title: Patients' preference for radiotherapy fractionation schedule in the palliation of symptomatic unresectable lung cancer.
abstract: The palliative radiotherapeutic management of unresectable non-small-cell lung cancer is controversial, with various fractionation (Fx) schedules available. We aimed to determine patient's choice of Fx schedule after involvement in a decision-making process using a decision board. A decision board outlining the various advantages and disadvantages apparent in the Medical Research Council study of Fx schedules (17 Gy in two fractions vs 39 Gy in 13 fractions) was discussed with patients who met Medical Research Council eligibility criteria. Patients were then asked to indicate their preferred Fx schedules, reasons and their level of satisfaction with being involved in the decision-making process. Radiation oncologists (RO) could prescribe radiotherapy schedules irrespective of patients' preferences. Of 92 patients enrolled, 55% chose the longer schedule. English-speaking patients were significantly more likely to choose the longer schedule (P = 0.02, 95% confidence interval: 1.2-7.6). Longer Fx was chosen because of longer survival (90%) and better local control (12%). Shorter Fx was chosen for shorter overall treatment duration (80%), cost (61%) and better symptom control (20%). In all, 56% of patients choosing the shorter schedule had their treatment altered by the treating RO, whereas only 4% of patients choosing longer Fx had their treatment altered (P < 0.001). Despite this, all (100%) patients were satisfied with being involved in the decision-making process. The decision board was useful in aiding decision-making, with both Fx schedules being acceptable to patients. Interestingly, despite the longer average survival associated with longer Fx, nearly half of the patients believed that this was not as important as a shorter duration of treatment and lower cost. Despite patients' preferences, there were significant alterations of preferred schedules because of RO's own biases.
authors.affiliation: Department of Radiation Oncology, The Cancer Institute, National University Hospital, Singapore. jtih@hotmail.com
authors.forename: J I
authors.initials: JI
authors.lastname: Tang
authors.forename: T P
authors.initials: TP
authors.lastname: Shakespeare
authors.forename: J J
authors.initials: JJ
authors.lastname: Lu
authors.forename: Y H
authors.initials: YH
authors.lastname: Chan
authors.forename: K M
authors.initials: KM
authors.lastname: Lee
authors.forename: L C
authors.initials: LC
authors.lastname: Wong
authors.forename: R K
authors.initials: RK
authors.lastname: Mukherjee
authors.forename: M F
authors.initials: MF
authors.lastname: Back
mesh_terms: D000368:Aged; D001071:Appointments and Schedules; D002289:Carcinoma, Non-Small-Cell Lung / Q000453:epidemiology* / Q000532:radiotherapy* / Q000601:surgery; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000532:radiotherapy* / Q000601:surgery; D008297:Male; D010166:Palliative Care / Q000706:statistics & numerical data*; D010358:Patient Participation / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D012846:Singapore / Q000453:epidemiology