhardt
- Division of Psychological Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Mignon D J M van Gent
- Department of Gynecologic Oncology, Amsterdam University Medical Center, location Academic Medical Center, Center for Gynecologic Oncology Amsterdam, Amsterdam, The Netherlands
| | - Constantijne H Mom
- Department of Gynecologic Oncology, Amsterdam University Medical Center, location Academic Medical Center, Center for Gynecologic Oncology Amsterdam, Amsterdam, The Netherlands
| | | | | | | | | | | | - Majoie Hemelaar
- Department of Gynecology, Dijklander Hospital, Hoorn and Purmerend, The Netherlands
| | | | - Haye C Knipscheer
- Department of Gynecology, Spaarne Hospital, Haarlem and Hoofddorp, The Netherlands
| | - Judith A F Huirne
- Department of Gynecology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | - Willemien J van Driel
- Department of Gynecologic Oncology, Netherlands Cancer Institute, Center for Gynecologic Oncology Amsterdam, Amsterdam, The Netherlands
| | - Eveline M A Bleiker
- Division of Psychological Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Frédéric Amant
- Department of Gynecologic Oncology, Netherlands Cancer Institute, Center for Gynecologic Oncology Amsterdam, Amsterdam, The Netherlands
- Department of Gynecologic Oncology, UZ Leuven, Leuven, Belgium
| | - Christianne A R Lok
- Department of Gynecologic Oncology, Netherlands Cancer Institute, Center for Gynecologic Oncology Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
8
|
Terra L, Beekman MJ, Engelhardt EG, Heemskerk-Gerritsen BAM, van Beurden M, Roeters van Lennep JE, van Doorn HC, de Hullu JA, Van Dorst EBL, Mom CH, Slangen BFM, Gaarenstroom KN, van der Kolk LE, Collée JM, Wevers MR, Ausems MGEM, Van Engelen K, van de Beek I, Berger LPV, van Asperen CJ, Gomez Garcia EB, Maas AHEM, Hooning MJ, Aaronson NK, Mourits MJE, van Leeuwen FE. Sexual functioning more than 15 years after premenopausal risk-reducing salpingo-oophorectomy. Am J Obstet Gynecol 2022; 228:440.e1-440.e20. [PMID: 36403862 DOI: 10.1016/j.ajog.2022.11.1289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/21/2022] [Accepted: 11/10/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Women with a BRCA1/2 pathogenic variant are advised to undergo premenopausal risk-reducing salpingo-oophorectomy after completion of childbearing, to reduce their risk of ovarian cancer. Several studies reported less sexual pleasure 1 to 3 years after a premenopausal oophorectomy. However, the long-term effects of premenopausal oophorectomy on sexual functioning are unknown. OBJECTIVE This study aimed to study long-term sexual functioning in women at increased familial risk of breast or ovarian cancer who underwent a risk-reducing salpingo-oophorectomy either before the age of 46 years (premenopausal group) or after the age of 54 years (postmenopausal group). Subgroup analyses were performed in the premenopausal group, comparing early (before the age of 41 years) and later (at ages 41-45 years) premenopausal risk-reducing salpingo-oophorectomy. STUDY DESIGN Between 2018 and 2021, 817 women with a high familial risk of breast or ovarian cancer from an ongoing cohort study were invited to participate in our study. Because of a large difference in age in the study between the premenopausal and postmenopausal salpingo-oophorectomy groups, we restricted the comparison of sexual functioning between the groups to 368 women who were 60 to 70 years old at completion of the questionnaire (226 in the premenopausal group and 142 in the postmenopausal group). In 496 women with a premenopausal risk-reducing salpingo-oophorectomy, we compared the sexual functioning between women in the early premenopausal group (n=151) and women in the later premenopausal group (n=345). Differences between groups were analyzed using multiple regression analyses, adjusting for current age, breast cancer history, use of hormone replacement therapy, body mass index, chronic medication use (yes or no), and body image. RESULTS Mean times since risk-reducing salpingo-oophorectomy were 20.6 years in the premenopausal group and 10.6 years in the postmenopausal group (P<.001). The mean age at questionnaire completion was 62.7 years in the premenopausal group, compared with 67.0 years in the postmenopausal group (P<.001). Compared with 48.9% of women in the postmenopausal group, 47.4% of women in the premenopausal group were still sexually active (P=.80). Current sexual pleasure scores were the same for women in the premenopausal group and women in the postmenopausal group (mean pleasure score, 8.6; P=.99). However, women in the premenopausal group more often reported substantial discomfort than women in the postmenopausal group (35.6% vs 20.9%; P=.04). After adjusting for confounders, premenopausal risk-reducing salpingo-oophorectomy was associated with substantially more discomfort during sexual intercourse than postmenopausal risk-reducing salpingo-oophorectomy (odds ratio, 3.1; 95% confidence interval, 1.04-9.4). Moreover, after premenopausal risk-reducing salpingo-oophorectomy, more severe complaints of vaginal dryness were observed (odds ratio, 2.6; 95% confidence interval, 1.4-4.7). Women with a risk-reducing salpingo-oophorectomy before the age of 41 years reported similar pleasure and discomfort scores as women with a risk-reducing salpingo-oophorectomy between ages 41 and 45 years. CONCLUSION More than 15 years after premenopausal risk-reducing salpingo-oophorectomy, the proportion of sexually active women was comparable with the proportion of sexually active women with a postmenopausal risk-reducing salpingo-oophorectomy. However, after a premenopausal risk-reducing salpingo-oophorectomy, women experienced more vaginal dryness and more often had substantial sexual discomfort during sexual intercourse. This did not lead to less pleasure with sexual activity.
Collapse
Affiliation(s)
- Lara Terra
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maarten J Beekman
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ellen G Engelhardt
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Marc van Beurden
- Department of Gynecologic Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Helena C van Doorn
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Joanne A de Hullu
- Department of Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eleonora B L Van Dorst
- Department of Gynecologic Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Constantijne H Mom
- Department of Gynecologic Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Brigitte F M Slangen
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, The Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Katja N Gaarenstroom
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lizet E van der Kolk
- Family Cancer Clinic, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J Margriet Collée
- Department of Clinical Genetics, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Marijke R Wevers
- Department of Clinical Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Margreet G E M Ausems
- Division of Laboratories, Pharmacy, and Biomedical Genetics, Department of Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Klaartje Van Engelen
- Department of Human Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Irma van de Beek
- Department of Human Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lieke P V Berger
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Christi J van Asperen
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Encarna B Gomez Garcia
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maartje J Hooning
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marian J E Mourits
- Department of Gynecologic Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Flora E van Leeuwen
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| |
Collapse
|
9
|
Schmitz RSJM, Wilthagen EA, van Duijnhoven F, van Oirsouw M, Verschuur E, Lynch T, Punglia RS, Hwang ES, Wesseling J, Schmidt MK, Bleiker EMA, Engelhardt EG, PRECISION Consortium GC. Prediction Models and Decision Aids for Women with Ductal Carcinoma In Situ: A Systematic Literature Review. Cancers (Basel) 2022; 14:cancers14133259. [PMID: 35805030 PMCID: PMC9265509 DOI: 10.3390/cancers14133259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Ductal carcinoma in situ (DCIS) is a potential precursor to invasive breast cancer (IBC). Although in many women DCIS will never become breast cancer, almost all women diagnosed with DCIS undergo surgery with/without radiotherapy. Several studies are ongoing to de-escalate treatment for DCIS. Multiple decision support tools have been developed to aid women with DCIS in selecting the best treatment option for their specific goals. The aim of this study was to identify these decision support tools and evaluate their quality and clinical utility. Thirty-three studies were reviewed, in which four decision aids and six prediction models were described. While some of these models might be promising, most lacked important qualities such as tools to help women discuss their options or good quality validation studies. Therefore, the need for good quality, well validated decision support tools remains unmet. Abstract Even though Ductal Carcinoma in Situ (DCIS) can potentially be an invasive breast cancer (IBC) precursor, most DCIS lesions never will progress to IBC if left untreated. Because we cannot predict yet which DCIS lesions will and which will not progress, almost all women with DCIS are treated by breast-conserving surgery +/− radiotherapy, or even mastectomy. As a consequence, many women with non-progressive DCIS carry the burden of intensive treatment without any benefit. Multiple decision support tools have been developed to optimize DCIS management, aiming to find the balance between over- and undertreatment. In this systematic review, we evaluated the quality and added value of such tools. A systematic literature search was performed in Medline(ovid), Embase(ovid), Scopus and TRIP. Following the PRISMA guidelines, publications were selected. The CHARMS (prediction models) or IPDAS (decision aids) checklist were used to evaluate the tools’ methodological quality. Thirty-three publications describing four decision aids and six prediction models were included. The decision aids met at least 50% of the IPDAS criteria. However, most lacked tools to facilitate discussion of the information with healthcare providers. Five prediction models quantify the risk of an ipsilateral breast event after a primary DCIS, one estimates the risk of contralateral breast cancer, and none included active surveillance. Good quality and external validations were lacking for all prediction models. There remains an unmet clinical need for well-validated, good-quality DCIS risk prediction models and decision aids in which active surveillance is included as a management option for low-risk DCIS.
Collapse
Affiliation(s)
- Renée S. J. M. Schmitz
- Department of Molecular Pathology, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands; (R.S.J.M.S.); (J.W.); (M.K.S.)
| | - Erica A. Wilthagen
- Department of Scientific Information Service, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands;
| | | | - Marja van Oirsouw
- Borstkanker Vereniging Nederland, 3511 DT Utrecht, The Netherlands; (M.v.O.); (E.V.)
| | - Ellen Verschuur
- Borstkanker Vereniging Nederland, 3511 DT Utrecht, The Netherlands; (M.v.O.); (E.V.)
| | - Thomas Lynch
- Division of Surgical Oncology, Duke University, Durham, NC 27708, USA; (T.L.); (E.S.H.)
| | - Rinaa S. Punglia
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA;
| | - E. Shelley Hwang
- Division of Surgical Oncology, Duke University, Durham, NC 27708, USA; (T.L.); (E.S.H.)
| | - Jelle Wesseling
- Department of Molecular Pathology, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands; (R.S.J.M.S.); (J.W.); (M.K.S.)
- Department of Pathology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Pathology, Nethelands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Marjanka K. Schmidt
- Department of Molecular Pathology, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands; (R.S.J.M.S.); (J.W.); (M.K.S.)
| | - Eveline M. A. Bleiker
- Department of Psycho-Oncology and Epidemiology, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands;
- Correspondence:
| | - Ellen G. Engelhardt
- Department of Psycho-Oncology and Epidemiology, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands;
| | | |
Collapse
|
10
|
Bokkers K, Vlaming M, Engelhardt EG, Zweemer RP, van Oort IM, Kiemeney LALM, Bleiker EMA, Ausems MGEM. The Feasibility of Implementing Mainstream Germline Genetic Testing in Routine Cancer Care-A Systematic Review. Cancers (Basel) 2022; 14:cancers14041059. [PMID: 35205807 PMCID: PMC8870548 DOI: 10.3390/cancers14041059] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/10/2022] [Accepted: 02/17/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary Germline genetic testing for patients with cancer can have important implications for treatment, preventive options, and for family members. In a mainstream genetic testing pathway, pre-test counseling is performed by non-genetic healthcare professionals, thereby making genetic testing more accessible to all patients who might benefit from it. These mainstream genetic testing pathways are being implemented in different hospitals around the world, and for different cancer types. It is important to evaluate how a mainstream genetic testing pathway can be made sustainable and if quality of genetic care is maintained. We show in this systematic review that it is feasible to incorporate a mainstream genetic testing pathway into routine cancer care while maintaining quality of care. A training procedure for non-genetic healthcare professionals and a close collaboration between genetics and other clinical departments are highly recommended to ensure sustainability. Abstract Background: Non-genetic healthcare professionals can provide pre-test counseling and order germline genetic tests themselves, which is called mainstream genetic testing. In this systematic review, we determined whether mainstream genetic testing was feasible in daily practice while maintaining quality of genetic care. Methods: PubMed, Embase, CINAHL, and PsychINFO were searched for articles describing mainstream genetic testing initiatives in cancer care. Results: Seventeen articles, reporting on 15 studies, met the inclusion criteria. Non-genetic healthcare professionals concluded that mainstream genetic testing was possible within the timeframe of a routine consultation. In 14 studies, non-genetic healthcare professionals completed some form of training about genetics. When referral was coordinated by a genetics team, the majority of patients carrying a pathogenic variant were seen for post-test counseling by genetic healthcare professionals. The number of days between cancer diagnosis and test result disclosure was always lower in the mainstream genetic testing pathway than in the standard genetic testing pathway (e.g., pre-test counseling at genetics department). Conclusions: Mainstream genetic testing seems feasible in daily practice with no insurmountable barriers. A structured pathway with a training procedure is desirable, as well as a close collaboration between genetics and other clinical departments.
