title: Utility scores and treatment preferences for clinical early-stage cervical cancer.
abstract: OBJECTIVE
  To determine utility scores for health states relevant to the treatment of early-stage, high-risk cervical cancer.
  
  
  METHODS
  Seven descriptive health states incorporating the physical and emotional aspects of medical treatment, recovery, and prognosis were developed. Forty-five female volunteers valuated each health state using the visual analogue score (VAS) and time trade off (TTO) methods. Treatment options were ranked by mean and median TTO scores. The 95% confidence intervals were calculated to determine the statistical significance of ranking preferences. The Wilcoxon rank-sum test was used to compare central tendencies related to age, race, parity, and subject history of abnormal cervical cytology.
  
  
  RESULTS
  VAS and TTO scores were highly correlated. Volunteers ranked minimally invasive radical hysterectomy with low-risk features as most preferred (mean TTO = 0.96; median TTO = 1.00) and aborted radical hysterectomy followed by chemoradiation as least preferred (mean TTO = 0.69; median TTO = 0.83). Health states that included radical surgery were ranked higher than those that included chemoradiation, either in the adjuvant or primary setting. When survival was comparable, volunteers rated radical hysterectomy with high-risk pathology followed by adjuvant chemoradiation (mean TTO = 0.78; median TTO = 0.92; 95% CI: 0.69-0.87) similarly to chemoradiation alone (mean TTO = 0.76; median TTO 0.90; 95% CI: 0.66-0.86; p = NS). Utility scores for the majority of health states were not significantly associated with age, race, parity, or subject history of abnormal cervical cytology.
  
  
  CONCLUSIONS
  Subjects consistently preferred surgical excision to treat early-stage, high-risk cervical cancer and chose a minimally invasive approach. Such utility scores can be used to incorporate quality-of-life effects into comparative-effectiveness models for cervical cancer.
authors.affiliation: Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA. jewelle@mskcc.org
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Jewell
authors.forename: Michael
authors.initials: M
authors.lastname: Smrtka
authors.forename: Gloria
authors.initials: G
authors.lastname: Broadwater
authors.forename: Fidel
authors.initials: F
authors.lastname: Valea
authors.forename: Debra M
authors.initials: DM
authors.lastname: Davis
authors.forename: Kimberly C
authors.initials: KC
authors.lastname: Nolte
authors.forename: Renea
authors.initials: R
authors.lastname: Valea
authors.forename: Evan R
authors.initials: ER
authors.lastname: Myers
authors.forename: Gregory
authors.initials: G
authors.lastname: Samsa
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Havrilesky
mesh_terms: D000328:Adult; D002755:Choice Behavior; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000523:psychology; D009367:Neoplasm Staging; D057240:Patient Preference / Q000523:psychology; D010865:Pilot Projects; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000523:psychology / Q000628:therapy*; D055815:Young Adult