title: Patients' Preferences for Surgical Management of Esophageal Cancer: A Discrete Choice Experiment.
abstract: BACKGROUND
  Obtaining insight into patients' preferences is important to optimize cancer care. We investigated patients' preferences for surgical management of esophageal cancer.
  
  
  METHODS
  We conducted a discrete choice experiment among adult patients who had undergone esophagectomy for adenocarcinoma or squamous cell cancer of the esophagus. Patients' preferences were quantified with regression analysis using scenarios based on five aspects: risk of in-hospital mortality, risk of persistent symptoms, chance of 5-year survival, risk of surgical and non-surgical complications, and hospital volume of esophageal cancer surgery.
  
  
  RESULTS
  The response rate was 68 % (104/142). All aspects proved to influence patients' preferences (p < 0.05). Persisting gastrointestinal symptoms and 5-year survival were the most important attributes, but preferences varied between patients. On average, patients were willing to trade-off 9.5 % (CI 2.4-16.6 %) 5-year survival chance to obtain a surgical treatment with 30 % lower risk of gastrointestinal symptoms, or 8.1 % (CI 4.0-12.2 %) 5-year survival chance for being treated in a high instead of a low-volume hospital.
  
  
  CONCLUSIONS
  Patients are willing to trade-off some 5-year survival chance to achieve an improvement in early outcomes. Given the preference heterogeneity among participants, the present study underlines the importance of a patient-tailored approach when discussing prognosis and treatment.
authors.affiliation: Department of Public Health, Erasmus MC - University Medical Centre Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands, e.debekker@erasmusmc.nl.
authors.forename: Esther W
authors.initials: EW
authors.lastname: de Bekker-Grob
authors.forename: Eva J
authors.initials: EJ
authors.lastname: Niers
authors.forename: J Jan B
authors.initials: JJ
authors.lastname: van Lanschot
authors.forename: Ewout W
authors.initials: EW
authors.lastname: Steyerberg
authors.forename: Bas P L
authors.initials: BP
authors.lastname: Wijnhoven
mesh_terms: D000230:Adenocarcinoma / Q000523:psychology / Q000601:surgery*; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000523:psychology / Q000601:surgery*; D002755:Choice Behavior; D004938:Esophageal Neoplasms / Q000523:psychology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects; D005260:Female; D017052:Hospital Mortality; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate