Abstract P4-11-11: Patient preferences for minimally invasive and conventional locoregional treatment for early-stage breast cancer; A utility assessment
Authors: Knuttel FM , van den Bosch MMAAJ , Young Afat DA , Emaus MJ , van den Bongard DHJG , Witkamp AJ , Verkooijen HM 
Published: May 2016

Abstract
Introduction
Breast cancer (BC) is increasingly diagnosed in an early stage due to improved imaging techniques and mammography screening. Non- or minimally invasive treatments, such as radiofrequency ablation (RFA) and MR-guided high-intensity focused ultrasound (MR-HIFU) ablation are currently being developed as alternatives to breast surgery. Patients' preferences with regard to these new treatments have not been investigated. The aim of this study is to assess the preferences of BC patients and healthy women regarding these new techniques, compared to conventional locoregional treatments.
Materials and methods
Six health states containing descriptions of BC treatments with their clinical consequences were developed based on literature and clinical expertise. Six treatment scenarios for treatment of early-stage BC without indication for adjuvant systemic therapy were proposed: 1) mastectomy with sentinel lymph node biopsy (SLNB); 2) mastectomy followed by direct reconstruction and SLNB; 3) breast conserving surgery with SLNB and whole breast radiotherapy; 4) radiofrequency ablation preceded by SLNB and followed by whole breast radiotherapy; 5) MR-HIFU ablation preceded by SLNB followed by whole breast radiotherapy; and 6) ablative partial breast radiotherapy (single dose) preceded by SLNB. Patients and healthy volunteers rated each scenario and corresponding health state by both visual analogue scale (VAS) and time trade-off (TTO). Eligible subjects are female BC patients who completed treatment &gt; 12 months ago and women aged &gt; 40 years without BC history. Patients were recruited from the UMBRELLA cohort at the department of Radiation Oncology of the University Medical Center Utrecht (The Netherlands). Healthy volunteers were friends or relatives of the BC patients enrolled in the study. Mean and standard deviation of VAS and TTO derived utility scores were calculated and health states were ranked by preference. Repeated measures ANOVA was used to test whether difference between ratings was significant. Spearman correlation coefficient was used to compare VAS and TTO scores.
Results
In a preliminary analysis in 23 women (18 patients and 5 healthy volunteers) mean age was 59±10.6 years. Responders rated breast conserving surgery as most preferred treatment (VAS 0.88±0.1, TTO 0.91±0.08). VAS scores were strongly correlated to TTO scores (ρ=0.74, p-value &lt; 0.005). Updated and more detailed results on 150 patients and healthy women will be presented in December.
Conclusion
We are performing a utility analysis of new and existing breast cancer treatments in breast cancer patients and healthy volunteers. This study will yield important information to guide the development and innovation of breast cancer therapies in the future.
Citation Format: Knuttel FM, van den Bosch MMAAJ, Young Afat DA, Emaus MJ, van den Bongard DHJG, Witkamp AJ, Verkooijen HM. Patient preferences for minimally invasive and conventional locoregional treatment for early-stage breast cancer; A utility assessment. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-11-11.