The use of preferences to measure the benefit of adjuvant radiation therapy for stage I seminoma.
OBJECTIVE
In Stage I seminoma, treatment with radiation therapy (RT) after radical inguinal orchiectomy reduces the likelihood of relapse by 15%, but does not improve survival, thus making quality of life an important outcome measure. The purpose of this study was to use utilities to assess the quality of life benefits associated with adjuvant RT in this setting.


METHODS
One hundred healthy men were interviewed using a utility assessment tool. Utilities for five health states were measured using the standard gamble technique: (A) adjuvant RT with 5% recurrence risk; (B) recurrence after RT, salvaged with chemotherapy; (C) orchiectomy alone with 20% recurrence risk; (D) recurrence after orchiectomy alone, salvaged with RT; and (E) recurrence after orchiectomy alone, salvaged with chemotherapy.


RESULTS
The median age was 25. Utilities were highest for nonrecurrent health states, and lowest for recurrence salvaged with chemotherapy. All differences in utilities between health states were significant, except between states A and C and B and E. Variability in utilities was not explained by the sociodemographic factors examined.


CONCLUSIONS
Our results suggest that healthy males do not value the 15% reduction in recurrence risk achievable with adjuvant RT. However, they do predict that an actual recurrence, especially one requiring salvage chemotherapy, will lead to significant decline in quality of life. We intend to use these utilities to further evaluate the cost-effectiveness of RT in this setting.
Chan
June L
JL
Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI, USA. chanj@umich.edu
Kabeto
Mohammed U
MU
Oldread
A Elizabeth
AE
Paisley
Kerry L
KL
Bennett
Jonathan E
JE
Sandler
Howard M
HM
Smith
David C
DC
Hayman
James A
JA
D000328:Adult; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D012008:Recurrence; D012306:Risk; D018239:Seminoma / Q000532:radiotherapy* / Q000628:therapy; D011795:Surveys and Questionnaires; D013736:Testicular Neoplasms / Q000532:radiotherapy* / Q000628:therapy