Academic Journal
Balancing fertility potential and oncologic and obstetric risks: a vignette study on decision-making in fertility-sparing surgery for early-stage cervical cancer.
| Τίτλος: | Balancing fertility potential and oncologic and obstetric risks: a vignette study on decision-making in fertility-sparing surgery for early-stage cervical cancer. |
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| Συγγραφείς: | Wolswinkel JT; Radboud University Medical Center, Department of Obstetrics and Gynecology, Nijmegen, The Netherlands; Maastricht University Medical Center (MUMC+), Department of Gynecology and Obstetrics, Maastricht, The Netherlands. Electronic address: janneke.wolswinkel@radboudumc.nl., van Lenthe I; Radboud University Medical Center, Department of Obstetrics and Gynecology, Nijmegen, The Netherlands., Maurits JSF; Radboud University Medical Center, IQ Health Science Department, Nijmegen, The Netherlands., Aarts JWM; Department of Obstetrics and Gynecology, Amsterdam UMC location Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands., Bekkers RLM; Radboud University Medical Center, Department of Obstetrics and Gynecology, Nijmegen, The Netherlands; Maastricht University, Medical Center and GROW School for Oncology and Reproduction, Department of Obstetrics and Gynecology, Maastricht, The Netherlands., Ten Eikelder MLG; Radboud University Medical Center, Department of Obstetrics and Gynecology, Nijmegen, The Netherlands., Stroeken Y; Leiden University Medical Center, Department of Obstetrics and Gynecology, Leiden, The Netherlands., Beltman JJ; Leiden University Medical Center, Department of Obstetrics and Gynecology, Leiden, The Netherlands., Ter Kuile MM; Leiden University Medical Center, Department of Obstetrics and Gynecology, Leiden, The Netherlands., Lok CAR; Center for Gynecologic Oncology Amsterdam (CGOA), location Antoni van Leeuwenhoek/Netherlands Cancer Institute, Amsterdam, The Netherlands., van Trommel NE; Center for Gynecologic Oncology Amsterdam (CGOA), location Antoni van Leeuwenhoek/Netherlands Cancer Institute, Amsterdam, The Netherlands., Kasius JC; Department of Obstetrics and Gynecology, Amsterdam UMC location Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands., Zusterzeel PLM; Radboud University Medical Center, Department of Obstetrics and Gynecology, Nijmegen, The Netherlands. |
| Πηγή: | International journal of gynecological cancer : official journal of the International Gynecological Cancer Society [Int J Gynecol Cancer] 2026 Aug; Vol. 36 (8), pp. 104802. Date of Electronic Publication: 2026 Jun 09. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: BMJ Country of Publication: United States NLM ID: 9111626 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1525-1438 (Electronic) Linking ISSN: 1048891X NLM ISO Abbreviation: Int J Gynecol Cancer Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2019- : [London] : BMJ Original Publication: Cambridge, MA, USA : Blackwell Scientific Publications, c1991- |
| Ιατρικοί όροι (MeSH): | Fertility Preservation*/methods , Fertility Preservation*/psychology , Uterine Cervical Neoplasms*/surgery , Uterine Cervical Neoplasms*/pathology , Clinical Decision-Making*, Humans ; Female ; Adult ; Pregnancy ; Hysterectomy ; Gynecologists ; Netherlands ; Decision Making ; Patient Preference ; Neoplasm Staging |
| Περίληψη: | Objective: Fertility-sparing surgery offers the opportunity to preserve fertility but comes with higher oncologic and obstetric risks. This study aims to identify key factors influencing decision-making of women with early-stage cervical cancer. Methods: We conducted a vignette-based study involving former patients and gynecologic oncologists in the Netherlands. Eligible patients were aged 25-42 years at the time of surgery and underwent radical trachelectomy or radical hysterectomy for early-stage cervical cancer between 2014 and 2024. All Dutch gynecologic oncologists were invited. Four vignette attributes were selected based on literature and patients' and experts' opinions. Different risk percentages for these attributes were varied in 16 scenarios. Participants rated their preference on a 5-point Likert scale, where 1 indicated a strong preference for hysterectomy and 5 a strong preference for fertility-sparing surgery. Preferences were analyzed using linear mixed-effects models. Results: A total of 58 out of 205 patients (28.3%) and 33 of 55 gynecologic oncologists (60%) participated. The mean preference for fertility-sparing surgery across all scenarios was 3.48 (95% confidence interval (CI) 3.22 to 3.74) for patients and 3.16 (95% CI 2.95 to 3.36) for gynecologic oncologists. All four attributes played significant roles in decision-making. For patients, the likelihood of achieving pregnancy was the most influential factor, increasing the preference score by 1.07 (scale 1 to 5) for an 85% chance of conception. For gynecologic oncologists, an increased risk of cancer-related death was the most decisive factor, resulting in a 1.84 decrease (scale 1 to 5) for a 10% additional risk of death. Conclusions: Patients and gynecologic oncologists showed a modest preference for fertility-sparing surgery over hysterectomy. Patients appeared to place relatively greater weight on likelihood of pregnancy and were less deterred than clinicians by hypothetical increases in cancer-related mortality risk. This underscores the importance of thoroughly involving patients in the decision-making process. (Copyright © 2026 The Author(s). Published by Elsevier Inc. All rights reserved.) |
| Competing Interests: | Declaration of Competing Interests None declared. |
| Contributed Indexing: | Keywords: Cervical Cancer; Fertility-Sparing Surgery; Gynecologists’ Preference; Patients’ Preference; Shared Decision-Making; Vignette-Based Study |
| Entry Date(s): | Date Created: 20260701 Date Completed: 20260803 Latest Revision: 20260803 |
| Update Code: | 20260804 |
| DOI: | 10.1016/j.ijgc.2026.104802 |
| PMID: | 42385629 |
| Βάση Δεδομένων: | MEDLINE |
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