Patient preferences for attributes of primary surgical debulking versus neoadjuvant chemotherapy for treatment of newly diagnosed ovarian cancer

Background Randomized trials have reported conflicting findings on survival for advanced‐stage ovarian cancer treated with primary debulking surgery (PDS) versus neoadjuvant chemotherapy with interval debulking; surgical complications and mortality are higher with PDS. We assessed women's preferences for tradeoffs related to this important clinical decision. Methods Ovarian cancer patients were recruited to complete a discrete‐choice experiment (DCE) consisting of 8 choice tasks presenting experimentally designed treatment alternatives in terms of treatment order, extent of surgery including risk of ostomy, chance of death from surgical complications (1%‐10%), readmission for surgical complications (5%‐50%), progression‐free survival (1‐3 years), and overall survival (3‐5 years). Random‐parameters logit regression was applied to model participants' choices as a function of attribute levels. Results A total of 101 ovarian cancer survivors completed the DCE survey; of these participants, 30% were receiving chemotherapy at the time, and 33% had prior recurrence. Overall survival was of greatest importance to participants (36/100), followed by risk of readmission due to complications (23/100), progression‐free survival (19/100), surgical mortality (16/100), extent of surgery (4/100), and order of surgery and chemotherapy (2/100). Overall, the participants would tolerate a 15‐percentage point increase in risk of major complications (95% confidence interval [CI], 3%‐29%) or a 4‐percentage point increase in the risk of surgical mortality (95% CI, 2%‐13%) in order to increase their expected overall survival from 3 to 3.5 years. Conclusions Patients would accept a moderately higher risk of perioperative complications and surgical mortality in exchange for substantial gains in survival. These quantitative findings provide clinicians with a framework to discuss preferences with patients and to incorporate preferences into clinical trial design. In a discrete‐choice experiment survey of women with ovarian cancer, participants were willing to accept a moderately higher risk of perioperative complications and surgical mortality in exchange for substantial gains in survival.