Patient Perspectives on Systemic Bevacizumab Treatment for Recurrent Respiratory Papillomatosis

Systemic bevacizumab has been shown to reduce the surgical burden of recurrent respiratory papillomatosis (RRP). However, no previous studies have examined specific patient-reported differences in quality-of-life (QoL) between systemic bevacizumab and surgical treatment. This study aimed to assess patient perspectives across two academic medical centers to inform clinical practice and shared decision-making.

A cross-institutional survey was distributed to patients who previously underwent both systemic bevacizumab and surgical treatment for RRP. Participants rated their experiences with each treatment across four domains: QoL, adverse effects, economics, and mental health. Paired responses were compared using the Wilcoxon signed-rank test.

Of 24 patients (mean age 48.3 years) who completed the survey, 18 (75%) were actively receiving systemic bevacizumab treatment. Mean age at RRP diagnosis was 17.1 years, and patients had undergone an average of 91.4 surgeries and 25.1 bevacizumab infusions. Compared with surgery, bevacizumab was associated with significantly improved self-reported voice (p < 0.001), breathing (p < 0.001), and swallowing (p < 0.001), with longer-lasting vocal improvement (p = 0.031), lower pain (p < 0.001), shorter vocal rest (p < 0.001), and fewer side effects (p = 0.002) with each treatment. Although expenditure (p = 0.649) and travel time (p = 0.288) did not differ significantly, patients reported missing fewer days of work (p < 0.001) during bevacizumab infusions. Moreover, optimism (p < 0.001) was greater with decreased fear (p = 0.002) during bevacizumab therapy. Overall, 79% wished to continue receiving bevacizumab treatment, and 83% believed it offered a better QoL.

Systemic bevacizumab improves patient QoL across multiple domains compared with surgical treatment and represents an important step toward more patient-centered care in RRP.

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