Collapse
Affiliation(s)
- Kyra Bokkers
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; (K.B.); (M.V.)
| | - Michiel Vlaming
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; (K.B.); (M.V.)
| | - Ellen G. Engelhardt
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; (E.G.E.); (E.M.A.B.)
| | - Ronald P. Zweemer
- Department of Gynecological Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands;
| | - Inge M. van Oort
- Department of Urology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands; (I.M.v.O.); (L.A.L.M.K.)
| | - Lambertus A. L. M. Kiemeney
- Department of Urology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands; (I.M.v.O.); (L.A.L.M.K.)
- Department for Health Evidence, Radboud University Medical Center, Geert Grooteplein Zuid 21, 6525 EZ Nijmegen, The Netherlands
| | - Eveline M. A. Bleiker
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; (E.G.E.); (E.M.A.B.)
- Department of Clinical Genetics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Family Cancer Clinic, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Margreet G. E. M. Ausems
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; (K.B.); (M.V.)
- Correspondence: ; Tel.: +31-88-75-538-00
| |
Collapse
|
11
|
Schmitz RSJM, Wilthagen E, van Duijnhoven F, van Oirsouw M, Verschuur E, Lynch T, Punglia RS, Hwang S, Wesseling J, Schmidt MK, Bleiker E, Engelhardt EG. Abstract P1-22-04: Decision aids and risk prediction models to support decision making about DCIS treatment: A systematic literature review. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p1-22-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Although most low-risk ductal carcinoma in situ (DCIS) lesions will not progress to invasive breast cancer if left untreated, clinical guidelines advise surgery with/without radiotherapy for all women diagnosed with DCIS. There is therefore increasing concern about the possible overtreatment of DCIS. Currently, clinical trials are being conducted to investigate the safety of active surveillance in low-risk DCIS patients. It is hypothesized that, in future, both surgery and active surveillance will be accepted treatment strategies. Active surveillance is offered to women in the ongoing trials and is expected to become a standard DCIS management option in the future. Choosing whether to undergo surgery for DCIS or to opt for active surveillance can be a difficult decision fraught with uncertainty for both patients and oncologists. Good quality decision support tools such as prediction models and patient decision aids to guide decision making about DCIS management, including the option of active surveillance, are therefore urgently needed. The aim of this study is to identify and evaluate the quality of published decision aids and prediction models aiming to support decision making about DCIS treatment. Methods: A systematic literature review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement criteria. The databases Medline(ovid), Embase (ovid), Scopus, and TRIP were searched to identify published manuscripts describing the development and/or evaluation of DCIS decision aids and prediction models. The protocol was published in the PROSPERO database (ID CRD42020212297). The CHARMS (Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies) checklist was used to evaluate the methodological quality of prediction models and the IPDAS (International Patient Decision Aid Standards) checklist was used to evaluate the quality of decision aids. Data extraction was performed by two researchers with discrepancies resolved through consensus. Results: The review identified 10,636 publications, 33 describing the development and/or validation of four decision aids and seven clinical prediction models were selected (Table 1). The decision aids identified met at least 50% of the IPDAS quality criteria. However, most decision aids lacked tools to help patients reflect on the information received and to facilitate discussion of the information with their family and healthcare providers. Most prediction models were designed to predict the risk of a subsequent ipsilateral breast event after a primary DCIS. No models included the option of active surveillance. Sufficient, good quality, external validation was lacking for all prediction models identified. Conclusions: There are only a few decision aids available that can be used to support patients diagnosed with DCIS. These decision aids could be improved to facilitate the processing of information by patients and enhance communication between patients and their support system and healthcare providers. There is no prediction model that considers active surveillance as a management option for DCIS, and based on the available evidence, there is no prediction model that can be recommended for use in clinical practice. More and qualitatively better validations are required in the future.
Table 1.Overview of DCIS decision aids and prediction models identifiedDCIS DECISION AIDSDecision aid by Berger-Hoger et al.(2014)Communication aid by De Morgan et al.(2009)onlineDeCISion.org by Ozanne et al.(2016)DCISoptions.org by COMET trial team(SABCS 2020)Target audience:Women with DCISCliniciansClinicians and women with DCISWomen with DCISLanguage:GermanEnglishEnglishEnglishEvaluation study conducted:YesYesNot reportedNot reportedDesign evaluation study:RCTInterviewNot applicableNot applicableSample size evaluation study:6425Not applicableNot applicableMain finding evaluation study:More active patient involvementCommunication tool assists shared decision makingNot applicableNot applicableImplementation study conducted:None retrievedNone retrievedNone retrievedNone retrieved% IPDAS criteria met regarding:Content87%57%65%78%Development process71%59%67%42%Effectiveness100%50%75%75%DCIS PREDICTION MODELSOncotype DCIS(Solin et al. (2013))DCISionRT/PreludeDX(Bremer et al. (2018))Van Nuysprognostic index(Silverstein et al. (1995))MSKCC DCIS nomogram(Rudlof et al. (2010))Patient prognostic score(Sagara et al. (2016))PredictCBC(Giardello et al. (2019))CBC Risk model(Chowdhury et al. (2017))Predicted outcome:Ipsilateral breast eventIpsilateral breast eventIpsilateral breast eventIpsilateral breast eventIpsilateral breast eventContralateral breast cancerContralateral breast cancerTool based on:Multigene assayBiomarkers + clinico-pathological factorsClinicopatho-logical factors onlyClinicopatho-logical factors onlyClinicopatho-logical factors onlyClinicopatho-logical factors onlyClinicopatho-logical factors onlyIntended to support decision making about:Need for adjuvant radiotherapyNeed for adjuvant radiotherapyType of surgery and need for radiotherapyNeed for adjuvant radiotherapyNeed for adjuvant radiotherapyScreening or prophylactic mastectomyScreening or prophylactic mastectomyRisk of bias based on CHARMS:ModerateModerateModerate/HighModerateLowLowLowNumber (external) validations:3193001Reported C-index/AUC0.68None reportedNone reported0.61-0.68None reported0.52None reportedThis work was supported by Cancer Research UK and by KWF Dutch Cancer Society (ref.C38317/A24043)
Citation Format: Renée SJM Schmitz, Erica Wilthagen, Frederieke van Duijnhoven, Marja van Oirsouw, Ellen Verschuur, Thomas Lynch, Rinaa S Punglia, Shelley Hwang, Jelle Wesseling, Marjanka K Schmidt, Eveline Bleiker, Ellen G Engelhardt, Grand Challenge PRECISION consortium. Decision aids and risk prediction models to support decision making about DCIS treatment: A systematic literature review [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-22-04.
Collapse
|
12
|
Custers PA, Geubels BM, Huibregtse IL, Peters FP, Engelhardt EG, Beets GL, Marijnen CAM, van Leerdam ME, van Triest B. Contact X-ray Brachytherapy for Older or Inoperable Rectal Cancer Patients: Short-Term Oncological and Functional Follow-Up. Cancers (Basel) 2021; 13:cancers13246333. [PMID: 34944953 PMCID: PMC8699080 DOI: 10.3390/cancers13246333] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022] Open
Abstract
Total mesorectal excision for rectal cancer is a major operation associated with morbidity and mortality. For older or inoperable patients, alternatives are necessary. This prospective study evaluated the oncological and functional outcome and quality of life of older or inoperable rectal cancer patients treated with a contact X-ray brachytherapy boost to avoid major surgery. During follow-up, tumor response and toxicity on endoscopy were scored. Functional outcome and quality of life were assessed with self-administered questionnaires. Additionally, in-depth interviews regarding patients' experiences were conducted. Nineteen patients were included with a median age of 80 years (range 72-91); nine patients achieved a clinical complete response and in another four local control of the tumor was established. The 12 month organ-preservation rate, progression-free survival, and overall survival were 88%, 78%, and 100%, respectively. A transient decrease in quality of life and bowel function was observed at 3 months, which was generally restored at 6 months. In-depth interviews revealed that patients' experience was positive despite the side-effects shortly after treatment. In older or inoperable rectal cancer patients, contact X-ray brachytherapy can be considered an option to avoid total mesorectal excision. Contact X-ray brachytherapy is well-tolerated and can provide good tumor control.
Collapse
Affiliation(s)
- Petra A. Custers
- Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, 1006 BE Amsterdam, The Netherlands; (P.A.C.); (B.M.G.); (G.L.B.)
- Department of Radiation Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, 1006 BE Amsterdam, The Netherlands; (F.P.P.); (C.A.M.M.)
- GROW School for Oncology and Developmental Biology, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Barbara M. Geubels
- Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, 1006 BE Amsterdam, The Netherlands; (P.A.C.); (B.M.G.); (G.L.B.)
- GROW School for Oncology and Developmental Biology, Maastricht University, 6200 MD Maastricht, The Netherlands
- Department of Surgery, Catharina Hospital, Postbox 1350, 5602 ZA Eindhoven, The Netherlands
| | - Inge L. Huibregtse
- Department of Gastroenterology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, 1006 BE Amsterdam, The Netherlands; (I.L.H.); (M.E.v.L.)
| | - Femke P. Peters
- Department of Radiation Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, 1006 BE Amsterdam, The Netherlands; (F.P.P.); (C.A.M.M.)
- Department of Radiation Oncology, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
| | - Ellen G. Engelhardt
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, 1006 BE Amsterdam, The Netherlands;
| | - Geerard L. Beets
- Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, 1006 BE Amsterdam, The Netherlands; (P.A.C.); (B.M.G.); (G.L.B.)
- GROW School for Oncology and Developmental Biology, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Corrie A. M. Marijnen
- Department of Radiation Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, 1006 BE Amsterdam, The Netherlands; (F.P.P.); (C.A.M.M.)
- Department of Radiation Oncology, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
| | - Monique E. van Leerdam
- Department of Gastroenterology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, 1006 BE Amsterdam, The Netherlands; (I.L.H.); (M.E.v.L.)
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
| | - Baukelien van Triest
- Department of Radiation Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, 1006 BE Amsterdam, The Netherlands; (F.P.P.); (C.A.M.M.)
- Correspondence: ; Tel.: +31-(0)20-512-9111
| |
Collapse
|
13
|
Byng D, Retèl VP, Engelhardt EG, Groothuis-Oudshoorn CGM, van Til JA, Schmitz RSJM, van Duijnhoven F, Wesseling J, Bleiker E, van Harten WH. Preferences of Treatment Strategies among Women with Low-Risk DCIS and Oncologists. Cancers (Basel) 2021; 13:3962. [PMID: 34439126 PMCID: PMC8394332 DOI: 10.3390/cancers13163962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 07/29/2021] [Accepted: 08/02/2021] [Indexed: 12/27/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Danalyn Byng
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands; (V.P.R.); (E.G.E.); (E.B.); (W.H.v.H.)
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands; (C.G.M.G.-O.); (J.A.v.T.)
| | - Valesca P. Retèl
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands; (V.P.R.); (E.G.E.); (E.B.); (W.H.v.H.)
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands; (C.G.M.G.-O.); (J.A.v.T.)
| | - Ellen G. Engelhardt
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands; (V.P.R.); (E.G.E.); (E.B.); (W.H.v.H.)
- Division of Molecular Pathology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands; (R.S.J.M.S.); (J.W.)
| | - Catharina G. M. Groothuis-Oudshoorn
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands; (C.G.M.G.-O.); (J.A.v.T.)
| | - Janine A. van Til
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands; (C.G.M.G.-O.); (J.A.v.T.)
| | - Renée S. J. M. Schmitz
- Division of Molecular Pathology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands; (R.S.J.M.S.); (J.W.)
| | - Frederieke van Duijnhoven
- Division of Surgical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands;
| | - Jelle Wesseling
- Division of Molecular Pathology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands; (R.S.J.M.S.); (J.W.)
