scholarly journals Treatment preferences in patients with axial spondyloarthritis

2020 ◽  
pp. 24-30
Author(s):  
D. Capelusnik ◽  
L. L. Macías Oviedo ◽  
J. M. Sevillano Gutiérrez ◽  
G. Citera
Keyword(s):  
Disease Activity ◽  
Axial Spondyloarthritis ◽  
Multiple Logistic Regression Analysis ◽  
Treatment Decision ◽  
Oral Route ◽  
Treat To Target ◽  
Treatment Preferences ◽  
Self Administration ◽  
Cross Sectional ◽  
Lower Disease Activity

Background: One of the premises of the Treat to Target (T2T) is the shared treatment decision between the rheumatologist and the patient. For this reason, patient preferences play a fundamental role in the success of treatment in the short and long term. The aims of this study were to evaluate the treatment preferences of patients with Axial Spondyloarthritis (axSpA) and to identify the factors associated with their choice. Material and methods: Cross sectional study. Patients ≥18 years old that fulfilled the ASAS 2009 criteria for axSpA were included. Sociodemographic data, comorbidities, disease characteristics, and treatments received were recorded. A specially designed questionnaire in both, multiple choice modality and response mode listed in order of priority of the statements was administered. Statistical analysis: Descriptive statistics. Student’s T-test, Chi2 test and multiple logistic regression analysis. A value of p <0.05 was considered significant. Results: Seventy patients were included with a median age (m) of 46.5 years (IQR: 38-57), 55 males (78.6%) and a median disease duration of 13.5 years (IQR: 7.75-23.25). The relevant aspects for choosing a treatment were: the ability to improve the quality of life (32.9%), followed by improvement in joint inflammation (22.9%), pain (21. 4%) and physical function (14.3%). The chosen administration routes in decreasing order of frequency were: oral (51.4%), subcutaneous (SC) (41.4%), intramuscular (IM) 4.3% and intravenous (IV) 2.9%. The preferred frequency of oral administration was one tablet per week (61.1%) and SC administration, once a month (34.5%). The choice of oral route was associated with: preference for self-administration, preference for receiving the medication at home and higher level of education. The choice of the SC route was independently associated with the type of axSpA (AS) and a lower educational level. The patients under biological SC treatment and with lower disease activity, showed higher level of treatment satisfaction. Conclusion: The most preferred way of administration by patients with axSpA was the oral route. Lower disease activity and SC biological treatment were associated with treatment greater compliance.

scholarly journals AB0564 RHEUMATOLOGISTS’ VIEWS AND EXPERIENCES IN MANAGING PsA PATIENTS BASED ON TREATING TO TARGET STRATEGY: A CROSS-SECTIONAL STUDY IN CHINA

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1318.2-1319
Author(s):  
L. Xu ◽  
Z. Wang ◽  
J. Xue ◽  
M. Bai ◽  
H. Zhong ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Western Medicine ◽  
Work Experience ◽  
Tertiary Hospital ◽  
Treat To Target ◽  
Cross Sectional ◽  
Activity Assessment ◽  
High Level

