TY - JOUR
T1 - Active surveillance versus treatment in low-risk DCIS
T2 - Women's preferences in the LORD-trial
AU - Schmitz, Renée S. J. M.
AU - Engelhardt, Ellen G.
AU - Gerritsma, Miranda A.
AU - Sondermeijer, Carine M. T.
AU - Verschuur, Ellen
AU - Houtzager, Julia
AU - Griffioen, Rosalie
AU - Retèl, Valesca
AU - Bijker, Nina
AU - Mann, Ritse M.
AU - van Duijnhoven, Frederieke
AU - Wesseling, Jelle
AU - Grand Challenge PRECISION consortium
AU - Bleiker, Eveline M. A.
N1 - Funding Information: This work was supported by the Dutch Cancer Society, KWF kankerbestrijding [grant numbers NKI 2014-7167; KWF NKI 2021-15093 ] and The Pink Ribbon Foundation [grant number: 2014-183 WO 54 PR130027 ]. Research at the Netherlands Cancer Institute is supported by institutional grants of the Dutch Cancer Society and of the Dutch Ministry of Health, Welfare and Sport . Publisher Copyright: © 2023 The Authors
PY - 2023/10/1
Y1 - 2023/10/1
N2 - 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.
AB - 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.
KW - DCIS
KW - Patient preference
KW - Shared decision making
UR - http://www.scopus.com/inward/record.url?scp=85169019274&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ejca.2023.113276
DO - https://doi.org/10.1016/j.ejca.2023.113276
M3 - Article
C2 - 37657228
SN - 0959-8049
VL - 192
JO - European Journal of Cancer
JF - European Journal of Cancer
M1 - 113276
ER -