- Department of Pathology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Eveline Bleiker
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands; (V.P.R.); (E.G.E.); (E.B.); (W.H.v.H.)
- Department of Clinical Genetics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Wim H. van Harten
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands; (V.P.R.); (E.G.E.); (E.B.); (W.H.v.H.)
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands; (C.G.M.G.-O.); (J.A.v.T.)
| |
Collapse
|
14
|
Révész D, Engelhardt EG, Tamminga JJ, Schramel FMNH, Onwuteaka-Philipsen BD, van de Garde EMW, Steyerberg EW, de Vet HC, Coupé VMH. Needs with Regard to Decision Support Systems for Treating Patients with Incurable Non-small Cell Lung Cancer. J Cancer Educ 2020; 35:345-351. [PMID: 30685832 PMCID: PMC7075822 DOI: 10.1007/s13187-019-1471-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Treatment decision-making for patients with incurable non-small cell lung cancer (NSCLC) is complex due to the rapidly increasing number of treatments and discovery of new biomarkers. Decision support systems (DSS) could assist thoracic oncologists (TO) weighing of the pros and cons of treatments in order to arrive at an evidence-based and personalized treatment advice. Our aim is to inventory (1) TO's needs with regard to DSS in the treatment of incurable (stage IIIB/IV) NSCLC patients, and (2) preferences regarding the development of future tools in this field. We disseminated an online inventory questionnaire among all members of the Section of Oncology within the Society of Physicians in Chest Medicine and Tuberculosis. Telephone interviews were conducted to better contextualize the findings from the questionnaire. In total, 58 TO completed the questionnaire and expressed a need for new DSS. They reported that it is important for tools to include genetic and immune markers, to be sufficiently validated, regularly updated, and time-efficient. Also, future DSS should incorporate multiple treatment options, integrate estimates of toxicity, quality of life and cost-effectiveness of treatments, enhance communication between caregivers and patients, and use IT solutions for a clear interface and continuous updating of tools. With this inventory among Dutch TO, we summarized the need for new DSS to aid treatment decision-making for patients with incurable NSCLC. To meet the expressed needs, substantial additional efforts will be required by DSS developers, above already existing tools.
Collapse
Affiliation(s)
- Dóra Révész
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1089a, PO Box 7057, 1081 HV Amsterdam, The Netherlands
| | - Ellen G. Engelhardt
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1089a, PO Box 7057, 1081 HV Amsterdam, The Netherlands
| | - Johannes J. Tamminga
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1089a, PO Box 7057, 1081 HV Amsterdam, The Netherlands
| | - Franz M. N. H. Schramel
- Department of Lung Diseases and Treatment, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
| | - Bregje D. Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, PO Box 7057, 1081 HV Amsterdam, The Netherlands
| | - Ewoudt M. W. van de Garde
- Department of Clinical Pharmacy, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
| | - Ewout W. Steyerberg
- Center for Medical Decision Sciences, Department of Public Health, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Henrica C.W. de Vet
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1089a, PO Box 7057, 1081 HV Amsterdam, The Netherlands
| | - Veerle M. H. Coupé
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1089a, PO Box 7057, 1081 HV Amsterdam, The Netherlands
| |
Collapse
|
15
|
Alaeikhanehshir S, Engelhardt EG, van Duijnhoven FH, van Seijen M, Bhairosing PA, Pinto D, Collyar D, Wesseling J, Lips EH, Schmidt MK. Abstract P5-08-15: The impact of patient characteristics and lifestyle factors on the risk of an ipsilateral event after a primary DCIS: A systematic review. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p5-08-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose The majority of ‘low-risk’ (grade I/II) Ductal Carcinoma In Situ (DCIS) lesions do not progress to invasive breast cancer during a woman’s lifetime. Therefore, the safety of active surveillance versus standard surgical treatment for grade I/II DCIS is being evaluated in several clinical trials. If active surveillance is proven safe and implemented in clinical practice, a significant group of women with low-risk DCIS may forego surgery and radiotherapy. To further reduce their risks, there is an urgent need to identify potentially modifiable risk factors. Nonetheless, non-modifiable risk factors are also of great importance to gain clear understanding of the overall risk for developing a subsequent event (invasive breast cancer, in situ recurrences, distant metastases) following untreated DCIS. A systematic literature review was performed to evaluate the impact of established breast cancer risk factors on the risk of developing in situ or invasive disease after treatment of primary pure DCIS. Methods A systematic literature search was performed in PUBMED, EMBASE and Web of Science. PRISMA methodology was applied for the selection of studies. We only included studies that were published after the review by Shamliyan et al in 2010. Results Nine out of the 3,852 articles retrieved were included for final data extraction and evaluation. These nine studies included a total of 11,602 patients with primary pure DCIS. The sample size of these studies ranged from 50 to 4,131 patients. Across the studies, a total of 979 (range: 2-239) subsequent events, such as ipsilateral invasive, ipsilateral in situ events, and distant metastases, were reported. The median follow-up varied between four and nine years. There was limited information published and limited evidence in the selected studies especially on modifiable factors; and all studies except one, were in women of European-descent. Of the modifiable factors only a high BMI (≥25) in mainly postmenopausal women seemed to be associated with a lower risk of a subsequent event. There was some evidence for several non-modifiable predictors, i.e. younger age at diagnosis of DCIS, positive family history of breast cancer, premenopausal status, and high breast density. Age was associated with a two to threefold risk for experiencing a subsequent event. A positive family history had an almost two-fold increased risk, and pre-menopausal status increased the risk for a subsequent event between 46 to 89%. Furthermore, the highest quintile for breast density was associated with a 70% increase in risk for a subsequent event. See table 1 for effect sizes with 95% confidence intervals. Conclusion There is a limited number of studies published on the impact of risk factors on subsequent events after pure DCIS. Moreover, the available evidence is insufficient to identify potential targets for risk reduction strategies, due to the relatively small numbers and the lack of long term follow-up in a low-event disease such as DCIS. Traditional risk factors for primary invasive breast cancer showed, in general, also to be associated with the risk for a subsequent event after primary pure DCIS. The single study that reported on BMI showed a direction of association that was contrary to expectations. In conclusion large scale, well-designed, studies with specific attention to lifestyle factors are necessary to enable identification of DCIS who are at low and high risk for a subsequent event after primary pure DCIS.
Table 1. Overview of published effect sizes of risk of a subsequent event after pure DCISIncluded articlesVariableHR/OR (95% CI)Moran et al. 2017 Age (≥50 vs < 50 years) HR(Multivariate) 0.54 (0.41-0.71)Alvarado et al. 2012Age (<40 vs ≥ 40 years)HR(Univariate) 2.70 (1.06–6.93) Baglia et al. 2018Family history (>2 relatives with Breast Cancer)OR(Multivariate) 1.78 (1.02–3.10)De Lorenzi et al. 2018BMI (high ≥ 25 vs low)HR(Multivariate)0.48(0.26-0.90)De Lorenzi et al. 2018Menopausal state (pre vs post)HR(Multivariate)1.89 (0.37-0.77)Shurell et al. 2017Menopausal state (post vs pre)HR(Multivariate)0.54 (0.37-0.77)Habel et al. 2010Breast density (highest quintile)HR(Multivariate)1.70 (1.00–2.39)
Citation Format: Sena Alaeikhanehshir, Ellen G Engelhardt, Frederieke H van Duijnhoven, Maartje van Seijen, Patrick A Bhairosing, Donna Pinto, Deborah Collyar, Jelle Wesseling, Esther H Lips, Marjanka K Schmidt. The impact of patient characteristics and lifestyle factors on the risk of an ipsilateral event after a primary DCIS: A systematic review [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-08-15.
Collapse
Affiliation(s)
- Sena Alaeikhanehshir
- 1Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Ellen G Engelhardt
- 1Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | | | - Maartje van Seijen
- 1Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Patrick A Bhairosing
- 1Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Donna Pinto
- 2Patient Leadership Team, PRECISION PROJECT, Amsterdam, Netherlands
| | - Deborah Collyar
- 2Patient Leadership Team, PRECISION PROJECT, Amsterdam, Netherlands
| | - Jelle Wesseling
- 1Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Esther H Lips
- 1Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Marjanka K Schmidt
- 1Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| |
Collapse
|
16
|
Engelhardt EG, Smets EMA, Sorial I, Stiggelbout AM, Pieterse AH, Hillen MA. Is There a Relationship between Shared Decision Making and Breast Cancer Patients' Trust in Their Medical Oncologists? Med Decis Making 2019; 40:52-61. [PMID: 31789100 PMCID: PMC7433397 DOI: 10.1177/0272989x19889905] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background. Adjuvant systemic treatment for early stage breast cancer significantly reduces the risk of mortality but is associated with side effects, reducing patients’ quality of life. Decisions about adjuvant treatment are preference sensitive and are thus ideally suited to a shared decision making (SDM) approach. Whether and how SDM affects patients’ trust in their oncologist is currently unknown. We investigated the association between patients’ trust in their oncologist and 1) observed level of SDM in the consultation, 2) congruence between patients’ preferred and perceived level of participation, and 3) patient and oncologist characteristics. Methods. Decision consultations (n = 101) between breast cancer patients and their medical oncologist were audio-recorded and transcribed verbatim. Patients’ trust in their oncologist was measured using the Trust in Oncologist Scale (TiOS). The observed level of SDM was scored using the 12-item Observing Patient Involvement In Decision Making scale (OPTION-12), preferred level of participation with the Control Preferences Scale, and perceived level of participation with an open question in telephonic interviews. Results. The average TiOS score was high overall (mean [SD] = 4.1 [.56]; range, 2.6–5.0). Low levels of SDM were observed (mean [SD] = 16 [11.6]; range, 2–56). Neither observed nor perceived level of participation in SDM was associated with trust. Patients’ preferred and perceived role in decision making was incongruent in almost 50% of treatment decisions. Congruence was not related to trust. A larger tumor size (β = 4.5, P = 0.03) and the use of a risk prediction model during the consultation (β = 4.1, P = 0.04) were associated with stronger trust. Conclusion. Patients reported strong trust in their oncologist. While low levels of SDM were observed, SDM was not associated with trust. These findings suggest it may not be necessary to worry about negative consequences for trust of using SDM or risk prediction models in oncological consultations. Considering the increased emphasis on implementing SDM, it is important to further explore how SDM affects trust in clinical practice.
