Journal of Clinical Oncology, Vol 15, 873-883, Copyright © 1997 by American Society of Clinical Oncology
Decision analysis in locally advanced non-small-cell lung cancer: is it useful?
MD Brundage, PA Groome, D Feldman-Stewart, JR Davidson and WJ Mackillop
Radiation Oncology Research Unit, Ontario Cancer Treatment and Research Foundation and Queen's University, Canada. mbrundage@octrf.on.ca
PURPOSE: The optimal management of locally advanced non-small-cell lung
cancer (NSCLC) has not been established. While combined-modality treatments
have been shown to increase the survival of patients with this illness, the
appropriate balance between the benefit of increased quantity of life and
the quality-of-life costs of the more toxic treatment combinations remains
unresolved. Decision analysis has been promoted as useful when medical
decisions must be made under conditions of uncertainty. We consider the
potential of this method to guide therapy in locally advanced NSCLC.
METHODS: We developed two types of decision models that addressed the
choice between radiation alone and combined chemotherapy-radiation therapy
in locally advanced NSCLC. The models were constructed using the principles
of decision analysis. RESULTS: The models successfully replicated results
of relevant clinical trials published in the literature. The analyses of
both models showed that the treatment decision was sensitive to patients'
values, despite significant increases in survival rates. The models
clarified a need for further validation of the three fundamental
components: structuring the decision, determining the probabilities of
events, and assigning utilities to treatment outcomes. CONCLUSION: In the
setting of NSCLC, the models suggest that quality-of-life considerations
are important in the treatment choice. Further research is required to
identify the health states critical to the decision, the probabilities for
occurrence of these health states, and valid measures of their utility.
