title: Preferences of patients with advanced colorectal cancer for treatment with oral or intravenous chemotherapy.
abstract: BACKGROUND
  In recent years, patient-reported outcomes such as health-related quality of life have become important areas of clinician focus in general cancer management. Patients' preferences for, and/or satisfaction with, oral versus intravenous (IV) chemotherapy schedules may have a major impact on such outcomes.
  
  
  OBJECTIVE
  To evaluate preferences for oral or IV chemotherapy in patients with advanced colorectal cancer.
  
  
  METHODS
  A multicenter, randomized, crossover trial was conducted in 12 hospitals in Southern Italy, in which 22 patients with advanced colorectal cancer received one cycle of oral capecitabine ± irinotecan or oxaliplatin, followed by one cycle of an IV de Gramont or similar regimen (arm A), or the same regimens in reverse order (arm B). Patients were aged 50-70 years and 21% had a higher level of education (graduate or similar). Patients received oral capecitabine 3500 mg/m/day for 7 days (± irinotecan 180 mg/m or oxaliplatin 85 mg/m on day 1 only), followed by an IV de Gramont regimen ± irinotecan (FOLFIRI) or oxaliplatin (FOLFOX); or the two schedules administered in reverse order.The main outcome measure was patients' preferences for oral versus IV chemotherapy, as determined by a pre- and post-treatment therapy preference questionnaire (TPQ).
  
  
  RESULTS
  Before treatment, 75% of patients preferred oral therapy. Characteristics that patients considered to be important were that treatment should not interfere with daily activities (100% of patients) and should not cause fatigue (95%), diarrhea (76%), or painful mouth ulcers (76%); other factors considered important were the risk of infection and nausea (90%), and that treatment could be administered at home (65%). After receiving both chemotherapy schedules, only 45% of patients preferred oral therapy, while 55% preferred IV therapy. Among the latter, the most important characteristics influencing treatment choice were less nausea (66%), fewer mood effects (65%), the safety of hospital IV treatment (62%), less interference with family relationships (55%), less vomiting (55%), less interference with daily activities (50%), and less diarrhea (50%). Although the order in which patients received therapy did not influence treatment preference, significantly fewer patients with a lower rather than higher educational level preferred oral therapy (47% vs 80%; chi-square test = 9.9; p = 0.002).
  
  
  CONCLUSIONS
  These results suggest that there may be a correlation between educational level and the preference of patients with advanced colorectal cancer for oral or IV chemotherapy.
authors.affiliation: 1 Mariano Santo Hospital, Cosenza, Italy 2 Siderno Hospital, Siderno, Italy 3 San Giovanni di Dio Hospital, Crotone, Italy.
authors.forename: Candida M
authors.initials: CM
authors.lastname: Mastroianni
authors.forename: Caterina
authors.initials: C
authors.lastname: Viscomi
authors.forename: Silvia
authors.initials: S
authors.lastname: Ceniti
authors.forename: Rosanna
authors.initials: R
authors.lastname: De Simone
authors.forename: Aldo
authors.initials: A
authors.lastname: Filice
authors.forename: Gennaro
authors.initials: G
authors.lastname: Gadaleta Caldarola
authors.forename: Stefania
authors.initials: S
authors.lastname: Infusino
authors.forename: Caterina
authors.initials: C
authors.lastname: Manfredi
authors.forename: Antonio
authors.initials: A
authors.lastname: Rea
authors.forename: Claudia
authors.initials: C
authors.lastname: Sandomenico
authors.forename: Salvatore
authors.initials: S
authors.lastname: Turano
authors.forename: Francesco
authors.initials: F
authors.lastname: Serranò
authors.forename: Giovanni
authors.initials: G
authors.lastname: Condemi
authors.forename: Carla
authors.initials: C
authors.lastname: Cortese
authors.forename: Tullia
authors.initials: T
authors.lastname: Prantera
authors.forename: Salvatore
authors.initials: S
authors.lastname: Palazzo