What question did this study set out to answer?

This study aims to identify the key factors influencing decision-making for fertility-sparing surgery in women with early-stage cervical cancer.

June 12, 2026Open Access

Balancing Fertility Potential and Oncological and Obstetric Risks: A Vignette Study on Decision-Making in Fertility Sparing Surgery for Early-Stage Cervical Cancer

JWJ.T. WolswinkelRadboud University Nijmegen ILI. van LentheRadboud University Nijmegen JMJ.S.F. MauritsRadboud University Nijmegen

Puntos clave

This study aims to identify the key factors influencing decision-making for fertility-sparing surgery in women with early-stage cervical cancer.
Vignette-based study conducted in the Netherlands with former patients and gynaecological oncologists.
Participants included 58 patients and 33 gynaecological oncologists, ages 25–42 at surgery between 2014 and 2024.
Preferences were rated on a 5-point Likert scale and analyzed using linear mixed-effects models.
Patients' mean preference score for fertility-sparing surgery was 3.48 (95% CI 3.22-3.74), while oncologists' score was 3.16 (95% CI 2.95-3.36).
An 85% chance of conception increased patients’ preference by 1.07 on the scale, whereas an additional 10% cancer-related death risk decreased oncologist preference by 1.84.
All four vignette attributes significantly influenced decision-making for both patients and clinicians.

Resumen

Objective Fertility-sparing surgery offers the opportunity to preserve fertility but comes with higher oncological and obstetric risks. This study aims to identify key factors influencing decision-making of women with early-stage cervical cancer. Methods We conducted a vignette-based study involving former patients and gynaecological oncologists in the Netherlands. Eligible patients were aged 25–42 years at the time of surgery and underwent radical trachelectomy or radical hysterectomy for early-stage cervical cancer between 2014 and 2024. All Dutch gynaecological oncologists were invited. Four vignette attributes were selected based on literature and patients'- and experts' opinions. Different risk percentages for these attributes were varied in 16 scenarios. Participants rated their preference on a 5-point Likert scale, where 1 indicated a strong preference for hysterectomy and 5 a strong preference for fertility-sparing surgery. Preferences were analysed using linear mixed-effects models. Results A total of 58 out of 205 patients (28.3%) and 33 of 55 gynaecologic oncologists (60%) participated. The mean preference for fertility-sparing surgery across all scenarios was 3.48 (95% Confidence Interval (CI) 3.22 to 3.74) for patients and 3.16 (95% CI 2.95-3.36) for gynaecological oncologists. All four attributes played significant roles in decision-making. For patients, the likelihood of achieving pregnancy was the most influential factor, increasing the preference score by 1.07 (scale 1-5) for an 85% chance of conception. For gynaecological oncologists, an increased risk of cancer related death was the most decisive factor, resulting in a 1.84 decrease (scale 1-5) for a 10% additional risk of death. Conclusion Patients and gynaecological oncologists showed a modest preference for fertility-sparing surgery above hysterectomy. Patients appeared to place relatively greater weight on likelihood of pregnancy and were less deterred than clinicians by hypothetical increases in cancer-related mortality risk. This underscores the importance of thoroughly involving patients in the decision-making process.

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