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 - 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 -