Collapse
Affiliation(s)
- Ellen G Engelhardt
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Noord-Holland, the Netherlands
| | - Irini Sorial
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Noord-Holland, the Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands
| | - Marij A Hillen
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Noord-Holland, the Netherlands
| |
Collapse
|
17
|
Klaver KM, Duijts SFA, Engelhardt EG, Geusgens CAV, Aarts MJB, Ponds RWHM, van der Beek AJ, Schagen SB. Cancer-related cognitive problems at work: experiences of survivors and professionals. J Cancer Surviv 2019; 14:168-178. [PMID: 31768861 PMCID: PMC7182611 DOI: 10.1007/s11764-019-00830-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/23/2019] [Indexed: 12/21/2022]
Abstract
Purpose Cancer-related cognitive problems (cancer-related cognitive problems) in working cancer survivors are found to affect work outcomes. We aimed to generate in-depth information regarding cancer-related cognitive problems in working cancer survivors, strategies used to cope with cancer-related cognitive problems at work, and needs of cancer survivors and professionals regarding cancer-related cognitive problems at work. Methods Five focus groups were formed, amongst which three focus groups with cancer survivors (n = 8, n = 7, and n = 8) and two focus groups with professionals (n = 7, n = 8). Thematic analysis of the transcripts was performed to create concepts. Results Both cancer survivors and professionals confirmed that cancer-related cognitive problems, which occurred in several domains of neurocognitive functioning, affect work functioning. Cancer survivors used several strategies (e.g., applying practical adjustments, re-organization of work, and accepting limitations) to cope with cancer-related cognitive problems at work, as did professionals in their attempt at supporting cancer survivors facing these problems. Various needs of cancer survivors (e.g., supportive care options, acknowledgment by others) and professionals (e.g., improvement of expertise, clarity about referral pathways) regarding cancer-related cognitive problems at work were mentioned. Conclusions Due to the growing number of working cancer survivors dealing with cancer-related cognitive problems, it is essential to sustain their employability. Therefore, cognitive rehabilitation interventions should be developed, taking functioning at work into account. Knowledge amongst professionals regarding cancer-related cognitive problems, as well as coordination of care for cancer-related cognitive problems, should be improved. Ensuring professional education regarding cancer-related cognitive problems, within both the healthcare and occupational setting, is of utmost importance. Implications for cancer survivors Support for working cancer survivors who experience cancer-related cognitive problems might increase their employability in the longer term. Electronic supplementary material The online version of this article (10.1007/s11764-019-00830-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Kete M Klaver
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands. .,Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Saskia F A Duijts
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Ellen G Engelhardt
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands.,Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Chantal A V Geusgens
- Department of Clinical and Medical Psychology, Zuyderland MC, Sittard, The Netherlands
| | - Maureen J B Aarts
- Department of Medical Oncology, Maastricht University MC, Maastricht, The Netherlands
| | - Rudolf W H M Ponds
- Department of Medical Psychology/School of Mental Health and Neurosciences (MHeNS), Maastricht University MC, Maastricht, The Netherlands
| | - Allard J van der Beek
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sanne B Schagen
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands.,Brain and Cognition Group, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
18
|
Engelhardt EG, Révész D, Tamminga HJ, Punt CJA, Koopman M, Onwuteaka-Philipsen BD, Steyerberg EW, de Vet HCW, Coupé VMH. Inventory of oncologists' unmet needs for tools to support decision-making about palliative treatment for metastatic colorectal cancer. BMC Med Inform Decis Mak 2018; 18:132. [PMID: 30551735 PMCID: PMC6295030 DOI: 10.1186/s12911-018-0712-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 11/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Decision-making about palliative care for metastatic colorectal cancer (mCRC) consists of many different treatment-related decisions, and there generally is no best treatment option. Decision support systems (DSS), e.g., prognostic calculators, can aid oncologists' decision-making. DSS that contain features tailored to the needs of oncologists are more likely to be implemented in clinical practice. Therefore, our aim is to inventory colorectal cancer specialists' unmet decision support needs. METHODS We asked oncologists from the Dutch colorectal cancer group (DCCG), to participate in an online inventory questionnaire on their unmet decision support needs. To get more in-depth insight in required features of the DSS they need, we also conducted semi-structured telephone interviews. RESULTS Forty-one oncologists started the inventory questionnaire, and 27 of them completed all items. Of all respondents, 18 were surgeons (44%), 22 were medical oncologists (54%), and 28 (68%) had more than 10 years of experience treating mCRC. In both the inventory questionnaire and interviews, respondents expressed a need for an overarching DSS incorporating multiple treatment options, and presenting both the treatment benefits and harms. Respondents found it relevant for other outcomes, such as cost-effectiveness of treatment or quality of life, to be incorporated in DSS. There was also a wish for DSS incorporating an up-to-date "personalized" overview of the ongoing trials for which a specific patient is eligible. CONCLUSIONS Experienced oncologists indicate that their treatment advice is currently almost solely based on the available clinical guidelines. They experience a lack of good quality DSS to help them personalize their treatment advice. New tools integrating multiple treatment options and providing a broad range of clinically relevant outcomes are urgently needed to stimulate and safeguard more personalized treatment decision-making.
Collapse
Affiliation(s)
- Ellen G Engelhardt
- Department of Epidemiology and Biostatistics, Amsterdam UMC, location VUMC, F-wing Medical Faculty building, PO Box 7057 1007, MB, Amsterdam, The Netherlands.
| | - Dóra Révész
- Department of Epidemiology and Biostatistics, Amsterdam UMC, location VUMC, F-wing Medical Faculty building, PO Box 7057 1007, MB, Amsterdam, The Netherlands
| | - Hans J Tamminga
- Department of Epidemiology and Biostatistics, Amsterdam UMC, location VUMC, F-wing Medical Faculty building, PO Box 7057 1007, MB, Amsterdam, The Netherlands
| | - Cornelis J A Punt
- Department of Medical Oncology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht and University Utrecht, Utrecht, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, and Palliative Care Expertise Centre, VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Ewout W Steyerberg
- Department of Public Health, Centre for Medical Decision Making, Erasmus Medical Center, Rotterdam, The Netherlands and Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Henrica C W de Vet
- Department of Epidemiology and Biostatistics, Amsterdam UMC, location VUMC, F-wing Medical Faculty building, PO Box 7057 1007, MB, Amsterdam, The Netherlands
| | - Veerle M H Coupé
- Department of Epidemiology and Biostatistics, Amsterdam UMC, location VUMC, F-wing Medical Faculty building, PO Box 7057 1007, MB, Amsterdam, The Netherlands
| |
Collapse
|
19
|
Henselmans I, van Laarhoven HWM, de Haes HCJM, Tokat M, Engelhardt EG, van Maarschalkerweerd PEA, Kunneman M, Ottevanger PB, Dohmen SE, Creemers GJ, Sommeijer DW, de Vos FYFL, Smets EMA. Training for Medical Oncologists on Shared Decision-Making About Palliative Chemotherapy: A Randomized Controlled Trial. Oncologist 2018; 24:259-265. [PMID: 29959285 DOI: 10.1634/theoncologist.2018-0090] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 04/26/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Systemic treatment for advanced cancer offers uncertain and sometimes limited benefit, while the burden can be high. This study examines the effect of shared decision-making (SDM) training for medical oncologists on observed SDM in standardized patient assessments. MATERIALS AND METHODS A randomized controlled trial comparing training with standard practice was conducted. Medical oncologists and oncologists-in-training (n = 31) participated in a video-recorded, standardized patient assessment at baseline (T0) and after 4 months (T1, after training). The training was based on a four-stage SDM model and consisted of a reader, two group sessions (3.5 hours each), a booster session (1.5 hours), and a consultation card. The primary outcome was observed SDM as assessed with the Observing Patient Involvement scale (OPTION12) coded by observers blinded for arm. Secondary outcomes were observed SDM per stage, communication skills, and oncologists' satisfaction with communication. RESULTS The training had a significant and large effect on observed SDM in the simulated consultations (Cohen's f = 0.62) and improved observed SDM behavior in all four SDM stages (f = 0.39-0.72). The training improved oncologists' information provision skills (f = 0.77), skills related to anticipating/responding to emotions (f = 0.42), and their satisfaction with the consultation (f = 0.53). CONCLUSION Training medical oncologists in SDM about palliative systemic treatment improves their performance in simulated consultations. The next step is to examine the effect of such training on SDM in clinical practice and on patient outcomes. IMPLICATIONS FOR PRACTICE Systemic treatment for advanced cancer offers uncertain and sometimes limited benefit, while the burden can be high. Hence, applying the premises of shared decision-making (SDM) is recommended. SDM is increasingly advocated based on the ethical imperative to provide patient-centered care and the increasing evidence for beneficial patient outcomes. Few studies examined the effectiveness of SDM training in robust designs. This randomized controlled trial demonstrated that SDM training (10 hours) improves oncologists' performance in consultations with standardized patients. The next step is to examine the effect of training on oncologists' performance and patient outcomes in clinical practice.
Collapse
Affiliation(s)
- Inge Henselmans
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Hanneke C J M de Haes
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Meltem Tokat
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Ellen G Engelhardt
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, VU Medical Center, Amsterdam, The Netherlands
| | | | - Marleen Kunneman
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, The Netherlands
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Petronella B Ottevanger
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Serge E Dohmen
- Department of Internal Medicine, BovenIJ Hospital, Amsterdam, The Netherlands
| | - Geert-Jan Creemers
- Department of Medical Oncology, Catharina Cancer Institute, Eindhoven, The Netherlands
| | - Dirkje W Sommeijer
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, The Netherlands
- Department of Internal Medicine, Flevo Hospital, Almere, The Netherlands
| | - Filip Y F L de Vos
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
20
|
Engelhardt EG, van den Broek AJ, Linn SC, Wishart GC, Rutgers EJT, van de Velde AO, Smit VTHBM, Voogd AC, Siesling S, Brinkhuis M, Seynaeve C, Westenend PJ, Stiggelbout AM, Tollenaar RAEM, van Leeuwen FE, van 't Veer LJ, Ravdin PM, Pharaoh PDP, Schmidt MK. Accuracy of the online prognostication tools PREDICT and Adjuvant! for early-stage breast cancer patients younger than 50 years. Eur J Cancer 2017; 78:37-44. [PMID: 28412587 DOI: 10.1016/j.ejca.2017.03.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 11/29/2016] [Accepted: 03/16/2017] [Indexed: 10/19/2022]
Abstract
IMPORTANCE Online prognostication tools such as PREDICT and Adjuvant! are increasingly used in clinical practice by oncologists to inform patients and guide treatment decisions about adjuvant systemic therapy. However, their validity for young breast cancer patients is debated. OBJECTIVE To assess first, the prognostic accuracy of PREDICT's and Adjuvant! 10-year all-cause mortality, and second, its breast cancer-specific mortality estimates, in a large cohort of breast cancer patients diagnosed <50 years. DESIGN Hospital-based cohort. SETTING General and cancer hospitals. PARTICIPANTS A consecutive series of 2710 patients without a prior history of cancer, diagnosed between 1990 and 2000 with unilateral stage I-III breast cancer aged <50 years. MAIN OUTCOME MEASURES Calibration and discriminatory accuracy, measured with C-statistics, of estimated 10-year all-cause and breast cancer-specific mortality. RESULTS Overall, PREDICT's calibration for all-cause mortality was good (predicted versus observed) meandifference: -1.1% (95%CI: -3.2%-0.9%; P = 0.28). PREDICT tended to underestimate all-cause mortality in good prognosis subgroups (range meandifference: -2.9% to -4.8%), overestimated all-cause mortality in poor prognosis subgroups (range meandifference: 2.6%-9.4%) and underestimated survival in patients < 35 by -6.6%. Overall, PREDICT overestimated breast cancer-specific mortality by 3.2% (95%CI: 0.8%-5.6%; P = 0.007); and also overestimated it seemingly indiscriminately in numerous subgroups (range meandifference: 3.2%-14.1%). Calibration was poor in the cohort of patients with the lowest and those with the highest mortality probabilities. Discriminatory accuracy was moderate-to-good for all-cause mortality in PREDICT (0.71 [95%CI: 0.68 to 0.73]), and the results were similar for breast cancer-specific mortality. Adjuvant!'s calibration and discriminatory accuracy for both all-cause and breast cancer-specific mortality were in line with PREDICT's findings. CONCLUSIONS Although imprecise at the extremes, PREDICT's estimates of 10-year all-cause mortality seem reasonably sound for breast cancer patients <50 years; Adjuvant! findings were similar. Prognostication tools should be used with caution due to the intrinsic variability of their estimates, and because the threshold to discuss adjuvant systemic treatment is low. Thus, seemingly insignificant mortality overestimations or underestimations of a few percentages can significantly impact treatment decision-making.
