Hormonal therapy or chemotherapy for advanced endometrial cancer? A mixed-methods study assessing physicians’ attitudes

PURPOSE: Hormonal therapy and chemotherapy are common systemic therapy options in advanced and recurrent endometrial cancer. There is limited consensus on factors that affect therapy selection. This study aims to gain insight into those factors at the level of clinical decision-making and at the level of patient- and tumor-specific factors. METHODS: We performed an international cross-sectional study among medical oncologists and gynecologists. The survey consisted of (1) statements about barriers and facilitators that affect the process of decision-making and (2) hypothetical vignette cases investigating three patients and tumor factors that were tested with three levels each. Results were analyzed with descriptive statistics and linear mixed-effects models. RESULTS: 167 physicians responded to the survey. The most important facilitating factors were: understanding the patient's personal context and the role of multidisciplinary tumor board discussions. The most important barrier was the lack of evidence for prediction of response to hormonal therapy and chemotherapy. The three patient and tumor factors included in the vignette cases were severity of symptoms, performance status, and progesterone-receptor (PR) expression in the tumor. PR expression and performance status were most discriminative, with high PR expression and poor performance status favoring hormonal therapy. CONCLUSION: The provision of personalized care in palliative treatment of endometrial cancer can be improved by multidisciplinary tumor board discussions with the personal context and preference of the patient in mind. The patient factors, severity of symptoms and WHO performance status, and the tumor factor, PR tumor expression, were most relevant for selecting hormonal therapy or chemotherapy.