Give me a break: oncologists’ perception of systemic treatment holidays

Abstract

Objective: To analyze physician opinions of, and experiences with patients who take a temporary break from treatment in the setting of metastatic primary or recurrent gynecologic cancer. Methods: An electronic survey was sent to the members of the Society of Gynecologic Oncology (SGO). A treatment holiday was defined as a planned temporary break from systemic treatment in a patient with recurrent or metastatic gynecologic malignancy. Descriptive statistics were calculated using Microsoft Excel, and continuous variables were compared using the Wilcoxon Rank Sum test. Free text responses were qualitatively analyzed. Results: Of the 1314 individuals invited to participate, 74 responded (5.6% response rate). Ninety-six percent of respondents had a patient take a treatment holiday. Ninety-five percent of respondents would offer a treatment holiday for ovarian cancer, 90% for endometrial cancer, 70% for cervical cancer, 57% for vulvar cancer, 52% for vaginal cancer, and 49% for sarcoma. Using a Likert scale, respondents identified life events (86.6%), fatigue from side effects (77.9%), schedule fatigue (67.6%) and desire for ''life off treatment'' (64.7%) as ''very important'' reasons for offering a treatment holiday. Patients resumed treatment for return of symptoms (62.9%), progression of disease (60.0%), end of pre-specified break (50%), patient anxiety (45.7%) and recommendation of the physician (11%). 6.8% of physicians experienced regret after a patient underwent a treatment holiday. Ninety-eight percent of respondents agreed that a treatment holiday can be valuable. Conclusion: The gynecologic and medical oncologists who responded to this survey almost uniformly offered their patients treatment holidays, were more likely to offer treatment holidays for ovarian and endometrial cancer, and were unlikely to express regret after the experience.