Cancer patient preferences for quality and length of life

Abstract

BACKGROUND. Optimal patient decision making requires integration of patient values, goals, and preferences with information received from the physician. In the case of a life‐threatening illness such as cancer, the weights placed on quality of life (QOL) and length of life (LOL) represent critical values. The objective of the current study was to describe cancer patient values regarding QOL and LOL and explore associations with communication preferences. METHODS. Patients with advanced cancer completed a computer‐based survey before the initial consultation with a medical oncologist. Assessments included sociodemographics, physical and mental health state, values regarding quality and length of life, communication preferences, and cancer‐related distress. RESULTS. Among 459 patients with advanced cancer, 55% placed equal valued on QOL and LOL, 27% preferred QOL, and 18% preferred LOL. Patients with a QOL preference had lower levels of cancer‐related distress (P < .001). A QOL preference was also associated with older age (P = .001), male sex (P = .003), and higher educational level (P = .062). Patients who preferred LOL over QOL desired a more supportive and less pessimistic communication style from their oncologists. CONCLUSIONS. These data indicate that a values preference for LOL versus QOL may be simply measured, and is associated with wishes regarding the nature of oncologist communication. Awareness of these values during the clinical encounter could improve decision making by influencing the style and content of the communication between oncologists and their patients. Cancer 2008. © 2008 American Cancer Society.

Healthcare professionals' preferences for surgery or primary endocrine therapy to treat older women with operable breast cancer

“…Increasing age results in rising rates of comorbidity and frailty [2] so tolerance to some standard breast cancer therapies may decrease [3] and older patients may prioritise quality of life over quantity [4]. Consequently, older patients with operable breast cancer may be offered alternative treatment modalities, such as primary endocrine therapy (PET) [5,6], where oestrogen receptor (ER) positive disease is treated with endocrine therapy alone.…”

“…Evidence suggests that elderly patients may prioritise quality of life over quantity [4] and patient choice is commonly stated as a reason for treating patients with PET [10,20]. However, a recent study by Lavelle and colleagues [23] found that lower rates of surgical treatment are unlikely to be due to patient choice and these results suggest that UK HCPs agree with this, believing that patients would not choose non-operative management if given the option.…”

What can Phase I clinical trials tell us about quality of life? A pilot study (MC0115)

“…Meropol et al (2008) indicated if the clinician knows the patient's preferences, communication is improved and distress is lessened, supporting the use of QOL assessments to facilitate communication [23]. Rummans et al (2006) utilized a multi-disciplinary psychosocial intervention, which encouraged patients to communicate needs and results indicated a short-term improvement in overall QOL (p=0.047) and spirituality (p=0.003) [24].…”

Anxiety, depression and pain-related coping behaviors with pain behaviors in cancer patients who are aware or unaware of their cancer

“…These treatment options may include standard therapy or experimental approaches, as well as supportive care. [32] In this case, the patient's preference is important. Bioethics supports incorporating patients in their own medical treatments.…”

“…In studies. [32,[34][35][36] In which patients were asked about their preferences regarding their treatment, the patients whose cancer-related distress was low (such as older patients, male, highly educated and childless patients) preferred quality of life; however, patients who were young and who had a child and a more functional health status preferred the prolongation of life. [34] Instead of trying to protect a patient by not informing him/ her about the cancer diagnosis, we should investigate the ways to inform a patient about his/her cancer diagnosis without causing negative consequences.…”