Treatment preferences of patients with esophageal cancer. Qualitative study with patients and medical experts on treatment preferences and willingness to participate in a randomized controlled trial

Background: The treatment of esophageal carcinoma (EC) according to current standards is surgery which follows neoadjuvant chemotherapy (nCT) or neoadjuvant radiochemotherapy (nRCT). For patients with clinical complete response to nCT/nCRT, active surveillance with surgery only when needed may be an equivalent option in terms of survival. Objectives: To identify factors influencing treatment preferences, decision-making motivations, and fears/hopes of EC patients regarding the choice of the two treatment options. Methods: Qualitative survey with semistructured individual interviews with EC patients and expert interviews with physicians, nurses and psycho-oncologists. Results: Consultations with the physician provide a basis for decision-making when it comes to therapy preference. Not only empathic and competent advice, but also concrete guidance regarding the choice of therapy is expected from the treating physicians. Age is mentioned as a significant factor in the choice of therapy. Above all, an increased risk of complications during or after surgery or physical weakness seem to be significant reasons for patients of advanced age to prefer surgery as needed. The decision for or against a certain therapy is based on the patients' age and quality of life, which is always interpreted differently and individually. Conclusions: According to the qualitative data presented here, immediate surgery is the primary treatment option in patients with esophageal cancer (7 of 11), yet some patients may well see the advantages of the alternative treatment option and would prefer surgery as needed. The vast majority of patients (8 of 11) would participate in a randomized controlled trial (RCT) and see participation as a unique opportunity to receive an alternative treatment option, avoid surgery, and thus improve their quality of life.