title: What survival benefits do premenopausal patients with early breast cancer need to make endocrine therapy worthwhile?
abstract: BACKGROUND
  Adjuvant endocrine therapies such as tamoxifen, goserelin, and oophorectomy improve survival for premenopausal women diagnosed with early-stage breast cancer. However, these treatments often result in menopausal symptoms, sexual dysfunction, permanent infertility, or the need to delay pregnancy. We aimed to quantify the survival gains that premenopausal patients with early-stage breast cancer require to justify the side-effects and inconvenience of adjuvant endocrine treatments.
  
  
  METHODS
  Participants consisted of 102 women who had been diagnosed with early-stage (stage I-II) breast cancer 6-60 months previously, who were aged 40 years or younger at diagnosis, and who had been treated for a minimum of 3 months with endocrine therapy (67 with tamoxifen alone, seven with goserelin alone, and 28 with tamoxifen and goserelin or oophorectomy). 76 patients also received chemotherapy, and 75 received radiotherapy. Participants attended a face-to-face patient-preference interview, in which they were presented with four hypothetical clinical scenarios that were used to quantify the gains in survival rate and life expectancy that women judged necessary to make their endocrine therapy worthwhile. They also completed a questionnaire on standard psychological measures.
  
  
  RESULTS
  About half of participants thought that adjuvant endocrine therapy was worthwhile for an absolute gain in survival of 2% from a baseline of either 65% or 85%, and for a gain in life expectancy of 3 months from a baseline of 5 years and of 6 months for a baseline of 15 years. Women who had had more severe endocrine side-effects required larger gains to make endocrine therapy worthwhile (univariate p=0.02, multivariate p=0.04).
  
  
  CONCLUSIONS
  Modest gains in survival are sufficient to make adjuvant endocrine treatment worthwhile for premenopausal women with early-stage breast cancer. Knowing and incorporating what women think should enhance shared decision-making.
authors.affiliation: Prince of Wales Hospital, Randwick, Sydney, Australia. b.thewes@unsw.edu.au
authors.forename: Belinda
authors.initials: B
authors.lastname: Thewes
authors.forename: Bettina
authors.initials: B
authors.lastname: Meiser
authors.forename: Vlatka M
authors.initials: VM
authors.lastname: Duric
authors.forename: Martin R
authors.initials: MR
authors.lastname: Stockler
authors.forename: Alan
authors.initials: A
authors.lastname: Taylor
authors.forename: Robin
authors.initials: R
authors.lastname: Stuart-Harris
authors.forename: Matthew
authors.initials: M
authors.lastname: Links
authors.forename: Nicholas
authors.initials: N
authors.lastname: Wilcken
authors.forename: Sue Anne
authors.initials: SA
authors.lastname: McLachlan
authors.forename: Kelly-Anne
authors.initials: KA
authors.lastname: Phillips
authors.forename: Jane
authors.initials: J
authors.lastname: Beith
authors.forename: Frances
authors.initials: F
authors.lastname: Boyle
authors.forename: Michael L
authors.initials: ML
authors.lastname: Friedlander
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003657:Decision Making; D005260:Female; D017273:Goserelin / Q000627:therapeutic use*; D006801:Humans; D010052:Ovariectomy; D017060:Patient Satisfaction; D017697:Premenopause; D011379:Prognosis; D016019:Survival Analysis; D013629:Tamoxifen / Q000627:therapeutic use*
chemical_list: D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen; D017273:Goserelin