title: Patient preferences for oropharyngeal cancer treatment de-escalation.
abstract: BACKGROUND
  The excellent prognosis of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinomas (SCCs) against severe chemoradiotherapy (CRT) toxicities has opened discussion of deintensification trials. The purpose of this study was to describe the perspective of patients with HPV-positive and HPV-negative disease toward such studies.
  
  
  METHODS
  Fifty-one patients with oropharyngeal SCC (post-CRT) underwent semistructured interviews contrasting toxicities of radiotherapy (RT) alone and CRT. Patients were asked what potential difference in cancer survival was acceptable to prefer RT over CRT. Initially, survival rate was the same for both treatments, then the RT rate was reduced until the preference switched. Treatment experience and preference for deintensified CRT were collected.
  
  
  RESULTS
  Ninety-percent of patients initially selected RT, but 69% switched to CRT after 0% to 5% reduction in survival. Patients that rated their treatment experience as mild would accept lower survival versus severe treatment (p = .02). Eighty-one percent of patients (33 of 40) indicated they preferred reduced chemotherapy in CRT.
  
  
  CONCLUSIONS
  Patients accept little difference in survival between treatments to avoid toxicity.
authors.affiliation: Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Drew C
authors.initials: DC
authors.lastname: Brotherston
authors.forename: Ian
authors.initials: I
authors.lastname: Poon
authors.forename: Tuyen
authors.initials: T
authors.lastname: Le
authors.forename: Martin
authors.initials: M
authors.lastname: Leung
authors.forename: Alex
authors.initials: A
authors.lastname: Kiss
authors.forename: Jolie
authors.initials: J
authors.lastname: Ringash
authors.forename: Judith
authors.initials: J
authors.lastname: Balogh
authors.forename: Justin
authors.initials: J
authors.lastname: Lee
authors.forename: James R
authors.initials: JR
authors.lastname: Wright
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods*; D002945:Cisplatin / Q000008:administration & dosage*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009959:Oropharyngeal Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000628:therapy*; D057240:Patient Preference / Q000706:statistics & numerical data; D011788:Quality of Life; D011832:Radiation Injuries / Q000453:epidemiology / Q000503:physiopathology; D011879:Radiotherapy Dosage; D012044:Regression Analysis; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D002945:Cisplatin