Background:Psoriatic arthritis (PsA) is a chronic inflammatory arthritis with progressive, erosive destruction associated with functional impairment. Principles of treat-to-target (T2T) have been widely used in rheumatoid arthritis, which has powerfully improved patient outcomes. In 2017, the concept of T2T has proposed to apply in PsA patients. However, the awareness and implementation of evidence-based T2T treatment guidelines varies across different geographical regions of China, hospital grades, professional status and specialities.Objectives:The study aimed to investigate Rheumatologists’ views and experiences in managing PsA patients with T2T strategy in china.Methods:A cross-sectional questionnaire survey of Rheumatologists in China from 5 August to 15 August 2020 was conducted for this study. Rheumatologists were contacted by WeChat (a Chinese cell/web app) and asked to complete a web-based questionnaire anonymously. The electronic questionnaire was sent out by the internet platform of WenJuanXing via WeChat (https://www.wjx.cn/). The questionnaire was designed to collect: (a) demographic information; (b) patient management in clinical practice for Rheumatologists; (c) familiarity and application of T2T strategy in Rheumatologists. P values ≤0.05 were considered significant.Results:(1) A total of 823 rheumatologists (69.87% female, 30.13% male) provided valid answers to the questionnaire. 71.09% of the participants major in Modern Western Medicine, 28.91% major in traditional chinese medicine. A total of 75.94% worked in Grade-A Tertiary Hospital. A total of 52.73% had more than 10 years of work experience and 63.55% had High-level title. (2) More than half of the patients were followed up by 69% Rheumatologists in their daily practice. The proportion of follow-up patients increased powerfully in the group of Rheumatologists who major in Modern Western Medicine (P=0.014), work in Grade-A Tertiary Hospital (P<0.001), have more than 10 years of work experience (P<0.001) and High-level title (P<0.001). (3) 36.45% Rheumatologist thought the frequency for patient disease activity assessment was every 1 month and 53.1% was every 3 months. And 41.7% Rheumatologist prefer to use PASDAS for disease activity criteria, and only 3.6% choose MDA. (4) A total of 62.43% thought they were familiar with T2T strategy, and 83.6% Rheumatologists applied T2T strategy in clinical practice. Among 135 Rheumatologists who did not apply T2T strategy, 62.2% of Rheumatologists thought that the main barrier to T2T application was that they did not fully understand the strategy. The frequency of application of T2T strategy in clinical practice was significantly different between Rheumatologists who major in Modern Western Medicine (60.75%) and traditional chinese medicine (22.84%) (P=0.023).Conclusion:In china, the management of PsA patients need to be standardized to improve patient outcomes. And the promotion of T2T strategy in PsA need to be further strengthened.References:[1]Smolen JS, Schöls M, Braun J,et al. Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force. Ann Rheum Dis. 2018 Jan;77(1):3-17.[2]Tucker LJ, Ye W, Coates LC. Novel Concepts in Psoriatic Arthritis Management: Can We Treat to Target? Curr Rheumatol Rep. 2018 Sep 18;20(11):71.[3]Coates LC, Helliwell PS. Treating to target in psoriatic arthritis: how to implement in clinical practice. Ann Rheum Dis. 2016;75(4):640-643.Figure 1A. Rheumatologist priority of frequency for patient follow-up in different disease status. B. Rheumatologist priority of frequency for patient disease activity assessment in clinical practice. C. Rheumatologist priority of disease activity criteria for PsA patients.Disclosure of Interests:None declared.

scholarly journals AB0499 PHYSICAL ACTIVITY ASSESSMENT IN TUNISIAN PATIENTS WITH SPONDYLOARTHRITIS: THE IPAQ EVALUATION

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1277.1-1277
Author(s):  
F. Majdoub ◽  
M. Sellami ◽  
S. Miladi ◽  
A. Fazaa ◽  
L. Souabni ◽  
...  
Keyword(s):  
Physical Activity ◽  
Disease Activity ◽  
Axial Spondyloarthritis ◽  
Cross Sectional Study ◽  
Urban Setting ◽  
Tnf Inhibitor ◽  
Sectional Study ◽  
Cross Sectional ◽  
Tunisian Patients ◽  
Different Levels