Collapse
Affiliation(s)
- Ellen G Engelhardt
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Alexandra J van den Broek
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Sabine C Linn
- Division of Molecular Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Division of Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gordon C Wishart
- Faculty of Medical Science, Anglia Ruskin University, Cambridge, UK
| | - Emiel J Th Rutgers
- Division of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Anthonie O van de Velde
- Biometrics Department, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Vincent T H B M Smit
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Adri C Voogd
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands; Department of Epidemiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sabine Siesling
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands; Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | | | - Caroline Seynaeve
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Anne M Stiggelbout
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Flora E van Leeuwen
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Laura J van 't Veer
- Division of Molecular Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Peter M Ravdin
- University of Texas, Health Sciences Center, San Antonio, USA
| | - Paul D P Pharaoh
- Department of Oncology, Strangeways Research Laboratory, University of Cambridge, Worts Causeway, Cambridge, UK
| | - Marjanka K Schmidt
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Division of Molecular Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
| |
Collapse
|
21
|
Engelhardt EG, Pieterse AH, Han PKJ, van Duijn-Bakker N, Cluitmans F, Maartense E, Bos MMEM, Weijl NI, Punt CJA, Quarles van Ufford-Mannesse P, Sleeboom H, Portielje JEA, van der Hoeven KJM, Woei-A-Jin FJS, Kroep JR, de Haes HCJM, Smets EMA, Stiggelbout AM. Disclosing the Uncertainty Associated with Prognostic Estimates in Breast Cancer. Med Decis Making 2016; 37:179-192. [DOI: 10.1177/0272989x16670639] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Treatment decision making is often guided by evidence-based probabilities, which may be presented to patients during consultations. These probabilities are intrinsically imperfect and embody 2 types of uncertainties: aleatory uncertainty arising from the unpredictability of future events and epistemic uncertainty arising from limitations in the reliability and accuracy of probability estimates. Risk communication experts have recommended disclosing uncertainty. We examined whether uncertainty was discussed during cancer consultations and whether and how patients perceived uncertainty. Methods. Consecutive patient consultations with medical oncologists discussing adjuvant treatment in early-stage breast cancer were audiotaped, transcribed, and coded. Patients were interviewed after the consultation to gain insight into their perceptions of uncertainty. Results. In total, 198 patients were included by 27 oncologists. Uncertainty was disclosed in 49% (97/197) of consultations. In those 97 consultations, 23 allusions to epistemic uncertainty were made and 84 allusions to aleatory uncertainty. Overall, the allusions to the precision of the probabilities were somewhat ambiguous. Interviewed patients mainly referred to aleatory uncertainty if not prompted about epistemic uncertainty. Even when specifically asked about epistemic uncertainty, 1 in 4 utterances referred to aleatory uncertainty. When talking about epistemic uncertainty, many patients contradicted themselves. In addition, 1 in 10 patients seemed not to realize that the probabilities communicated during the consultation are imperfect. Conclusions. Uncertainty is conveyed in only half of patient consultations. When uncertainty is communicated, oncologists mainly refer to aleatory uncertainty. This is also the type of uncertainty that most patients perceive and seem comfortable discussing. Given that it is increasingly common for clinicians to discuss outcome probabilities with their patients, guidance on whether and how to best communicate uncertainty is urgently needed.
Collapse
Affiliation(s)
- Ellen G. Engelhardt
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands (EGE, AHP, NvD, AMS)
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME (PKJH)
- Department of Oncology, Alrijne Hospital, Leiderdorp, the Netherlands (FC)
- Department of Oncology, Reinier de Graaf Hospital, Delft, the Netherlands (ED, MMEMB)
- Department of Internal Medicine and Oncology, MCH Bronovo Hospital, The Hague, the Netherlands (NIW)
| | - Arwen H. Pieterse
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands (EGE, AHP, NvD, AMS)
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME (PKJH)
- Department of Oncology, Alrijne Hospital, Leiderdorp, the Netherlands (FC)
- Department of Oncology, Reinier de Graaf Hospital, Delft, the Netherlands (ED, MMEMB)
- Department of Internal Medicine and Oncology, MCH Bronovo Hospital, The Hague, the Netherlands (NIW)
| | - Paul K. J. Han
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands (EGE, AHP, NvD, AMS)
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME (PKJH)
- Department of Oncology, Alrijne Hospital, Leiderdorp, the Netherlands (FC)
- Department of Oncology, Reinier de Graaf Hospital, Delft, the Netherlands (ED, MMEMB)
- Department of Internal Medicine and Oncology, MCH Bronovo Hospital, The Hague, the Netherlands (NIW)
| | - Nanny van Duijn-Bakker
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands (EGE, AHP, NvD, AMS)
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME (PKJH)
- Department of Oncology, Alrijne Hospital, Leiderdorp, the Netherlands (FC)
- Department of Oncology, Reinier de Graaf Hospital, Delft, the Netherlands (ED, MMEMB)
- Department of Internal Medicine and Oncology, MCH Bronovo Hospital, The Hague, the Netherlands (NIW)
| | - Frans Cluitmans
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands (EGE, AHP, NvD, AMS)
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME (PKJH)
- Department of Oncology, Alrijne Hospital, Leiderdorp, the Netherlands (FC)
- Department of Oncology, Reinier de Graaf Hospital, Delft, the Netherlands (ED, MMEMB)
- Department of Internal Medicine and Oncology, MCH Bronovo Hospital, The Hague, the Netherlands (NIW)
| | - Ed Maartense
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands (EGE, AHP, NvD, AMS)
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME (PKJH)
- Department of Oncology, Alrijne Hospital, Leiderdorp, the Netherlands (FC)
- Department of Oncology, Reinier de Graaf Hospital, Delft, the Netherlands (ED, MMEMB)
- Department of Internal Medicine and Oncology, MCH Bronovo Hospital, The Hague, the Netherlands (NIW)
| | - Monique M. E. M. Bos
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands (EGE, AHP, NvD, AMS)
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME (PKJH)
- Department of Oncology, Alrijne Hospital, Leiderdorp, the Netherlands (FC)
- Department of Oncology, Reinier de Graaf Hospital, Delft, the Netherlands (ED, MMEMB)
- Department of Internal Medicine and Oncology, MCH Bronovo Hospital, The Hague, the Netherlands (NIW)
| | - Nir I. Weijl
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands (EGE, AHP, NvD, AMS)
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME (PKJH)
- Department of Oncology, Alrijne Hospital, Leiderdorp, the Netherlands (FC)
- Department of Oncology, Reinier de Graaf Hospital, Delft, the Netherlands (ED, MMEMB)
- Department of Internal Medicine and Oncology, MCH Bronovo Hospital, The Hague, the Netherlands (NIW)
| | - Cornelis J. A. Punt
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands (EGE, AHP, NvD, AMS)
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME (PKJH)
- Department of Oncology, Alrijne Hospital, Leiderdorp, the Netherlands (FC)
- Department of Oncology, Reinier de Graaf Hospital, Delft, the Netherlands (ED, MMEMB)
- Department of Internal Medicine and Oncology, MCH Bronovo Hospital, The Hague, the Netherlands (NIW)
| | - Patricia Quarles van Ufford-Mannesse
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands (EGE, AHP, NvD, AMS)
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME (PKJH)
- Department of Oncology, Alrijne Hospital, Leiderdorp, the Netherlands (FC)
- Department of Oncology, Reinier de Graaf Hospital, Delft, the Netherlands (ED, MMEMB)
- Department of Internal Medicine and Oncology, MCH Bronovo Hospital, The Hague, the Netherlands (NIW)
| | - Harm Sleeboom
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands (EGE, AHP, NvD, AMS)
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME (PKJH)
- Department of Oncology, Alrijne Hospital, Leiderdorp, the Netherlands (FC)
- Department of Oncology, Reinier de Graaf Hospital, Delft, the Netherlands (ED, MMEMB)
- Department of Internal Medicine and Oncology, MCH Bronovo Hospital, The Hague, the Netherlands (NIW)
| | - Johanneke E. A. Portielje
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands (EGE, AHP, NvD, AMS)
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME (PKJH)
- Department of Oncology, Alrijne Hospital, Leiderdorp, the Netherlands (FC)
- Department of Oncology, Reinier de Graaf Hospital, Delft, the Netherlands (ED, MMEMB)
- Department of Internal Medicine and Oncology, MCH Bronovo Hospital, The Hague, the Netherlands (NIW)
| | - Koos J. M. van der Hoeven
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands (EGE, AHP, NvD, AMS)
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME (PKJH)
- Department of Oncology, Alrijne Hospital, Leiderdorp, the Netherlands (FC)
- Department of Oncology, Reinier de Graaf Hospital, Delft, the Netherlands (ED, MMEMB)
- Department of Internal Medicine and Oncology, MCH Bronovo Hospital, The Hague, the Netherlands (NIW)
| | - F. J. Sherida Woei-A-Jin
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands (EGE, AHP, NvD, AMS)
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME (PKJH)
- Department of Oncology, Alrijne Hospital, Leiderdorp, the Netherlands (FC)
- Department of Oncology, Reinier de Graaf Hospital, Delft, the Netherlands (ED, MMEMB)
- Department of Internal Medicine and Oncology, MCH Bronovo Hospital, The Hague, the Netherlands (NIW)
| | - Judith R. Kroep
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands (EGE, AHP, NvD, AMS)
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME (PKJH)
- Department of Oncology, Alrijne Hospital, Leiderdorp, the Netherlands (FC)
- Department of Oncology, Reinier de Graaf Hospital, Delft, the Netherlands (ED, MMEMB)
- Department of Internal Medicine and Oncology, MCH Bronovo Hospital, The Hague, the Netherlands (NIW)
| | - Hanneke C. J. M. de Haes
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands (EGE, AHP, NvD, AMS)
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME (PKJH)
- Department of Oncology, Alrijne Hospital, Leiderdorp, the Netherlands (FC)
- Department of Oncology, Reinier de Graaf Hospital, Delft, the Netherlands (ED, MMEMB)
- Department of Internal Medicine and Oncology, MCH Bronovo Hospital, The Hague, the Netherlands (NIW)
| | - Ellen M. A. Smets
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands (EGE, AHP, NvD, AMS)
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME (PKJH)
- Department of Oncology, Alrijne Hospital, Leiderdorp, the Netherlands (FC)
- Department of Oncology, Reinier de Graaf Hospital, Delft, the Netherlands (ED, MMEMB)
- Department of Internal Medicine and Oncology, MCH Bronovo Hospital, The Hague, the Netherlands (NIW)
| | - Anne M. Stiggelbout
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands (EGE, AHP, NvD, AMS)
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME (PKJH)
- Department of Oncology, Alrijne Hospital, Leiderdorp, the Netherlands (FC)
- Department of Oncology, Reinier de Graaf Hospital, Delft, the Netherlands (ED, MMEMB)
- Department of Internal Medicine and Oncology, MCH Bronovo Hospital, The Hague, the Netherlands (NIW)
| |
Collapse
|
22
|
Pieterse AH, Kunneman M, Engelhardt EG, Brouwer NJ, Kroep JR, Marijnen CAM, Stiggelbout AM, Smets EMA. Oncologist, patient, and companion questions during pretreatment consultations about adjuvant cancer treatment: a shared decision-making perspective. Psychooncology 2016; 26:943-950. [PMID: 27502561 DOI: 10.1002/pon.4241] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 06/17/2016] [Accepted: 07/27/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To assess the occurrence of questions that foster shared decision making, in particular cancer patients' understanding of treatment decisions and oncologists' understanding of patients' priorities, during consultations in which preference-sensitive decisions are discussed. Specifically, (a) regarding patient understanding, do oncologists ask about patients' preexisting knowledge, information preferences, and understanding and do patients and companions ask about the disease and treatment, and (b) regarding patient priorities, do oncologists ask about patients' treatment- and decision-related preferences and do patients and companions ask about the decision? METHODS Audiotaped pretreatment consultations of 100 cancer patients with 32 oncologists about (neo)adjuvant treatment were coded and analyzed to document question type, topic, and initiative. RESULTS The oncologists ascertained prior knowledge in 50 patients, asked 24 patients about preferred (probability) information, and invited questions from 56 patients. The oncologists asked 32 patients about treatment preferences and/or for consent. Respectively, one-third and one-fifth of patients and companions asked about treatment benefits compared with three-quarters of them who asked about treatment harms and/or procedures. CONCLUSIONS It would be helpful to patients if oncologists more often assessed patients' existing knowledge to tailor their information provision. Also, patients could receive treatment recommendations that better fit their personal situation if oncologists collected information on patients' views about treatments. Moreover, by educating patients to ask about treatment alternatives, benefits, and harms, patients may gain a better understanding of the choice they have.
