Research biopsies in gynecologic oncology: patients’ perspective

Objectives: The aim of this study was to assess the impact of research biopsies on quality of life of patients (pts) with gynecologic malignancies, and determine which factors are associated with the pts willingness to undergo future biopsies. Methods: We conducted a prospective study on pts with gynecologic malignancies undergoing research biopsies between 2015 and 2020 at a tertiary Canadian cancer centre. Eligible pts were ≥18 years old and had an ECOG status of ≤2. Pts completed the questionnaires prior to the biopsy (Q1) and 1 week after the biopsy (Q2). Q1 collected general information, perceived risks and the modified Hospital Anxiety and Depression Scale (HADS; range 0-21, normal Results: 129 pts were enrolled, 88 were evaluable and completed Q1/Q2. The site of biopsy was abdomen/pelvis 78%, liver 16%, other 6%. Pts had predominantly recurrent disease (99%), 91% had ovarian and 9% endometrial cancer. Median age was 61.5 years (32-80). Ethnicity was White in 79%, Asian 15%, and others in 6% of pts. 92% of pts were involved in interventional clinical trials. Mean time from biopsy request to biopsy was 10.4 days (standard deviation [sd] 13.9). The mean HADS score was within normal ranges in Q1 and Q2, with a significant decline in the total score after the biopsy (Q1 5.3 [sd 4.7] and Q2 3.7 [sd 4.5]; p=0.005). Figure 1 describes the pts reported post-biopsy symptoms and perceptions in Q2. At Q2, 83% of pts reported that they would definitely or likely consent for another research biopsy. We then correlated each of the factors with pts willingness to undergo future research biopsies. There was no significant difference according to ECOG status (p=0.74), site of biopsy (p=0.99), age (p=0.56). None of the post-biopsy reported symptoms showed a significant impact in pts willingness to undergo future biopsies, including feverish feeling (OR:0.33, p=0.12), nausea/vomiting (OR:0.51, p=0.3), pain in biopsy area (OR:0.4, p=0.19), flu-like symptoms (OR:0.3, p=0.06). In terms of biopsy related perceptions, we did not detect a significant correlation with pain during procedure (OR:0.3 p=0.23). Whereas, pts with higher HADS scores in Q2 (OR:0.83, p=0.005), those who felt physically uncomfortable (OR:0.1, p=0.02), felt embarrassed (OR:0.03, p=0.005), or felt loss of dignity during the biopsy (OR:0.05, p=0.015) were less likely to consent for future research biopsies. Download : Download high-res image (244KB) Download : Download full-size image Conclusions: Research biopsies were generally well accepted in pts that underwent a biopsy, and 83% of pts reported willingness to undergo subsequent research biopsies. The mean HADS level was within normal ranges before the biopsy and decreased significantly post-procedure. Higher HADS scores, embarrassment, loss of dignity and physical discomfort during the procedure significantly influenced the likelihood of obtaining serial biopsies. A better understanding of the impact of research biopsies in pts is vital to improve their experience.