Background:The occurrence of Spondyloarthritis (SpA) often conditions patients’ quality of life and hinders their well-being. Physical activity (PA) is associated with various health-related benefits among adults with chronic inflammatory rheumatism but may be insufficiently performed.Objectives:This study aimed to assess PA in patients with SpA and explore its associated factors.Methods:This is a single-center cross-sectional study, involving patients with SpA, visiting our outpatient hospital over eight weeks. Patients responded to the International Physical Activity Questionnaire-Short form (IPAQ-S).Results:Sixty patients were included (39 M/21 F) with an average age of 45.8 years [25-78]. The mean duration of SpA was 13.2 years [1-25]. About 80% of patients were from an urban setting. Sixty-three percent of patients had a professional activity, while 13.3% were retired. Twenty-nine patients (48.3%) had axial and peripheral form, 18 patients (30%) had SpA with enteropathic arthritis, 8 (13.3%) with psoriatic arthritis, 3 patients (5%) had axial spondyloarthritis, and only 2 patients (3.3%) with SAPHO-Syndrom. About 23% of patients had hip arthritis and only 5% had uveitis. Fifty-eight patients were on TNF-inhibitor (21/58 Adalimumab, 15/58 Infliximab, 14/58 Etanercept, 8/58 Golimumab). The average BASDAI was 2.7/10. The average ASDASCRP was 2.1/10. The average BASFI was 3.3/10. IPAQ results were distributed as follows: 78.3% of patients were in the « low physical activity » category, 21.7% were in the « moderate physical activity » while none of the patients were in the « high physical activity ». Patients without employment had lower levels of physical activity (29.7%) but no association was observed between those two items (p=0.082). Disease activity objectified with BASDAI was related to low physical activity (p=0.045) whereas no association was observed with ASDASCRP (p=0.870) or BASFI (p=0.056). Otherwise, TNF-inhibitor treatment was not related to different levels of PA (p=0.09).Conclusion:Tunisian patients with SpA don’t perform enough physical activity. Except for high disease activity, the different levels of PA did not appear to be explained by other disease-related variables. Thereby, physical activity should be encouraged in SpA.References:[1]Fabre, S., Molto, A., Dadoun, S. et al. Physical activity in patients with axial spondyloarthritis: a cross-sectional study of 203 patients. Rheumatol Int 36, 1711–1718 (2016).Disclosure of Interests:None declared.

Combination therapy in rheumatoid arthritis

2020 ◽  
pp. 457-462
Author(s):  
Ben G.T. Coumbe ◽  
Elena Nikiphorou ◽  
Tuulikki Sokka-Isler
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Treat To Target ◽  
Combination Therapies ◽  
Treatment Benefit ◽  
Combination Strategies ◽  
Therapeutic Landscape ◽  
The Cost ◽  
Lower Disease Activity ◽  
Radiologic Progression

The therapeutic armamentarium available for treatment of rheumatoid arthritis (RA) has changed significantly over the past 30 years, transforming the therapeutic landscape and prognosis for a substantial proportion of patients with RA. Combination therapies represent an important therapeutic paradigm for management of rheumatoid arthritis. The rationale for combination therapies is clear and demonstrated to bring treatment benefit to patients achieving lower disease activity scores and reduced radiologic progression according to ‘treat-to-target’ principles. A rigorous evidence-based debate is required involving not only parameters related to disease activity scores and radiologic progression, but related to the cost-effectiveness analysis of using many of these newer agents compared to older csDMARDs. This chapter addresses the evidence related to the utilization of combination strategies for the management of RA as compared to monotherapy.

scholarly journals Cross-sectional study of patients with axial spondyloarthritis fulfilling imaging arm of ASAS classification criteria: baseline clinical characteristics and subset differences in a single-centre cohort

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e024713 ◽  
Author(s):  
Kristyna Bubová ◽  
Šárka Forejtová ◽  
Kateřina Zegzulková ◽  
Monika Gregová ◽  
Markéta Hušáková ◽  
...  
Keyword(s):  
Disease Activity ◽  
Axial Spondyloarthritis ◽  
Cross Sectional Study ◽  
Classification Criteria ◽  
Spinal Mobility ◽  
Sectional Study ◽  
Single Centre ◽  
Peripheral Arthritis ◽  
Cross Sectional ◽  
Asas Classification Criteria

ObjectiveThis study compared demographic, clinical and laboratory characteristics between patients with radiographic and non-radiographic axial spondyloarthritis (axSpA).MethodsIn this single-centre cross-sectional study, a total of 246 patients with axSpA fulfilling the imaging arm of Assessment of SpondyloArthritis International Society classification criteria were recruited. A total of 140 patients were diagnosed as non-radiographic axial spondyloarthritis (nr-axSpA), and 106 patients had ankylosing spondylitis (AS). Sociodemographic characteristics, disease manifestations, clinical and laboratory disease activity and their differences between subsets were analysed. P values below 0.05 with CI 95% were considered statistically significant.ResultsMore nr-axSpA patients were women (61.4%) compared with 24.7% of AS patients. First symptoms developed earlier in AS patients compared with nr-axSpA (23.0 (IQR 17.5–30.0) vs 27.8 (IQR 21.0–33.7) years, p=0.001). Disease manifestations did not differ, but patients with nr-axSpA experienced peripheral arthritis more frequently (35.7% vs 17.0%, p=0.001) with less hip involvement (8.6% vs 18.9%, p=0.022) compared with patients with AS. Patients with AS exhibited worse spinal mobility and physical function compared with nr-axSpA. AS Disease Activity Scores and CRP levels were significantly higher in patients with AS compared with nr-axSpA (2.4 (IQR 1.7–2.8) vs 2.0 (IQR 1.1–2.3), p=0.022 and 7.1 (IQR 2.6–14.9) vs 2.5 (IQR 0.8–8.2) mg/L, p<0.001, respectively).ConclusionsOur data demonstrated some known and also novel differences between the two imaging arm fulfilling axSpA subgroups. Non-radiographic patients were mostly women who had experienced shorter disease duration, milder disease activity and better functional status with less hip involvement but more peripheral arthritis compared with patients with AS.

