Journal of Clinical Oncology, Vol 15, 1252-1260, Copyright © 1997 by American Society of Clinical Oncology
Patient preferences concerning the trade-off between the risks and benefits of routine radiation therapy after conservative surgery for early-stage breast cancer
JA Hayman, DL Fairclough, JR Harris and JC Weeks
Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA. hayman@umich.edu
PURPOSE: To assess patients' preferences regarding the trade-off between
risks and benefits of radiation therapy after conservative surgery for
early-stage breast cancer. PATIENTS AND METHODS: Utilities (measures of
preference) of 97 early-stage breast cancer patients treated with
conservative surgery and radiation therapy and 20 medical oncology nurses
were assessed for five health states using standard gambles. RESULTS:
Patients had the highest mean utility for treatment with conservative
surgery and radiation therapy without a local recurrence (0.92),
intermediate utilities for treatment with conservative surgery alone
followed either by no local recurrence or by a local recurrence salvaged by
conservative surgery and radiation therapy (0.88 and 0.87, respectively),
and the lowest utilities for treatment with or without radiation therapy
followed by a local recurrence salvaged by mastectomy and reconstructive
surgery (0.82 and 0.81, respectively). All differences between health
states' utilities were significant (P < .0001), except between the two
intermediate and two lowest rated health states. None of the clinical or
sociodemographic factors examined explained more than 5% of the variability
in the patients' utilities or their differences. Nurses' utilities were
similar to those of the patients. CONCLUSIONS: These results strongly
suggest that fear of a local recurrence and an actual local recurrence
leading to mastectomy have such a negative impact on quality of life that
patients are willing to accept the risks and inconvenience of radiation
therapy to avoid them. There is also considerable interpatient variability
that was not explained by the clinical or sociodemographic factors
examined.
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