Patients' Preferences Regarding Invasive Mediastinal Nodal Staging of Resectable Lung Cancer

• Published in: Patient preference and adherence Vol. 15; pp. 2185 - 2196
• Main Authors: Bousema, Jelle E, Hoeijmakers, Fieke, Dijkgraaf, Marcel G W, Annema, Jouke T, van den Broek, Frank J C, van den Akker-van Marle, M Elske
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.01.2021; Taylor & Francis Ltd; Dove; Dove Medical Press
• Subjects: Cancer patients; Cancer surgery; Decision making; Diagnosis; endosonography; General anesthesia; Lung cancer; Lung cancer, Non-small cell; Lymphatic system; mediastinal nodal staging; Mediastinoscopy; Metastasis; Mortality; non-small cell lung cancer; Original Research; patients’ preferences; Preferences; Psychological aspects; Questionnaires; Surveys; thoracic surgery; Tumor staging; Netherlands; mediastinal nodal staging; non-small cell lung cancer; patients’ preferences; mediastinoscopy; endosonography; thoracic surgery
• ISSN: 1177-889X; 1177-889X
• DOI: 10.2147/PPA.S319790

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