Serum visfatin levels in patients with axial spondyloarthritis and their relationship to disease activity and spinal radiographic damage: a cross-sectional study

2019 ◽  
Vol 39 (6) ◽  
pp. 1037-1043 ◽  
Author(s):  
Hana Hulejová ◽  
Tereza Kropáčková ◽  
Kristýna Bubová ◽  
Olga Kryštůfková ◽  
Mária Filková ◽  
...  
Keyword(s):  
Disease Activity ◽  
Axial Spondyloarthritis ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Radiographic Damage

scholarly journals Alcohol and disease activity in axial spondyloarthritis: a cross-sectional study

2018 ◽  
Vol 38 (3) ◽  
pp. 375-381 ◽  
Author(s):  
Sizheng Zhao ◽  
Daniel Thong ◽  
Stephen J. Duffield ◽  
David Hughes ◽  
Nicola J. Goodson
Keyword(s):  
Disease Activity ◽  
Axial Spondyloarthritis ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional

scholarly journals POS0243 WHAT DOES REMISSION IN AXIAL SPONDYLOARTHRITIS MEAN FOR CLINICIANS? AN EXPLORATORY STUDY OF 200 FRENCH RHEUMATOLOGISTS BASED ON A VIGNETTE EXERCISE INCLUDING 36 CASES AND PRIORITY RATINGS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 343.1-343
Author(s):  
K. Aouad ◽  
D. Wendling ◽  
A. Baglin ◽  
M. Breban ◽  
S. Dadoun ◽  
...  
Keyword(s):  
Disease Activity ◽  
Axial Spondyloarthritis ◽  
Morning Stiffness ◽  
Task Force ◽  
Inactive Disease ◽  
Treat To Target ◽  
French Society ◽  
Cross Sectional Survey ◽  
Axial Pain ◽  
A Priority

