Patients’ preferences for adjuvant chemotherapy in early-stage breast cancer: is treatment worthwhile?

Abstract

SummaryWhen making decisions about adjuvant chemotherapy for early-stage breast cancer, costs and benefits of treatment should be carefully weighed. In this process, patients' preferences are of major importance. The objectives of the present study were: (1) to determine the minimum benefits that patients need to find chemotherapy acceptable, and (2) to explore potential preference determinants, namely: positive experience of the treatment, reconciliation with the treatment decision, and demographic variables. Preferences were elicited from patients scheduled for adjuvant chemotherapy (chemotherapy group: n = 38) before (T 1 ), during (T 2 ), and 1 month after chemotherapy (T 3 ), and were compared to responses from patients not scheduled for chemotherapy (no-chemotherapy group: n = 38). The patients were asked, for a hypothetical situation, to indicate the minimum benefit (in terms of improved 5-year disease-free survival) to find adjuvant chemotherapy acceptable. In the chemotherapy group, the median benefit was 1% at all 3 measurement points. In the no-chemotherapy group the attitude towards chemotherapy became more negative over time, although not statistically significantly so (T 1 : 12%, T 2 : 15%, T 3 : 15%; P = 0.10). At all measurement points, the patients in the chemotherapy group indicated that they would accept chemotherapy for significantly (P < 0.01) less benefit than the patients in the no-chemotherapy group. Of the demographic variables, age was related to preferences, but only at T 2 and only in the no-chemotherapy group. The more positive attitude towards chemotherapy and the stability of preferences in the chemotherapy group indicated that reconciliation with the treatment decision was a more important determinant of patients' preferences than positive experience of the treatment.

Benefit from preoperative radiotherapy in rectal cancer treatment: disease-free patients' and oncologists' preferences

“…We were aware that our retrospective interviews would incorporate the biases generally seen in the literature, but by asking all types of patients, both with and without treatment experience, and with and without symptoms, we wished to obtain an impression of all possible attitudes towards the tradeoffs involved. Patients have been shown to have a strong preference for the therapy they have undergone (Yellen et al, 1994;McQuellon et al, 1995;Stiggelbout et al, 1996;Lindley et al, 1998;Jansen et al, 2001), possibly embracing it psychologically as the best possible for them. Indeed, patients in this study who underwent PRT desired a lower benefit from irradiation than non-irradiated patients.…”

The impact of the perception of treatment choice on satisfaction with treatment, experienced chemotherapy burden and current quality of life

“…All patients will experience the side effects, but only some patients will actually benefit from this treatment. Patients' preferences regarding this trade-off have shown to vary widely (e.g., Jansen et al, 2001) and to differ from the preferences of doctors (e.g., Slevin et al, 1990). Charles et al (1997) stress the importance of shared decision-making in the case of adjuvant chemotherapy, because: (1) several treatment options exist with different possible outcomes and substantial uncertainty, (2) there is often no clear-cut right or wrong answer and (3) the impact of the treatment on the patient's physical and psychological well being will vary.…”

Patients’ preferences for adjuvant endocrine therapy in early breast cancer: what makes it worthwhile?

“…More than half the women who had adjuvant endocrine therapy as part of routine clinical practice judged 2% gain in survival rate or an additional 3 -6 months sufficient to make adjuvant endocrine therapy worthwhile (Thewes et al, 2005). Yet women in this study required larger benefits to make adjuvant endocrine worthwhile than those judged necessary to make chemotherapy worthwhile in comparable studies using almost identical methods (Duric and Stockler, 2001;Jansen et al, 2001;Duric et al, 2005) and larger still than those required by women who had endocrine therapy as part of routine clinical practice (Thewes et al, 2005).…”

“…This is surprising given the widespread perception by healthcare professionals that endocrine therapy has only modest toxicity. Women who have had adjuvant chemotherapy for early breast cancer judge small benefits sufficient to make it worthwhile, despite its significant side effects and inconvenience (Duric and Stockler, 2001;Jansen et al, 2001;Duric et al, 2005). Adjuvant endocrine therapy provides comparable benefits for women with hormone-receptor positive disease, and is generally considered to do so with less severe side effects and less inconvenience.…”

“…Measuring the preferences of patients who have had a treatment gives insights into how they trade-off the treatment's benefits and harms. Many women with early breast cancer judge small benefits sufficient to make adjuvant chemotherapy worthwhile despite its inconvenience and side effects (Duric and Stockler, 2001;Jansen et al, 2001;Duric et al, 2005). The benefits of adjuvant endocrine therapy in women with hormone-receptor positive breast cancer are comparable to those of adjuvant chemotherapy.…”