Patients' preferences for adjuvant chemotherapy in early breast cancer: what makes AC and CMF worthwhile now?
BACKGROUND
Studies of women who had adjuvant chemotherapy for early breast cancer 10-20 years ago showed that many judged small benefits sufficient to make it worthwhile. Indications, regimens and supportive care have changed. We sought the preferences of contemporary women who received similar chemotherapy.


METHODS
Ninety-seven consecutive consenting women who completed adjuvant chemotherapy for early breast cancer 3-34 months previously were interviewed. Preferences were elicited with a structured, scripted interview using the trade-off method. Women were presented with four hypothetical scenarios based on known life expectancies (5 and 15 years) and survival rates (65% and 85% at 5 years) without adjuvant chemotherapy.


RESULTS
Improvements of an additional year in life expectancy or 3% in survival rates were judged sufficient to make adjuvant chemotherapy worthwhile by 68-84% of women. Half the women judged 1 day or 0.1% sufficient to make adjuvant chemotherapy worthwhile. Recollections of better well-being during adjuvant chemotherapy, having dependants and having a friend or relative who died from cancer were independently associated with judging smaller benefits sufficient to make adjuvant chemotherapy worthwhile (all P < 0.05).


CONCLUSIONS
Preferences were highly variable, but the benefits judged sufficient to make adjuvant chemotherapy worthwhile were even smaller than those found in previous studies. Preferences were influenced by factors other than direct benefits and harms of chemotherapy.
Duric
V M
VM
NHMRC Clinical Trials Centre, University of Sydney,Camperdown, NSW 2050, Australia.
Stockler
M R
MR
Heritier
S
S
Boyle
F
F
Beith
J
J
Sullivan
A
A
Wilcken
N
N
Coates
A S
AS
Simes
R J
RJ
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000523:psychology; D017024:Chemotherapy, Adjuvant; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D008017:Life Expectancy; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D017060:Patient Satisfaction; D011379:Prognosis; D012307:Risk Factors; D011795:Surveys and Questionnaires; D015996:Survival Rate
D004317:Doxorubicin; D003520:Cyclophosphamide; D005472:Fluorouracil; D008727:Methotrexate