Collapse
Affiliation(s)
- A H Pieterse
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - M Kunneman
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.,Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| | - E G Engelhardt
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - N J Brouwer
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - J R Kroep
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - C A M Marijnen
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - A M Stiggelbout
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - E M A Smets
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
23
|
Engelhardt EG, Pieterse AH, van der Hout A, de Haes HJCJM, Kroep JR, Quarles van Ufford-Mannesse P, Portielje JEA, Smets EMA, Stiggelbout AM. Use of implicit persuasion in decision making about adjuvant cancer treatment: A potential barrier to shared decision making. Eur J Cancer 2016; 66:55-66. [PMID: 27525573 DOI: 10.1016/j.ejca.2016.07.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 07/07/2016] [Accepted: 07/08/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Shared decision making (SDM) is widely advocated, especially for preference-sensitive decisions like those on adjuvant treatment for early-stage cancer. Here, decision making involves a subjective trade-off between benefits and side-effects, and therefore, patients' informed preferences should be taken into account. If clinicians consciously or unconsciously steer patients towards the option they think is in their patients' best interest (i.e. implicit persuasion), they may be unwittingly subverting their own efforts to implement SDM. We assessed the frequency of use of implicit persuasion during consultations and whether the use of implicit persuasion was associated with expected treatment benefit and/or decision making. METHODS Observational study design in which consecutive consultations about adjuvant systemic therapy with stage I-II breast cancer patients treated at oncology outpatient clinics of general teaching hospitals and university medical centres were audiotaped, transcribed and coded by two researchers independently. RESULTS In total, 105 patients (median age = 59; range: 35-87 years) were included. A median of five (range: 2-10) implicitly persuasive behaviours were employed per consultation. The number of behaviours used did not differ by disease stage (P = 0.07), but did differ by treatment option presented (P = 0.002) and nodal status (P = 0.01). About 50% of patients with stage I or node-negative disease were steered towards undergoing chemotherapy, whereas 96% of patients were steered towards undergoing endocrine therapy, irrespective of expected treatment benefit. Decisions were less often postponed if more implicit persuasion was used (P = 0.03). INTERPRETATION Oncologists frequently use implicit persuasion, steering patients towards the treatment option that they think is in their patients' best interest. Expected treatment benefit does not always seem to be the driving force behind implicit persuasion. Awareness of one's use of these steering behaviours during decision making is a first step to help overcome the performance gap between advocating and implementing SDM.
Collapse
Affiliation(s)
- Ellen G Engelhardt
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Arwen H Pieterse
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Anja van der Hout
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Judith R Kroep
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Ellen M A Smets
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| | - Anne M Stiggelbout
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
| |
Collapse
|
24
|
Wevers MR, Schmidt MK, Engelhardt EG, Verhoef S, Hooning MJ, Kriege M, Seynaeve C, Collée M, van Asperen CJ, Tollenaar RAEM, Koppert LB, Witkamp AJ, Rutgers EJT, Aaronson NK, Rookus MA, Ausems MGEM. Timing of risk reducing mastectomy in breast cancer patients carrying a BRCA1/2 mutation: retrospective data from the Dutch HEBON study. Fam Cancer 2016; 14:355-63. [PMID: 25700605 PMCID: PMC4559099 DOI: 10.1007/s10689-015-9788-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
It is expected that rapid genetic counseling and testing (RGCT) will lead to increasing numbers of breast cancer (BC) patients knowing their BRCA1/2 carrier status before primary surgery. Considering the potential impact of knowing one’s status on uptake and timing of risk-reducing contralateral mastectomy (RRCM), we aimed to evaluate trends over time in RRCM, and differences between carriers identified either before (predictively) or after (diagnostically) diagnosis. We collected data from female BRCA1/2 mutation carriers diagnosed with BC between 1995 and 2009 from four Dutch university hospitals. We compared the timing of genetic testing and RRCM in relation to diagnosis in 1995–2000 versus 2001–2009 for all patients, and predictively and diagnostically tested patients separately. Of 287 patients, 219 (76 %) had a diagnostic BRCA1/2 test. In this cohort, the median time from diagnosis to DNA testing decreased from 28 months for those diagnosed between 1995 and 2000 to 14 months for those diagnosed between 2001 and 2009 (p < 0.001). Similarly, over time women in this cohort underwent RRCM sooner after diagnosis (median of 77 vs. 27 months, p = 0.05). Predictively tested women who subsequently developed BC underwent an immediate RRCM significantly more often than women who had a diagnostic test (21/61, 34 %, vs. 13/170, 7.6 %, p < 0.001). Knowledge of carrying a BRCA1/2 mutation when diagnosed with BC influenced decisions concerning primary surgery. Additionally, in more recent years, women who had not undergone predictive testing were more likely to undergo diagnostic DNA testing and RRCM sooner after diagnosis. This suggests the need for RGCT to guide treatment decisions.
Collapse
Affiliation(s)
- M R Wevers
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, PO Box 90203, 1006 BE, Amsterdam, The Netherlands,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Kunneman M, Engelhardt EG, Ten Hove FLL, Marijnen CAM, Portielje JEA, Smets EMA, de Haes HJCJMH, Stiggelbout AM, Pieterse AH. Deciding about (neo-)adjuvant rectal and breast cancer treatment: Missed opportunities for shared decision making. Acta Oncol 2015; 55:134-9. [PMID: 26237738 DOI: 10.3109/0284186x.2015.1068447] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The first step in shared decision making (SDM) is creating choice awareness. This is particularly relevant in consultations concerning preference-sensitive treatment decisions, e.g. those addressing (neo-)adjuvant therapy. Awareness can be achieved by explicitly stating, as the 'reason for encounter', that a treatment decision needs to be made. It is unknown whether oncologists express such reason for encounter. This study aims to establish: 1) if 'making a treatment decision' is stated as a reason for the encounter and if not, what other reason for encounter is provided; and 2) whether mentioning that a treatment decision needs to be made is associated with enhanced patient involvement in decision making. MATERIAL AND METHODS Consecutive first consultations with: 1) radiation oncologists and rectal cancer patients; or 2) medical oncologists and breast cancer patients, facing a preference-sensitive treatment decision, were audiotaped. The tapes were transcribed and coded using an instrument developed for the study. Oncologists' involvement of patients in decision making was coded using the OPTION-scale. RESULTS Oncologists (N = 33) gave a reason for encounter in 70/100 consultations, usually (N = 52/70, 74%) at the start of the consultation. The reason for encounter stated was 'making a treatment decision' in 3/100 consultations, and 'explaining treatment details' in 44/100 consultations. The option of foregoing adjuvant treatment was not explicitly presented in any consultation. Oncologist' involvement of patients in decision making was below baseline (Md OPTION-score = 10). Given the small number of consultations in which the need to make a treatment decision was stated, we could not investigate the impact thereof on patient involvement. CONCLUSION This study suggests that oncologists rarely express that a treatment decision needs to be made in consultations concerning preference-sensitive treatment decisions. Therefore, patients might not realize that foregoing (neo-)adjuvant treatment is a viable choice. Oncologists miss a crucial opportunity to facilitate SDM.
Collapse
Affiliation(s)
- Marleen Kunneman
- a Department of Medical Decision Making , Leiden University Medical Center , Leiden , The Netherlands
| | - Ellen G Engelhardt
- a Department of Medical Decision Making , Leiden University Medical Center , Leiden , The Netherlands
| | - F L Laura Ten Hove
- a Department of Medical Decision Making , Leiden University Medical Center , Leiden , The Netherlands
| | - Corrie A M Marijnen
- b Department of Radiotherapy , Leiden University Medical Center , Leiden , The Netherlands
| | | | - Ellen M A Smets
- d Department of Medical Psychology , Academic Medical Center , Amsterdam , The Netherlands
| | | | - Anne M Stiggelbout
- a Department of Medical Decision Making , Leiden University Medical Center , Leiden , The Netherlands
| | - Arwen H Pieterse
- a Department of Medical Decision Making , Leiden University Medical Center , Leiden , The Netherlands
| |
Collapse
|
26
|
Engelhardt EG, de Haes HCJM, van de Velde CJH, Smets EMA, Pieterse AH, Stiggelbout AM. Oncologists' weighing of the benefits and side effects of adjuvant systemic therapy: Has it changed over time? Acta Oncol 2015; 54:956-9. [PMID: 25591819 DOI: 10.3109/0284186x.2014.993478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Ellen G Engelhardt
- Department of Medical Decision Making, Leiden University Medical Center , Leiden , The Netherlands
| | | | | | | | | | | |
Collapse
|
27
|
Rudolph A, Milne RL, Truong T, Knight JA, Seibold P, Flesch-Janys D, Behrens S, Eilber U, Bolla MK, Wang Q, Dennis J, Dunning AM, Shah M, Munday HR, Darabi H, Eriksson M, Brand JS, Olson J, Vachon CM, Hallberg E, Castelao JE, Carracedo A, Torres M, Li J, Humphreys K, Cordina-Duverger E, Menegaux F, Flyger H, Nordestgaard BG, Nielsen SF, Yesilyurt BT, Floris G, Leunen K, Engelhardt EG, Broeks A, Rutgers EJ, Glendon G, Mulligan AM, Cross S, Reed M, Gonzalez-Neira A, Perez JIA, Provenzano E, Apicella C, Southey MC, Spurdle A, Investigators KC, Group AOCS, Häberle L, Beckmann MW, Ekici AB, Dieffenbach AK, Arndt V, Stegmaier C, McLean C, Baglietto L, Chanock SJ, Lissowska J, Sherman ME, Brüning T, Hamann U, Ko YD, Orr N, Schoemaker M, Ashworth A, Kosma VM, Kataja V, Hartikainen JM, Mannermaa A, Swerdlow A, Giles GG, Brenner H, Fasching PA, Chenevix-Trench G, Hopper J, Benítez J, Cox A, Andrulis IL, Lambrechts D, Gago-Dominguez M, Couch F, Czene K, Bojesen SE, Easton DF, Schmidt MK, Guénel P, Hall P, Pharoah PDP, Garcia-Closas M, Chang-Claude J. Investigation of gene-environment interactions between 47 newly identified breast cancer susceptibility loci and environmental risk factors. Int J Cancer 2015; 136:E685-96. [PMID: 25227710 PMCID: PMC4289418 DOI: 10.1002/ijc.29188] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 06/04/2014] [Accepted: 06/06/2014] [Indexed: 12/21/2022]
Abstract
A large genotyping project within the Breast Cancer Association Consortium (BCAC) recently identified 41 associations between single nucleotide polymorphisms (SNPs) and overall breast cancer (BC) risk. We investigated whether the effects of these 41 SNPs, as well as six SNPs associated with estrogen receptor (ER) negative BC risk are modified by 13 environmental risk factors for BC. Data from 22 studies participating in BCAC were pooled, comprising up to 26,633 cases and 30,119 controls. Interactions between SNPs and environmental factors were evaluated using an empirical Bayes-type shrinkage estimator. Six SNPs showed interactions with associated p-values (pint ) <1.1 × 10(-3) . None of the observed interactions was significant after accounting for multiple testing. The Bayesian False Discovery Probability was used to rank the findings, which indicated three interactions as being noteworthy at 1% prior probability of interaction. SNP rs6828523 was associated with increased ER-negative BC risk in women ≥170 cm (OR = 1.22, p = 0.017), but inversely associated with ER-negative BC risk in women <160 cm (OR = 0.83, p = 0.039, pint = 1.9 × 10(-4) ). The inverse association between rs4808801 and overall BC risk was stronger for women who had had four or more pregnancies (OR = 0.85, p = 2.0 × 10(-4) ), and absent in women who had had just one (OR = 0.96, p = 0.19, pint = 6.1 × 10(-4) ). SNP rs11242675 was inversely associated with overall BC risk in never/former smokers (OR = 0.93, p = 2.8 × 10(-5) ), but no association was observed in current smokers (OR = 1.07, p = 0.14, pint = 3.4 × 10(-4) ). In conclusion, recently identified BC susceptibility loci are not strongly modified by established risk factors and the observed potential interactions require confirmation in independent studies.
Collapse
Affiliation(s)
- Anja Rudolph
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Roger L. Milne
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology & Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Thérèse Truong
- Inserm (National Institute of Health and Medical Research), CESP (Center for Research in Epidemiology and Population Health), U1018, Environmental Epidemiology of Cancer, Villejuif, France
- Unité Mixte de Recherche Scientifique (UMRS) 1018, University Paris-Sud, Villejuif, France
| | - Julia A. Knight
- Prosserman Centre for Health Research, Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, Toronto, Ontario, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Petra Seibold
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dieter Flesch-Janys
- Department of Cancer Epidemiology/Clinical Cancer Registry, University Clinic Hamburg-Eppendorf, Hamburg, Germany
- Institute for Medical Biometrics and Epidemiology, University Clinic Hamburg-Eppendorf, Hamburg, Germany
| | - Sabine Behrens
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ursula Eilber
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Manjeet K. Bolla
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Qin Wang
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Joe Dennis
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Alison M. Dunning
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Mitul Shah
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Hannah R. Munday
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Hatef Darabi
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Eriksson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Judith S. Brand
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Janet Olson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Celine M. Vachon
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Emily Hallberg
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - J. Esteban Castelao
- Oncology and Genetics Unit, Biomedical Research Institute of Vigo (IBIV), Complejo Hospitalario Universitario de Vigo, Servicio Galego de Saude (SERGAS), Vigo, Spain
| | - Angel Carracedo
- Genomic Medicine Group, Galician Foundation of Genomic Medicine, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
- National Genotyping Center - Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), University of Santiago de Compostela, Spain
- Center of Excellence in Genomic Medicine Research, King Abdulaziz University, Jeddah, KSA
| | - Maria Torres
- National Genotyping Center - Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), University of Santiago de Compostela, Spain
| | - Jingmei Li
- Human Genetics Division, Genome Institute of Singapore, Singapore, Singapore
| | - Keith Humphreys
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Emilie Cordina-Duverger
- Inserm (National Institute of Health and Medical Research), CESP (Center for Research in Epidemiology and Population Health), U1018, Environmental Epidemiology of Cancer, Villejuif, France
- Unité Mixte de Recherche Scientifique (UMRS) 1018, University Paris-Sud, Villejuif, France
| | - Florence Menegaux
- Inserm (National Institute of Health and Medical Research), CESP (Center for Research in Epidemiology and Population Health), U1018, Environmental Epidemiology of Cancer, Villejuif, France
- Unité Mixte de Recherche Scientifique (UMRS) 1018, University Paris-Sud, Villejuif, France
| | - Henrik Flyger
- Department of Breast Surgery, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Børge G. Nordestgaard
- Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Sune F. Nielsen
- Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Giuseppe Floris
- Multidisciplinary Breast Center, University Hospital Gasthuisberg, Leuven, Belgium
| | - Karin Leunen
- Multidisciplinary Breast Center, University Hospital Gasthuisberg, Leuven, Belgium
| | - Ellen G. Engelhardt
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands
| | - Annegien Broeks
- Division of Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands
| | - Emiel J. Rutgers
- Department of Surgery, Netherlands Cancer Institute, Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands
| | - Gord Glendon
- Ontario Cancer Genetics Network, Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Anna Marie Mulligan
- Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Simon Cross
- Academic Unit of Pathology, Department of Neuroscience, University of Sheffield, UK
| | - Malcolm Reed
- Sheffield Cancer Research Centre, Department of Oncology, University of Sheffield, Sheffield, UK
| | - Anna Gonzalez-Neira
- Human Genotyping Unit-CEGEN, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | | | - Elena Provenzano
- Cancer Research UK Cambridge Institute, Cambridge, UK
- Cambridge Breast Unit, Addenbrooke’s Hospital, Cambridge University Hospital NHS Foundation Trust and NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Carmel Apicella
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, University of Melbourne, Melbourne, Australia
| | | | - Amanda Spurdle
- Department of Genetics, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | | | - AOCS Group
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Matthias W. Beckmann
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Arif B. Ekici
- Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Aida Karina Dieffenbach
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Volker Arndt
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Catriona McLean
- Anatomical Pathology, The Alfred Hospital, Melbourne, Australia
| | - Laura Baglietto
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology & Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Stephen J. Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Jolanta Lissowska
- Department of Cancer Epidemiology and Prevention, M. Sklodowska-Curie Memorial Cancer Center & Institute of Oncology, Warsaw, Poland
| | - Mark E. Sherman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland, USA
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Ute Hamann
- Molecular Genetics of Breast Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Yon-Dschun Ko
- Department of Internal Medicine, Evangelische Kliniken Bonn gGmbH, Johanniter Krankenhaus, Bonn, Germany
| | - Nick Orr
- Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK
| | - Minouk Schoemaker
- Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, Surrey, UK
| | - Alan Ashworth
- Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK
| | - Veli-Matti Kosma
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine and Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland
- Imaging Center, Department of Clinical Pathology, Kuopio University Hospital, Kuopio, Finland
| | - Vesa Kataja
- School of Medicine, Institute of Clinical Medicine, Oncology and Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland
- Cancer Center, Kuopio University Hospital, Kuopio, Finland
- Jyväskylä Central Hospital, Jyväskylä, Finland
| | - Jaana M. Hartikainen
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine and Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland
- Imaging Center, Department of Clinical Pathology, Kuopio University Hospital, Kuopio, Finland
| | - Arto Mannermaa
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine and Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland
- Imaging Center, Department of Clinical Pathology, Kuopio University Hospital, Kuopio, Finland
| | - Anthony Swerdlow
- Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, Surrey, UK
- Division of Breast Cancer Research, Institute of Cancer Research, Sutton, Surrey, UK
| | - GENICA-Network
- The GENICA Network: Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, and University of Tübingen, Germany; Department of Internal Medicine, Evangelische Kliniken Bonn gGmbH, Johanniter Krankenhaus, Bonn, Germany, Institute of Pathology, University of Bonn, Germany, Molecular Genetics of Breast Cancer, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany, and Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany; Institute of Occupational Medicine and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - Graham G. Giles
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology & Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Peter A. Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
- David Geffen School of Medicine, Department of Medicine Division of Hematology and Oncology, University of California at Los Angeles, CA, USA
| | | | - John Hopper
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, University of Melbourne, Melbourne, Australia
| | - Javier Benítez
- Human Genetics Group, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Angela Cox
- Sheffield Cancer Research Centre, Department of Oncology, University of Sheffield, Sheffield, UK
| | - Irene L. Andrulis
- Ontario Cancer Genetics Network, Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | | | - Manuela Gago-Dominguez
- Genomic Medicine Group, Galician Foundation of Genomic Medicine, Servicio Galego de Saude (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
| | - Fergus Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Stig E. Bojesen
- Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Doug F. Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Marjanka K. Schmidt
- Netherlands Cancer Institute, Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands
| | - Pascal Guénel
- Inserm (National Institute of Health and Medical Research), CESP (Center for Research in Epidemiology and Population Health), U1018, Environmental Epidemiology of Cancer, Villejuif, France
- Unité Mixte de Recherche Scientifique (UMRS) 1018, University Paris-Sud, Villejuif, France
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul D. P. Pharoah
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Montserrat Garcia-Closas
- Division of Genetics and Epidemiology, Institute of Cancer Research, Sutton, Surrey, UK
- Breakthrough Breast Cancer Research Centre, Division of Breast Cancer Research, The Institute of Cancer Research, London, UK
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| |
Collapse
|
28
|
Engelhardt EG, Pieterse AH, van Duijn-Bakker N, Kroep JR, de Haes HCJM, Smets EMA, Stiggelbout AM. Breast cancer specialists' views on and use of risk prediction models in clinical practice: a mixed methods approach. Acta Oncol 2015; 54:361-7. [PMID: 25307407 PMCID: PMC4445013 DOI: 10.3109/0284186x.2014.964810] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Purpose Risk prediction models (RPM) in breast cancer quantify survival benefit from adjuvant systemic treatment. These models [e.g. Adjuvant! Online (AO)] are increasingly used during consultations, despite their not being designed for such use. As still little is known about oncologists' views on and use of RPM to communicate prognosis to patients, we investigated if, why, and how they use RPM. Methods We disseminated an online questionnaire that was based on the literature and individual and group interviews with oncologists. Results Fifty-one oncologists (partially) completed the questionnaire. AO is the best known (95%) and most frequently used RPM (96%). It is used to help oncologists decide whether or not to recommend chemotherapy (> 85%), to inform (86%) and help patients decide about treatment (> 80%), or to persuade them to follow the proposed course of treatment (74%). Most oncologists (74%) believe that using AO helps patients understand their prognosis. Conclusion RPM have found a place in daily practice, especially AO. Oncologists think that using AO helps patients understand their prognosis, yet studies suggest that this is not always the case. Our findings highlight the importance of exploring whether patients understand the information that RPM provide.
Collapse
Affiliation(s)
- Ellen G. Engelhardt
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
- Correspondence: E. G. Engelhardt, Department of Medical Decision Making, Leiden University Medical Center, Zone J10-S, PO Box 9600, 2300 RC Leiden, The Netherlands. Tel: + 31 71 5261203. Fax: + 31 71 5266838. E-mail:
| | - Arwen H. Pieterse
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Nanny van Duijn-Bakker
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Judith R. Kroep
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Ellen M. A. Smets
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| | - Anne M. Stiggelbout
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
29
|
Engelhardt EG, Kriege M, Hooning MJ, Seynaeve C, Tollenaar RAEM, Asperen CJV, Ausems MGEM, Poll-Franse LVVD, Mook S, Verhoef S, Rookus MA, Collaborators HEBON, Schmidt MK. Familial versus Sporadic Breast Cancer: Different Treatments for Similar Tumors? ACTA ACUST UNITED AC 2015. [DOI: 10.4236/abcr.2015.44010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
30
|
de Glas NA, van de Water W, Engelhardt EG, Bastiaannet E, de Craen AJM, Kroep JR, Putter H, Stiggelbout AM, Weijl NI, van de Velde CJH, Portielje JEA, Liefers GJ. Validity of Adjuvant! Online program in older patients with breast cancer: a population-based study. Lancet Oncol 2014; 15:722-9. [DOI: 10.1016/s1470-2045(14)70200-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
31
|
Perry JR, Hsu YH, Chasman DI, Johnson AD, Elks C, Albrecht E, Andrulis IL, Beesley J, Berenson GS, Bergmann S, Bojesen SE, Bolla MK, Brown J, Buring JE, Campbell H, Chang-Claude J, Chenevix-Trench G, Corre T, Couch FJ, Cox A, Czene K, D'adamo AP, Davies G, Deary IJ, Dennis J, Easton DF, Engelhardt EG, Eriksson JG, Esko T, Fasching PA, Figueroa JD, Flyger H, Fraser A, Garcia-Closas M, Gasparini P, Gieger C, Giles G, Guenel P, Hägg S, Hall P, Hayward C, Hopper J, Ingelsson E, Kardia SL, Kasiman K, Knight JA, Lahti J, Lawlor DA, Magnusson PK, Margolin S, Marsh JA, Metspalu A, Olson JE, Pennell CE, Polasek O, Rahman I, Ridker PM, Robino A, Rudan I, Rudolph A, Salumets A, Schmidt MK, Schoemaker MJ, Smith EN, Smith JA, Southey M, Stöckl D, Swerdlow AJ, Thompson DJ, Truong T, Ulivi S, Waldenberger M, Wang Q, Wild S, Wilson JF, Wright AF, Zgaga L, Ong KK, Murabito JM, Karasik D, Murray A. DNA mismatch repair gene MSH6 implicated in determining age at natural menopause. Hum Mol Genet 2014; 23:2490-7. [PMID: 24357391 PMCID: PMC3976329 DOI: 10.1093/hmg/ddt620] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 11/19/2013] [Accepted: 12/06/2013] [Indexed: 12/17/2022] Open
Abstract
The length of female reproductive lifespan is associated with multiple adverse outcomes, including breast cancer, cardiovascular disease and infertility. The biological processes that govern the timing of the beginning and end of reproductive life are not well understood. Genetic variants are known to contribute to ∼50% of the variation in both age at menarche and menopause, but to date the known genes explain <15% of the genetic component. We have used genome-wide association in a bivariate meta-analysis of both traits to identify genes involved in determining reproductive lifespan. We observed significant genetic correlation between the two traits using genome-wide complex trait analysis. However, we found no robust statistical evidence for individual variants with an effect on both traits. A novel association with age at menopause was detected for a variant rs1800932 in the mismatch repair gene MSH6 (P = 1.9 × 10(-9)), which was also associated with altered expression levels of MSH6 mRNA in multiple tissues. This study contributes to the growing evidence that DNA repair processes play a key role in ovarian ageing and could be an important therapeutic target for infertility.
