title: Psychosocial factors and patients' preferences for adjuvant chemotherapy in early breast cancer.
abstract: OBJECTIVE
  Many women who have had adjuvant chemotherapy for early breast cancer judge small benefits sufficient to make it worthwhile despite significant side effects and inconvenience. The rationality of these preferences has been questioned. We sought to better understand such preferences by assessing associations between preferences and psychosocial factors, and by asking women who judged negligible benefits sufficient to explain why.
  
  
  METHODS
  We recruited 83 consecutive consenting women who had completed adjuvant chemotherapy for early breast cancer 3-34 months earlier. Preferences were elicited during a structured, scripted interview using four sets of validated, hypothetical trade-off scenarios about the possible benefits of adjuvant chemotherapy on survival times (5 and 15 years) and rates (65 and 85% at 5 years). Women completed questionnaires measuring anxiety, depression, optimism, quality and quantity of social support, and illness perceptions.
  
  
  RESULTS
  More than half the women judged benefits of 1 day or 0.1% sufficient to make adjuvant chemotherapy worthwhile. The most important factors in multivariable models were whether the woman had dependants and number of non-specific symptoms attributed to breast cancer and adjuvant chemotherapy since completing treatment. The proportion of variance explained was modest. Preferences were not associated with: scores for anxiety, optimism, and perceived quality and quantity of social support. Explanations for judging negligible benefits sufficient included minimising regret, parenting concerns, doubts about the information provided and feeling that they had no choice.
  
  
  CONCLUSIONS
  Preferences were highly variable and influenced by women's unique circumstances and attitudes, but not by their anxiety or optimism scores.
authors.affiliation: NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia. vlatka@ctc.usyd.edu.au
authors.forename: Vlatka M
authors.initials: VM
authors.lastname: Duric
authors.forename: Phyllis N
authors.initials: PN
authors.lastname: Butow
authors.forename: Louise
authors.initials: L
authors.lastname: Sharpe
authors.forename: Frances
authors.initials: F
authors.lastname: Boyle
authors.forename: Jane
authors.initials: J
authors.lastname: Beith
authors.forename: Nicholas R C
authors.initials: NR
authors.lastname: Wilcken
authors.forename: Stephane
authors.initials: S
authors.lastname: Heritier
authors.forename: Alan S
authors.initials: AS
authors.lastname: Coates
authors.forename: R
authors.initials: R
authors.lastname: John Simes
authors.forename: Martin R
authors.initials: MR
authors.lastname: Stockler
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001007:Anxiety; D001943:Breast Neoplasms / Q000188:drug therapy / Q000523:psychology*; D017024:Chemotherapy, Adjuvant / Q000523:psychology*; D002755:Choice Behavior; D005260:Female; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D012944:Social Support; D011795:Surveys and Questionnaires