TY - JOUR
T1 - Factors associated with deciding between risk-reducing salpingo-oophorectomy and ovarian cancer screening among high-risk women enrolled in GOG-0199
T2 - An NRG Oncology/Gynecologic Oncology Group study
AU - Mai, Phuong L.
AU - Piedmonte, Marion
AU - Han, Paul K.
AU - Moser, Richard P.
AU - Walker, Joan L.
AU - Rodriguez, Gustavo
AU - Boggess, John
AU - Rutherford, Thomas J.
AU - Zivanovic, Oliver
AU - Cohn, David E.
AU - Thigpen, J. Tate
AU - Wenham, Robert M.
AU - Friedlander, Michael L.
AU - Hamilton, Chad A.
AU - Bakkum-Gamez, Jamie
AU - Olawaiye, Alexander B.
AU - Hensley, Martee L.
AU - Greene, Mark H.
AU - Huang, Helen Q.
AU - Wenzel, Lari
N1 - Funding Information:
This study was supported by the Intramural (DCEG, CCR) and Extramural (DCTD/CTEP, DCP/CCOP) Research Programs of the National Cancer Institute. In addition, this study was supported by National Cancer Institute grants to the Gynecologic Oncology Group (GOG) Administrative Office and the GOG Tissue Bank (CA 27469), and to the GOG Statistical and Data Center (CA 37517) as well as NRG Oncology Operations grant number U10 CA180868 and NRG SDMC grant U10 CA180822.
Publisher Copyright:
© 2017
PY - 2017/4/1
Y1 - 2017/4/1
N2 - Objectives Women at increased genetic risk of ovarian cancer (OC) are recommended to have risk-reducing salpingo-oophorectomy (RRSO) after completion of reproductive planning. Effective screening has not been established, and novel screening modalities are being evaluated. Methods Participants chose either RRSO or a novel OC screening regimen (OCS) as their risk management option, and provided demographic and other data on BRCA mutation status, cancer worry, perceived intervention risks/benefits, perceived cancer risk, and quality-of-life at enrollment. We performed univariate and multivariate analyses to evaluate factors influencing decision between RRSO and OCS. Results Of 2287 participants enrolled, 904 (40%) chose RRSO and 1383 (60%) chose OCS. Compared with participants choosing OCS, participants choosing RRSO were older (p < 0.0001), more likely to carry deleterious BRCA1/2 mutations (p < 0.0001), perceive RRSO as effective, be more concerned about surgical harms and OCS limitations, and report higher perceived OC risk and OC-related worry. OCS participants were more likely to perceive screening as effective, be more concerned about menopausal symptoms, infertility, and loss of femininity, and report better overall quality-of-life. Twenty-four percent of participants believed they would definitely develop OC, and half estimated their lifetime OC risk as > 50%, both higher than objective risk estimates. Conclusions Cancer worry, BRCA1/2 mutation status, and perceived intervention-related risks and benefits were associated with choosing between RRSO and OCS. Efforts to promote individualized, evidence-based, shared medical decision-making among high-risk women facing management choices should focus on conveying accurate OC risk estimates, clarifying the current understanding of intervention-related benefits and limitations, and addressing OC worry.
AB - Objectives Women at increased genetic risk of ovarian cancer (OC) are recommended to have risk-reducing salpingo-oophorectomy (RRSO) after completion of reproductive planning. Effective screening has not been established, and novel screening modalities are being evaluated. Methods Participants chose either RRSO or a novel OC screening regimen (OCS) as their risk management option, and provided demographic and other data on BRCA mutation status, cancer worry, perceived intervention risks/benefits, perceived cancer risk, and quality-of-life at enrollment. We performed univariate and multivariate analyses to evaluate factors influencing decision between RRSO and OCS. Results Of 2287 participants enrolled, 904 (40%) chose RRSO and 1383 (60%) chose OCS. Compared with participants choosing OCS, participants choosing RRSO were older (p < 0.0001), more likely to carry deleterious BRCA1/2 mutations (p < 0.0001), perceive RRSO as effective, be more concerned about surgical harms and OCS limitations, and report higher perceived OC risk and OC-related worry. OCS participants were more likely to perceive screening as effective, be more concerned about menopausal symptoms, infertility, and loss of femininity, and report better overall quality-of-life. Twenty-four percent of participants believed they would definitely develop OC, and half estimated their lifetime OC risk as > 50%, both higher than objective risk estimates. Conclusions Cancer worry, BRCA1/2 mutation status, and perceived intervention-related risks and benefits were associated with choosing between RRSO and OCS. Efforts to promote individualized, evidence-based, shared medical decision-making among high-risk women facing management choices should focus on conveying accurate OC risk estimates, clarifying the current understanding of intervention-related benefits and limitations, and addressing OC worry.
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U2 - 10.1016/j.ygyno.2017.02.008
DO - 10.1016/j.ygyno.2017.02.008
M3 - Article
C2 - 28190649
AN - SCOPUS:85012008455
SN - 0090-8258
VL - 145
SP - 122
EP - 129
JO - Gynecologic oncology
JF - Gynecologic oncology
IS - 1
ER -