Collapse
Affiliation(s)
- John R.B. Perry
- University of Exeter Medical School, Exeter, UK,
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK,
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK,
- Medical Research Council (MRC) Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK,
| | - Yi-Hsiang Hsu
- Hebrew SeniorLife Institute for Aging Research and Harvard Medical School, Boston, MA, USA,
- Molecular and Integrative Physiological Sciences Program, Harvard School of Public Health, Boston, MA, USA,
| | - Daniel I. Chasman
- Division of Preventive Medicine, Brigham and Women's Hospital, 900 Commonwealth Avenue East, Boston MA 02215, USA,
- Harvard Medical School, Boston, MA, USA,
| | - Andrew D. Johnson
- The National Heart Lung and Blood Institute's Framingham Heart Study, Framingham, MA, USA,
- NHLBI Cardiovascular Epidemiology & Human Genomics Branch, Bethesda, MD, USA,
| | - Cathy Elks
- Medical Research Council (MRC) Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK,
| | | | - Irene L. Andrulis
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada,
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada,
| | - Jonathan Beesley
- Department of Genetics, Queensland Institute of Medical Research, Brisbane, QLD, Australia,
| | | | - Sven Bergmann
- Department of Medical Genetics, University of Lausanne, Lausanne, Switzerland,
- Swiss Institute of Bioinformatics, Lausanne, Switzerland,
| | - Stig E. Bojesen
- Department of Clinical Biochemistry and the Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark,
| | - Manjeet K. Bolla
- Centre for Cancer Genetic Epidemiology and Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK,
| | - Judith Brown
- Centre for Cancer Genetic Epidemiology and Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK,
| | - Julie E. Buring
- Division of Preventive Medicine, Brigham and Women's Hospital, 900 Commonwealth Avenue East, Boston MA 02215, USA,
- Harvard Medical School, Boston, MA, USA,
| | - Harry Campbell
- Centre for Population Health Sciences, University of Edinburgh, EdinburghEH8 9AG, UK,
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany,
| | | | - Tanguy Corre
- Department of Medical Genetics, University of Lausanne, Lausanne, Switzerland,
- Swiss Institute of Bioinformatics, Lausanne, Switzerland,
| | - Fergus J. Couch
- Departments of Laboratory Medicine and Pathology, and Health Science Research
| | - Angela Cox
- CR-UK/YCR Sheffield Cancer Research Centre, Department of Oncology, University of Sheffield, UK,
| | - Kamila Czene
- Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,
| | - Adamo Pio D'adamo
- Institute for Maternal and Child Health, IRCCS ‘Burlo Garofolo’, University of Trieste, Trieste, Italy,
| | - Gail Davies
- Centre for Cognitive Ageing and Cognitive Epidemiology
- Department of Psychology and
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK,
| | - Ian J. Deary
- Centre for Cognitive Ageing and Cognitive Epidemiology
- Department of Psychology and
| | - Joe Dennis
- Centre for Cancer Genetic Epidemiology and Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK,
| | - Douglas F. Easton
- Centre for Cancer Genetic Epidemiology and Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK,
| | | | - Johan G. Eriksson
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland,
- National Institute for Health and Welfare, Helsinki, Finland,
- Folkhälsan Research Centre, Helsinki, Finland,
- University Central Hospital, Unit of General Practice, Helsinki, Finland,
- Vasa Central Hospital, Vasa, Finland,
| | - Tõnu Esko
- Divisions of Endocrinology, Children's Hospital, Boston, MA, USA,
- Broad Institute, Cambridge, MA, USA,
- Estonian Genome Center, University of Tartu, 51010Tartu, Estonia,
| | - Peter A. Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany,
| | - Jonine D. Figueroa
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, Maryland, USA,
| | - Henrik Flyger
- Department of Breast Surgery, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark,
| | - Abigail Fraser
- School of Social and Community Medicine, MRC Centre for Causal Analyses in Translational Epidemiology, University of Bristol, Bristol, UK,
| | - Montse Garcia-Closas
- Divisions of Breast Cancer Research and of Genetics and Epidemiology, and the Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK,
| | - Paolo Gasparini
- Institute for Maternal and Child Health, IRCCS ‘Burlo Garofolo’, University of Trieste, Trieste, Italy,
| | | | - Graham Giles
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, Melbourne School of Population Health, The University of Melbourne, Melbourne, VIC, Australia,
- Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, VIC, Australia,
| | - Pascal Guenel
- Environmental Epidemiology of Cancer, Inserm U1018, Villejuif, France,
| | - Sara Hägg
- Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden,
| | - Per Hall
- Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,
| | - Caroline Hayward
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, EdinburghEH4 2XU, UK,
| | - John Hopper
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, Melbourne School of Population Health, The University of Melbourne, Melbourne, VIC, Australia,
| | - Erik Ingelsson
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden,
| | | | | | - Katherine Kasiman
- Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,
| | - Julia A. Knight
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada,
| | - Jari Lahti
- Folkhälsan Research Centre, Helsinki, Finland,
- Institute of Behavioural Science, University of Helsinki, Helsinki, Finland,
| | - Debbie A. Lawlor
- School of Social and Community Medicine, MRC Centre for Causal Analyses in Translational Epidemiology, University of Bristol, Bristol, UK,
| | | | - Sara Margolin
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden,
| | - Julie A. Marsh
- School of Women's and Infants’ Health, University of Western Australia, Australia,
| | - Andres Metspalu
- Estonian Genome Center, University of Tartu, 51010Tartu, Estonia,
| | - Janet E. Olson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA,
| | - Craig E. Pennell
- School of Women's and Infants’ Health, University of Western Australia, Australia,
| | - Ozren Polasek
- Department of Public Health, Faculty of Medicine, University of Split, Croatia,
| | - Iffat Rahman
- Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,
| | - Paul M. Ridker
- Division of Preventive Medicine, Brigham and Women's Hospital, 900 Commonwealth Avenue East, Boston MA 02215, USA,
- Harvard Medical School, Boston, MA, USA,
| | - Antonietta Robino
- Institute for Maternal and Child Health, IRCCS ‘Burlo Garofolo’, University of Trieste, Trieste, Italy,
| | - Igor Rudan
- Centre for Population Health Sciences, University of Edinburgh, EdinburghEH8 9AG, UK,
| | - Anja Rudolph
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany,
| | - Andres Salumets
- Department of Obstetrics and Gynecology, University of Tartu, 51014 Tartu, Estonia,
- Competence Centre on Reproductive Medicine and Biology, 50410 Tartu, Estonia,
| | - Marjanka K. Schmidt
- Division of Psychosocial Research and Epidemiology and
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands,
| | - Minouk J. Schoemaker
- Divisions of Breast Cancer Research and of Genetics and Epidemiology, and the Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK,
| | - Erin N. Smith
- Department of Pediatrics and Rady Children's Hospital, University of California San Diego, La Jolla, CA 92093, USA,
| | - Jennifer A. Smith
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA,
| | - Melissa Southey
- Genetic Epidemiology Laboratory, Department of Pathology, The University of Melbourne, Melbourne, VIC, Australia,
| | - Doris Stöckl
- Institute of Epidemiology II and
- Department of Obstetrics and Gynaecology, Campus Grosshadern, Ludwig-Maximilians-University, Munich, Germany,
| | - Anthony J. Swerdlow
- Divisions of Breast Cancer Research and of Genetics and Epidemiology, and the Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK,
| | - Deborah J. Thompson
- Centre for Cancer Genetic Epidemiology and Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK,
| | - Therese Truong
- Environmental Epidemiology of Cancer, Inserm U1018, Villejuif, France,
| | - Sheila Ulivi
- Institute for Maternal and Child Health, IRCCS ‘Burlo Garofolo’, Trieste, Italy,
| | - Melanie Waldenberger
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München – German Research Center for Environmental Health, Neuherberg, Germany,
| | - Qin Wang
- Centre for Cancer Genetic Epidemiology and Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK,
| | - Sarah Wild
- Centre for Population Health Sciences, University of Edinburgh, EdinburghEH8 9AG, UK,
| | - James F Wilson
- Centre for Population Health Sciences, University of Edinburgh, EdinburghEH8 9AG, UK,
| | - Alan F. Wright
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK,
| | - Lina Zgaga
- Centre for Population Health Sciences, University of Edinburgh, EdinburghEH8 9AG, UK,
| | | | - Ken K. Ong
- Medical Research Council (MRC) Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK,
- Department of Paediatrics, University of Cambridge, Cambridge, UK,
| | - Joanne M. Murabito
- The National Heart Lung and Blood Institute's Framingham Heart Study, Framingham, MA, USA,
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - David Karasik
- Hebrew SeniorLife Institute for Aging Research and Harvard Medical School, Boston, MA, USA,
| | - Anna Murray
- University of Exeter Medical School, Exeter, UK,
| |
Collapse
|
32
|
Engelhardt EG, Garvelink MM, de Haes JHCJM, van der Hoeven JJM, Smets EMA, Pieterse AH, Stiggelbout AM. Predicting and communicating the risk of recurrence and death in women with early-stage breast cancer: a systematic review of risk prediction models. J Clin Oncol 2013; 32:238-50. [PMID: 24344212 DOI: 10.1200/jco.2013.50.3417] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND It is a challenge for oncologists to distinguish patients with breast cancer who can forego adjuvant systemic treatment without negatively affecting survival from those who cannot. Risk prediction models (RPMs) have been developed for this purpose. Oncologists seem to have embraced RPMs (particularly Adjuvant!) in clinical practice and often use them to communicate prognosis to patients. We performed a systematic review of published RPMs and provide an overview of the prognosticators incorporated and reported clinical validity. Subsequently, we selected the RPMs that are currently used in the clinic for a more in-depth assessment of clinical validity. Finally, we assessed lay comprehensibility of the reports generated by RPMs. METHODS Pubmed, EMBASE, and Web of Science were searched. Two reviewers independently selected relevant articles and extracted data. Agreement on article selection and data extraction was achieved in consensus meetings. RESULTS We identified RPMs based on clinical prognosticators (N = 6) and biomolecular features (N = 14). Generally predictions from RPMs seem to be accurate, except for patients ≤ 50 years or ≥ 75 years at diagnosis, in addition to Asian populations. RPM reports contain much medical jargon or technical details, which are seldom explained in lay terms. CONCLUSION The accuracy of RPMs' prognostic estimates is suboptimal in some patient subgroups. This urgently needs to be addressed. In their current format, RPM reports are not conducive to patient comprehension. Communicating survival probabilities using RPM might seem straightforward, but it is fraught with difficulties. If not done properly, it can backfire and confuse patients. Evidence to guide best communication practice is needed.
Collapse
Affiliation(s)
- Ellen G Engelhardt
- Ellen G. Engelhardt, Mirjam M. Garvelink, Jacobus J.M. van der Hoeven, Arwen H. Pieterse, and Anne M. Stiggelbout, Leiden University Medical Center, Leiden; and J. (Hanneke) C.J.M. de Haes and Ellen M. Smets, Academic Medical Center, Amsterdam, the Netherlands
| | | | | | | | | | | | | |
Collapse
|
33
|
van den Berg T, Engelhardt EG, Haanstra TM, Langius JAE, van Tulder MW. Comment on Schütz et al. JPEN J Parenter Enteral Nutr 2012. [DOI: 10.1177/0148607112453334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
34
|
van den Berg T, Engelhardt EG, Haanstra TM, Langius JAE, van Tulder MW. Methodology of Clinical Nutrition Guidelines for Adult Cancer Patients. JPEN J Parenter Enteral Nutr 2011; 36:316-22. [DOI: 10.1177/0148607111414027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tobias van den Berg
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, Netherlands
| | - Ellen G. Engelhardt
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, Netherlands
| | - Tsjitske M. Haanstra
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, Netherlands
| | - Jacqueline A. E. Langius
- Department of Nutrition and Dietetics, Internal Medicine, VU University, Medical Center, Amsterdam, Netherlands
| | - Maurits W. van Tulder
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, Netherlands
| |
Collapse
|