Patient Perspectives of Quality Compared to Quantity of Life Regarding Orbital Exenteration.

Abstract

Orbital exenteration (OE) impacts patients cosmetically, functionally, and psychosocially. Eye-sparing strategies with the advent of immunotherapy have developed the potential to avoid OE but may result in suboptimal oncologic outcomes and reduced survival. This study assesses patients' perceptions regarding quantity versus quality of life when considering OE compared to alternative treatment modalities. Mixed-methods study, utilizing quantitative health utility tasks and qualitative patient interviews. Tertiary care center. Fifty-one patients previously treated for head or neck cutaneous malignancies completed interviews utilizing well-established methodology to assess health state utility values (HSUVs) through time trade-off and standard gamble tasks. This methodology assessed the level of risk patients would be willing to accept to avoid OE in the context of alternate treatment options. Open-ended discussions regarding factors influencing decision-making facilitated an inductive qualitative analysis highlighting patient priorities. Patients were willing to accept 40.6% ± 28.7% risk of death or give up 3.2 ± 2.8 years of survival to avoid OE. This translated to an HSUV for OE of 0.68. The main factors influencing treatment decisions were (1) family, (2) healthcare perceptions, (3) age, (4) social consequences, and (5) risk tolerance. The consequences of OE on patients' quality of life impact their decision-making. Patients may be willing to accept relatively high levels of risk to avoid OE. This highlights the importance of eye-sparing strategies and shared decision-making to ensure patient-centered care, which may not be solely prioritized to survival when it comes to OE.