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

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

doi:10.2147/PPA.S319790

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

Patient Prefer Adherence. 2021 Sep 22:15:2185-2196. doi: 10.2147/PPA.S319790. eCollection 2021.

Authors

Jelle E Bousema¹, Fieke Hoeijmakers², Marcel G W Dijkgraaf³, Jouke T Annema⁴, Frank J C van den Broek¹, M Elske van den Akker-van Marle⁵; MEDIASTrial Study Group

Affiliations

¹ Department of Surgery, Máxima MC, Veldhoven, 5500 MB, the Netherlands.
² Department of Surgery, Leiden University Medical Center, Leiden, 2300 RC, the Netherlands.
³ Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, 1100 DE, the Netherlands.
⁴ Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, 1100 DE, the Netherlands.
⁵ Department of Biomedical Data Sciences, Unit Medical Decision Making, LUMC, Leiden, 2300 RC, the Netherlands.

Abstract

Background: Variability in practice and ongoing debate on optimal invasive mediastinal staging of patients with resectable non-small cell lung cancer (NSCLC) are widely described in the literature. Patients' preferences on this topic have, however, been underexposed so far.

Methods: An internet-based questionnaire was distributed among MEDIASTrial 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.

Results: Ninety-seven patients completed the questionnaire (57%). The length of the staging period was significantly the most important attribute (RI 26.24; 95% CI: 25.05-27.43), followed by the risk of a futile surgical lung resection (RI 23.44; 95% CI: 22.28-24.60) and resection of the primary tumor (RI 22.21; 95% CI: 21.09-23.33). Avoidance of 7% (IQR 1- >14%) futile lung resections would cover the burden of confirmatory mediastinoscopy, with a dichotomy among patients always (39%) or never (38%) willing to undergo confirmatory mediastinoscopy after N2 and N3-negative endosonography.

Conclusion: Although a strong dichotomy among patients always or never willing to undergo confirmatory mediastinoscopy was found, the length of the staging period was the most important attribute in invasive mediastinal staging according to patients with resectable NSCLC.

Trial registration: Not applicable.

Keywords: endosonography; mediastinal nodal staging; mediastinoscopy; non-small cell lung cancer; patients’ preferences; thoracic surgery.

Grants and funding

This patients’ preferences study is part of the MEDIASTrial which is funded by ZonMw (project number 843004109) and The Dutch Cancer Society (project number 11313). The funding sources had no involvement in the study design, data analysis and interpretation and the decision to submit the article for publication.