Introduction/Background Acceptance of the role of fallopian tubes in ovarian carcinogenesis and the detrimental sequelae of surgical menopause in pre-menopausal women following risk reducing salpingo-oophorectomy (RRSO), has resulted in risk reducing early salpingectomy with delayed oophorectomy (RRESDO) being proposed as an attractive alternative risk reducing strategy in women who decline/delay oophorectomy. We present the results of a qualitative study evaluating the decision making process amongst BRCA carriers considering prophylactic surgeries (RRSO/RRESDO) as part of the multicentre PROTECTOR trial (ISRCTN:25173360).
Methodology In depth semi-structured 1:1 interviews conducted using a pre-developed topic guide (development informed by literature review and expert consultation) until informational saturation reached. Wording and sequencing of questions were left open with probes used to elicit additional information. All interviews were audio recorded, transcribed verbatim, transcripts analysed using an inductive theoretical framework and data managed using NVIVO v12.
Results Informational saturation was reached following twenty four interviews. Seven interconnected themes integral to surgical decision making were identified: fertility, menopause, cancer risk reduction, surgical choices, surgical complications, sequence of ovarian and breast prophylactic surgeries, support, satisfaction. Women for whom maximising ovarian cancer (OC) risk reduction was relatively more important than early menopause/quality of life preferred RRSO, whereas those more concerned about detrimental impact of menopause chose RRESDO. Women preferred educational support groups to online support groups to help with decision-making. Women engage concurrently in both OC and breast cancer (BC) prevention decision-making and we identified a demand for combined OC and BC prevention-surgery. While preventative surgery reduced anxiety, interviewees wished to be routinely offered an ‘optional’ (not compulsory) consultation with a psychologist. Women managed in specialist familial cancer clinic (FCC) settings compared to non-specialist settings received better quality care, improved HRT access and were more satisfied.
Conclusion Medical, physical, psychological, social contextual factors influence timing of risk reducing surgeries. RRESDO offers women delaying/declining premenopausal oophorectomy, particularly those concerned about menopausal effects, a degree of ovarian cancer risk reduction whilst avoiding premature menopause. Care of high risk women should be centralised to centres with specialist familial gynaecological cancer risk management services to provide a better quality, streamlined, holistic multidisciplinary approach.
Disclosures Funding: Barts Charity and Rosetrees Trust.
RM declares research funding from Cancer Research UK and The Eve Appeal outside this work, an honorarium for advisory board membership from Astrazeneca/MSD and Israel National Institute for Health Policy Research. RM is supported by an NHS Innovation Accelerator (NIA) Fellowship. The other authors declare no conflict of interest.
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