PATIENT STATED PREFERENCES FOR NEOADJUVANT THERAPY IN PANCREATIC DUCTAL ADENOCARCINOMA
Jordan Cloyd*, Allan Tsung, Aslam Ejaz, Timothy M. Pawlik, Angela Sarna, Heena P. Santry, Celia Wills, Norah Crossnohere
Surgery, OHIO STATE UNIVERSITY, Columbus, OH
Background: Physicians are increasingly recommending neoadjuvant therapy (NT) prior to surgery for pancreatic ductal adenocarcinoma (PDAC). However, patient preferences for and opinions regarding NT have not been previously explored.
Methods: Survivors and caregivers from a national PDAC patient advocacy organization were invited to participate in an online survey to assess their preferences for NT versus surgery first (SF) and factors influencing their decision making regarding treatment options. The survey was designed based on preliminary interviews, literature review, expert input, and patient engagement. Responses were summarized and differences assessed using chi square analysis.
Results: Among 54 responders (response rate 47.0%), 74.1% had a personal history of pancreatic cancer. The majority (55.8%) were 50-69 years old and 44.1% were male. While most patients preferred SF for resectable disease (SF: 62.2%, NT: 31.1%, Uncertain: 6.7%), NT was the preferred treatment approach for borderline resectable (SF: 19.6%, NT: 71.7%, U: 8.7%), locally advanced (SF: 19.6%, NT: 71.7%, U: 8.7%), and resectable cancers with high CA 19-9 (SF: 26.1%, NT: 71.7%, U: 2.2%) (p<0.001). The most important factor influencing patient decision making regarding NT was its impact on overall survival while the least important was published national guidelines (Figure 1). In evaluating the strength of potential physician explanations for recommending NT, responders reported the ability to downstage to surgical resection and early treatment of micrometastatic disease as the best reasons (Figure 2). Qualitative comments noted a strong emphasis on the perceived importance of undergoing surgery but also individualizing the treatment decision for each patient and providing hope.
Conclusions: Among a national cohort of PDAC survivors and caregivers, the majority prefer SF compared to NT for resectable PDAC. The impact of NT on quantity and quality of life as well as the likelihood of achieving surgical resection were most highly valued by responders. These data are important for informing shared decision making and promoting patient-centered care.
Relative importance of factors influencing patient decision-making regarding neoadjuvant therapy or surgery first for pancreatic cancer
Patient perspectives of physician explanations for recommending neoadjuvant therapy for pancreatic cancer
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