Patient choice of breast cancer treatment: impact on health state preferences.
BACKGROUND
Multiple treatment options exist for many medical conditions. The extent to which physicians should involve the patient in the choice the treatment to be delivered is not well understood.


OBJECTIVE
To test the impact of breast cancer treatment choice on patients' health state preferences.


METHODS
A cohort from 29 hospitals (primarily referral centers) in Massachusetts, Texas, Washington DC, and New York. Subjects were surveyed at 5 months, 1 year, and 2 years following surgery and asked whether they had a choice in the type of treatment received.


METHODS
Women age 67 or older treated in 1996 to 1997 for localized breast cancer (n = 683).


METHODS
Patient preferences for current health state, assessed with patient valuations using the visual analogue scale (VAS) from the EuroQol instrument and with general public valuations using the Health Utilities Index (HUI), and 1-year medical costs.


RESULTS
For the adjusted analysis at 5 months, the adjusted mean VAS score was 78.7 for women who reported a choice and 75.3 for women who reported no choice, a difference of 3.4 (P = 0.03). The difference in the HUI score was 3.6 (P= 0.10) and the difference in the 1-year medical costs was -4363 dollars (P = 0.01). There were no statistically significant differences at the 1-year and 2-year interviews.


CONCLUSIONS
A woman's perception of choice of surgical treatment for breast cancer is associated with a short-term benefit on her preference of health state, suggesting choice helps with recovery, but does not provide long-term benefits.
Polsky
Daniel
D
Division of General Internal Medicine, Department of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA. polsky@mail.med.upenn.edu
Keating
Nancy L
NL
Weeks
Jane C
JC
Schulman
Kevin A
KA
D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000601:surgery*; D016009:Chi-Square Distribution; D002755:Choice Behavior; D015331:Cohort Studies; D005260:Female; D006304:Health Status; D006801:Humans; D015411:Mastectomy, Modified Radical; D015412:Mastectomy, Segmental; D010358:Patient Participation; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D012044:Regression Analysis