title: Do patients consider preoperative chemoradiation for primary rectal cancer worthwhile?
abstract: BACKGROUND
  The objective of this study was to elicit future patients' preferences for preoperative chemoradiation (pre-CRT) for rectal cancer to determine whether patients' preferences are consistent with current treatment guidelines.
  
  
  METHODS
  During a standardized interview, the treatment protocol, risks, benefits, and long-term outcomes associated with 1) surgery alone (SA) and 2) pre-CRT followed by surgery (CR + S) were described to healthy individuals, and a threshold task was performed. Each participant was asked which treatment option they would prefer when the risk of local recurrence was set initially at 15% for both options. If the participant indicated SA (which was expected), then the risk of local recurrence for CR + S was lowered systematically until the participant's preference changed from SA to CR + S. This threshold point represented the risk of local recurrence for pre-CRT that the participant would require before they would choose treatment with pre-CRT.
  
  
  RESULTS
  Fifty individuals participated in the study, and the majority were well educated. Twenty-seven of 50 participants (54%) required a risk of local recurrence with CR + S of ≤ 5% (ie, equivalent to an absolute risk reduction ≥ 10%) before they would choose treatment with pre-CRT. Regression analysis did not identify any variables that were predictive of the participants' preferences.
  
  
  CONCLUSIONS
  Participants seemed to highly value functional outcomes and seemed willing to accept a higher risk of local recurrence to achieve this. Therefore, developers of future guidelines may need to downgrade the use of pre-CRT for all patients with stage II/III tumors from a guideline to an option.
authors.affiliation: Division of General Surgery, Toronto General Hospital and Toronto General Research Institute, Toronto, Ontario, Canada. ekennedy@mtsinai.on.ca
authors.forename: Erin D
authors.initials: ED
authors.lastname: Kennedy
authors.forename: Selina
authors.initials: S
authors.lastname: Schmocker
authors.forename: Charles
authors.initials: C
authors.lastname: Victor
authors.forename: Nancy N
authors.initials: NN
authors.lastname: Baxter
authors.forename: John
authors.initials: J
authors.lastname: Kim
authors.forename: James
authors.initials: J
authors.lastname: Brierley
authors.forename: Robin S
authors.initials: RS
authors.lastname: McLeod
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D057240:Patient Preference; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome