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Patient preferences regarding intraoperative versus external beam radiotherapy for early breast cancer and the impact of socio-demographic factors

Archives of Gynecology and Obstetrics volume 299, pages 1121–1130 (2019)Cite this article

Abstract

Purpose

Patient comfort and preference have steadily gained attention in radio-oncologic treatment of breast cancer. Therefore, the purpose of this investigation was to further explore patient preferences in choosing between intraoperative radiotherapy (IORT) and external beam radiotherapy (EBRT).

Methods

We prospectively analysed data of 101 women, who were candidates for breast-conserving surgery with adjuvant radiotherapy. A two-part video was shown to patients: an educational section about EBRT/IORT, followed by a preference elicitation section focusing on additional accepted risk (AAR) of recurrence after either treatment. Furthermore, participants completed a questionnaire to identify factors that influence patient preference of radiation modality.

Results

The data demonstrate that 42.5% of patients would accept additional risk of recurrence for IORT versus 9% AAR for EBRT, while 48.5% of patients would not accept any additional risk, yet would choose IORT over EBRT if risks of recurrence were equivalent. When combining patient preferences and the results from the questionnaire, no single socio-economic/-demographic factor was found to significantly correlate with AAR of IORT.

Conclusion

Our study confirms the existence of subgroups of breast cancer patients who would accept an additional risk of recurrence associated with choice of radiation modality to receive a single dose of IORT as adjuvant radiotherapy for breast cancer instead of EBRT over several weeks; yet our data fail to identify a single factor significantly associated with these patient preferences and, therefore, helpful for individualised decision-making processes.

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Abbreviations

AAR:

Additional accepted risk

BCS:

Breast-conserving surgery

EBRT:

External beam whole breast radiotherapy

IORT:

Intraoperative radiotherapy

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Author information

Author notes

  1. Axel Gerhardt and Marc Sütterlin authors contributed equally.

Affiliations

  1. Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Saskia Spaich, Sophie Krickeberg, Axel Gerhardt & Marc Sütterlin

  2. Department of Gynaecology and Obstetrics, St. Hedwig Klinik, Mannheim, Germany

    Axel Gerhardt

  3. Department of Medical Statistics and Biomathematics, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany

    Svetlana Hetjens

  4. Department of Radiation Oncology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany

    Frederik Wenz

Authors
  1. Saskia Spaich
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  2. Sophie Krickeberg
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  3. Svetlana Hetjens
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  4. Frederik Wenz
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  5. Axel Gerhardt
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  6. Marc Sütterlin
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Contributions

SS: project development, data management, data analysis, provision of study patients, manuscript writing, final approval of manuscript. SK: data collection, data analysis, provision of study patients, final approval of manuscript. SH: data analysis, final approval of manuscript. FW: project development, administrative support, provision of study patients, final approval of manuscript. AG: project development, data analysis, administrative support, provision of study patients, final approval of manuscript. MS: project development, data analysis, administrative support, provision of study patients, final approval of manuscript, supervision.

Corresponding author

Correspondence to Saskia Spaich.

Ethics declarations

Conflict of interest

Carl Zeiss Meditec supports radiobiological research in the Department of Radiation Oncology (Frederik Wenz). Marc Sütterlin reports reception of lecture fees in regard to IORT. The remaining authors declare that they have no competing interests.

Informed consent

All patients provided informed consent.

Ethical approval

The ethical approval for this study was obtained through Ethics Committee II, Heidelberg University, Medical Faculty Mannheim (2013-591N-MA).

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Spaich, S., Krickeberg, S., Hetjens, S. et al. Patient preferences regarding intraoperative versus external beam radiotherapy for early breast cancer and the impact of socio-demographic factors. Arch Gynecol Obstet 299, 1121–1130 (2019). https://doi.org/10.1007/s00404-018-5025-9

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  • DOI: https://doi.org/10.1007/s00404-018-5025-9

Keywords

  • Intraoperative radiotherapy (IORT)
  • Breast cancer
  • Breast-conserving surgery
  • Patient preference
  • External beam whole breast radiotherapy (EBRT)
  • Shared decision-making