title: Patient preferences for the chemoprevention of esophageal adenocarcinoma in Barrett's esophagus.
abstract: OBJECTIVE
  Although evidence suggests that aspirin and celecoxib may reduce the risk of esophageal adenocarcinoma (EAC) in patients with Barrett's esophagus (BE), these drugs can also cause harmful side effects. Our aim was to determine and characterize preferences for these two drugs in patients with BE.
  
  
  METHODS
  Preferences data were collected from recruited BE patients using a customized questionnaire, which incorporated standard risk communication techniques. Summary profiles outlined the benefits and harms of celecoxib and aspirin presented anonymously. Both drugs were portrayed as reducing the risk of EAC and increasing the risk of GI events. However, celecoxib increased the risk of myocardial infarction (MI) while aspirin reduced the risk. Factors influencing patient acceptance of each drug were analyzed.
  
  
  RESULTS
  One hundred of 109 (92%) subjects completed the study. Under base case conditions, 15% stated that they would take celecoxib and 76% aspirin (P < 0.0001). Patients identified the greater risk of MI as the primary reason for their unwillingness to take celecoxib and the lower risk of EAC for aspirin. Even in scenarios in which the benefits of celecoxib were improved and the harms reduced, a majority continued to find it unacceptable.
  
  
  CONCLUSIONS
  A majority of those surveyed stated that they would take aspirin but would not take celecoxib. Most patients are interested in EAC chemoprevention, but the amount of protection and the side effect profile of a drug determine its acceptability. These data can inform physicians regarding the tradeoffs patients are willing to consider for chemoprevention.
authors.affiliation: Gastrointestinal Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Chin
authors.initials: C
authors.lastname: Hur
authors.forename: Darcy E
authors.initials: DE
authors.lastname: Broughton
authors.forename: Elissa
authors.initials: E
authors.lastname: Ozanne
authors.forename: Patrick
authors.initials: P
authors.lastname: Yachimski
authors.forename: Norman S
authors.initials: NS
authors.lastname: Nishioka
authors.forename: G Scott
authors.initials: GS
authors.lastname: Gazelle
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000517:prevention & control*; D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use*; D001471:Barrett Esophagus / Q000188:drug therapy* / Q000473:pathology; D002318:Cardiovascular Diseases / Q000517:prevention & control; D000068579:Celecoxib; D018890:Chemoprevention / Q000379:methods; D016861:Cyclooxygenase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D018450:Disease Progression; D004359:Drug Therapy, Combination; D004938:Esophageal Neoplasms / Q000473:pathology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011230:Precancerous Conditions; D011720:Pyrazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D012307:Risk Factors; D013449:Sulfonamides / Q000008:administration & dosage / Q000627:therapeutic use*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D016861:Cyclooxygenase Inhibitors; D011720:Pyrazoles; D013449:Sulfonamides; D000068579:Celecoxib; D001241:Aspirin
references.citation: Heart. 2001 Mar;85(3):265-71
references.pmid: 11179262
references.citation: Postgrad Med. 1999 Mar;105(3):100-2, 105-8, 110
references.pmid: 10086036
references.citation: N Engl J Med. 2006 Aug 31;355(9):873-84
references.pmid: 16943400
references.citation: Ann Intern Med. 2002 Jan 15;136(2):161-72
references.pmid: 11790072
references.citation: Gastroenterology. 2003 Jan;124(1):47-56
references.pmid: 12512029
references.citation: Gastroenterology. 2002 Apr;122(4):1101-12
references.pmid: 11910360
references.citation: Ann Intern Med. 2005 Feb 1;142(3):157-64
references.pmid: 15684203
references.citation: J Natl Cancer Inst. 2007 Apr 4;99(7):545-57
references.pmid: 17405999
references.citation: N Engl J Med. 1989 Jul 20;321(3):129-35
references.pmid: 2664509
references.citation: Gastroenterology. 2000 Aug;119(2):333-8
references.pmid: 10930368
references.citation: Gastroenterology. 2005 Aug;129(2):429-36
references.pmid: 16083700
references.citation: BMJ. 2002 Apr 6;324(7341):827-30
references.pmid: 11934777
references.citation: J Gen Intern Med. 1993 Oct;8(10):543-8
references.pmid: 8271086
references.citation: JAMA. 1999 Nov 24;282(20):1921-8
references.pmid: 10580457
references.citation: Cancer Epidemiol Biomarkers Prev. 1998 Feb;7(2):97-102
references.pmid: 9488582
references.citation: BMJ. 2002 Sep 21;325(7365):619
references.pmid: 12242171
references.citation: BMJ. 2006 Jun 3;332(7553):1302-8
references.pmid: 16740558
references.citation: Ann Intern Med. 2006 Mar 7;144(5):326-36
references.pmid: 16520473
references.citation: J Natl Cancer Inst. 1998 Sep 16;90(18):1371-88
references.pmid: 9747868
references.citation: Med Decis Making. 2002 Nov-Dec;22(6):464-74
references.pmid: 12458976
references.citation: Cancer. 2004 Jul 1;101(1):189-97
references.pmid: 15222006
references.citation: Dis Esophagus. 2007;20(3):265-8
references.pmid: 17509125
references.citation: J Natl Cancer Inst. 2002 Mar 20;94(6):422-9
references.pmid: 11904314
references.citation: Stroke. 2006 Feb;37(2):345-50
references.pmid: 16397184
references.citation: J Natl Cancer Inst. 2004 Feb 18;96(4):316-25
references.pmid: 14970280
references.citation: Lancet. 1999 Jan 9;353(9147):89-92
references.pmid: 10023892
references.citation: Gastroenterology. 2003 Jun;124(7):1758-66
references.pmid: 12806608
references.citation: N Engl J Med. 2002 Jun 27;346(26):2033-8
references.pmid: 12087138
references.citation: N Engl J Med. 2006 Aug 31;355(9):885-95
references.pmid: 16943401