Background:Treat-to-target in axial spondyloarthritis (axSpA) aims to achieve and maintain clinical remission/inactive disease or alternatively, low disease activity [1]. However, there is no consensual definition of remission in axSpA: the T2T international task force has proposed Ankylosing Spondylitis Disease Activity Score (ASDAS) inactive disease, but this definition is not widely accepted [1, 2].Objectives:To explore rheumatologists’ perception of remission in axSpA, using vignette cases and a priority exercise.Methods:A steering group of 7 rheumatologists designed a national cross-sectional survey during two face-to-face meetings in 2019-2020. The survey comprised 36 vignette cases: fixed elements included the clinical picture (34 year-old-male with confirmed axSpA, normal C-reactive protein (CRP), without synovitis, enthesitis, dactylitis or extra-articular manifestations) and there were 3 varying parameters (axial pain (0-10) [ranging 2 to 5], fatigue (0-10) [2 to 8], and morning stiffness [<15 minutes, 30 minutes or 1 hour]. For each vignette, the rheumatologist answered binarily: “do you consider this patient in remission: yes/no”. The second part of the survey comprised a priority rating (0-10 priority and 4 top items) of elements important to consider for remission, from a list of 12 items (BASDAI, ASDAS, elements of BASDAI and ASDAS including CRP, NSAIDs use, extra-articular manifestations, and other explanations for the symptoms e.g., fibromyalgia). The analysis was descriptive.Results:Overall, 200 French rheumatologists participated between June and September 2020. Out of 2,400 vignette evaluations (mean of 66 evaluations per vignette), 463 (19%) were classified as remission by rheumatologists. Six vignette cases constituted 56% of all remission cases (Figure 1): these comprised a short duration of morning stiffness (<15 minutes), a low VAS axial pain (2 or 3) but with varying levels of VAS fatigue. When the duration of morning stiffness increased from 15 to 30 minutes and VAS axial pain increased from 2-3 to 4-5 independently, classification as remission decreased from 42% to 12% and from 28-33% to 5-11%, respectively. However, when VAS fatigue increased, it impacted less remission.In priority ratings, 4 items were selected as important by 68-75% of rheumatologists: morning stiffness and axial pain (both included in the vignettes), as well as extra-articular manifestations and NSAID use, whereas only 18% selected fatigue. BASDAI was cited as the 1st priority criteria by 24% of rheumatologists and ASDAS as the 2nd by 16% of rheumatologists.Figure 1.Frequencies of the declared remission states by rheumatologists for each of the 36 vignette casesConclusion:Morning stiffness, axial pain, NSAIDs use, and extra-articular manifestations seem to impact the physicians’ perception of remission in axSpA, whereas fatigue has less impact on remission for rheumatologists. Consensus is needed on remission in axSpA.References:[1Smolen JS et al. Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force. Ann Rheum Dis 2018;77:3–17.[2]Wendling D et al. 2018 update of French Society for Rheumatology (SFR) recommendations about the everyday management of patients with spondyloarthritis. Joint Bone Spine 2018;85:275–84.Funding:This study was funded and organized by Novartis FranceDisclosure of Interests:Krystel Aouad: None declared, Daniel Wendling: None declared, Anne BAGLIN Employee of: Novartis, Maxime Breban: None declared, sabrina DADOUN: None declared, Christophe Hudry: None declared, Anna Moltó: None declared, Edouard Pertuiset: None declared, Laure Gossec: None declared

scholarly journals SAT0362 ASSOCIATION OF GUT DYSBIOSIS WITH STRUCTURAL DAMAGE AND ACTIVITY IN AXIAL SPONDYLOARTHRITIS PATIENTS. DATA FROM THE COSPAR REGISTRY.

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1128.2-1128
Author(s):  
G. G. Ignacio ◽  
I. Moreno-Indias ◽  
M. D. C. Castro Villegas ◽  
M. D. C. Abalos-Aguilera ◽  
M. Ladehesa Pineda ◽  
...  
Keyword(s):  
Gut Microbiota ◽  
Disease Activity ◽  
Structural Damage ◽  
Axial Spondyloarthritis ◽  
Alpha Diversity ◽  
Cross Sectional Study ◽  
X Rays ◽  
Research Support ◽  
Cross Sectional ◽  
Positive Correlation

Background:The etiopathogenesis of axial spondyloarthritis (AxSpA) is multifactorial. The possible role of alteration in gut microbiome (dysbiosis) has been recently suggested. However, the association of dysbiosis with structural damage is still unknown and further studies are needed to assess its association with disease activity.Objectives:To determine the alterations in the gut microbiota in AxSpA patients. To evaluate whether changes in the gut microbiota in AxSpA patients are associated with structural damage or disease activity.Methods:Fifteen AxSpA patients and 15 healthy donors (HDs) were included in a cross-sectional study. Disease activity variables such as C-reactive protein and ESR were measured. Structural damage was determined by lateral X-rays of the cervical and lumbar spine to establish the mSASSS index. Axial mobility was evaluated using the BASMI index and the enthesis affectation was evaluated using ultrasound to obtain the MASEI index. Gut microbiota was measured using the Ion Torrent S5 platform and sequences were processed using the QIIME2. Chi-square and Mann-Whitney U were used, and correlations were determined using the Spearman Rho test. Significant differences were considered p <0.05.Results:Alpha diversity indicators, such as the number of observed OTUs group and the faith index, showed a greater richness in AxSpA compared to HDs (p=0.03 and p=0.01). A significant decrease in family Bacteroidaceae (p=0.006) and an increase in families Synergistaceae and Bifidobacteriaceae were found in the microbiota of AxSpA (p=0.036, p=0.049). According to genera, Bacteroides decreased in AxSpA (p=0.006), while Dialister and Bifidobacterium increased (p=0.010 and p=0.046). Positive correlation among lumbar mSASSS (r=0.508, p=0.019) and Synergistaceae was found. This family was also increased along with the increase in enthesis damage (MASEI index (r=0.656, p=0.028)) and axial mobility by the BASMI index (r=0.529, p=0.011). Correlation studies between the decrease in Bacteroidaceae and Bacteroides with disease activity measured by ASDAS (r=-0.697, p=0.025; r=-0.770, p=0.009) was also significant. Positive correlation was observed between Dialister with mSASSS (r=0.549, p=0.010) and BASMI (r=0.512, p=0.015).Conclusion:1) AxSpA patients had a significant alteration of the gut microbiota. 2) These alterations are associated with radiographic damage, disease activity, affectation of enthesis and axial mobility.Acknowledgments:PRL, supported by “Sara Borrell” (CD19/00216), IMI supported by “Miguel Servet tipo I” (CP16/00163), CGR supported by JdC Incorporación (IJCI-2017-33065). This work is supported by JA PI-0151-2018. Pablo Rodríguez Bada metagenomic platform CIBER-IBIMA.Disclosure of Interests:Gómez García Ignacio: None declared, Isabel Moreno-Indias: None declared, María del Carmen Castro Villegas: None declared, Maria del Carmen Abalos-Aguilera: None declared, MLourdes Ladehesa Pineda: None declared, Inmaculada Concepcion Aranda-Valera: None declared, Carolina Gutierrez Repiso: None declared, Alejandro Escudero Contreras Grant/research support from: ROCHE and Pfizer, Speakers bureau: ROCHE, Lilly, Bristol and Celgene., Jiménez Gómez Yolanda: None declared, Nuria Barbarroja: None declared, Francisco Jose Tinahones: None declared, Eduardo Collantes Estevez Grant/research support from: ROCHE and Pfizer, Speakers bureau: ROCHE, Lilly, Bristol and Celgene, Patricia Ruiz-Limon: None declared

scholarly journals Treatment decision-making in men with localized prostate cancer living in remote area: A cross-sectional observational study

2020 ◽  
Vol 15 (3) ◽  
Author(s):  
Abir El-Haouly ◽  
Alice Dragomir ◽  
Hares El-Rami ◽  
Frédéric Liandier ◽  
Anaïs Lacasse
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Multiple Logistic Regression Analysis ◽  
Treatment Decision ◽  
Treatment Choice ◽  
Localized Prostate Cancer ◽  
Cancer Stage ◽  
Cross Sectional ◽  
Remote Areas ◽  
Treatment Decision Making

Introduction: For the management of localized prostate cancer, patient treatment choice is poorly documented among people living in remote areas where access to certain treatments offered in large centres involves travelling several hundred kilometres. This study aimed to describe and identify the determinants of treatment decision-making in men with localized prostate cancer living in remote areas. Methods: In this cross-sectional study, patients with prostate cancer were recruited from Rouyn-Noranda’s urology clinic (Quebec, Canada) between 2017 and 2019. Results: A total of 127 men (mean age 68.34±7.23 years) constituted the study sample. Radiotherapy, a treatment not available locally, was chosen most frequently (67.7%), followed by options available locally, such as surgery (22.8%) and active surveillance (9.4%). Most patients preferred to play an active role in this choice (53.5%) and agreed with the statement, “I chose that treatment because it gives the best chance for a cure” (86.6%). Multiple logistic regression analysis revealed that cancer stage (odds ratio [OR] 10.15; 95% confidence interval [CI] 3.18–32.40) was the only factor associated with radiotherapy choice (patients with lower stage cancer were more likely to choose radiotherapy). The socioeconomic status was not associated with treatment choice. Conclusions: While radiotherapy was not available locally, it was the most frequently chosen treatment, even though the available literature suggests that no one treatment option is superior in terms of cancer control. The choice of radiotherapy is not associated with patient income, but rather the cancer stage. This result could be explained by the patients’ desire to avoid surgery and its adverse effects.

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