title: Chemotherapy use and patient treatment preferences in advanced colorectal cancer: a prospective cohort study.
abstract: BACKGROUND
  The objective of this study was to determine how patient preferences guide the course of palliative chemotherapy for advanced colorectal cancer.
  
  
  METHODS
  Eligible patients with metastatic colorectal cancer (mCRC) were enrolled nationwide in a prospective, population-based cohort study. Data were obtained through medical record abstraction and patient surveys. Logistic regression analysis was used to evaluate patient characteristics associated with visiting medical oncology and receiving chemotherapy and patient characteristics, beliefs, and preferences associated with receiving >1 line of chemotherapy and receiving combination chemotherapy.
  
  
  RESULTS
  Among 702 patients with mCRC, 91% consulted a medical oncologist; and among those, 82% received chemotherapy. Patients ages 65 to 75 years and aged ≥75 years were less likely to visit an oncologist, as were patients who were too sick to complete their own survey. In adjusted analyses, patients aged ≥75 years who had moderate or severe comorbidity were less likely to receive chemotherapy, as were patients who were too sick to complete their own survey. Patients received chemotherapy even if they believed that chemotherapy would not extend their life (90%) or that chemotherapy would not likely help with cancer-related problems (89%), or patients preferred treatment focusing on comfort even if it meant not living as long (90%). Older patients were less likely to receive combination first-line therapy. Patient preferences and beliefs were not associated with receipt of >1 line of chemotherapy or combination chemotherapy.
  
  
  CONCLUSIONS
  The majority of patients received chemotherapy even if they expressed negative or marginal preferences or beliefs regarding chemotherapy. Patient preferences and beliefs were not associated with the intensity or number of chemotherapy regimens.
authors.affiliation: Duke Cancer Institute, Durham, North Carolina 27710, USA. yousuf.zafar@duke.edu
authors.forename: S Yousuf
authors.initials: SY
authors.lastname: Zafar
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Malin
authors.forename: Steven C
authors.initials: SC
authors.lastname: Grambow
authors.forename: David H
authors.initials: DH
authors.lastname: Abbott
authors.forename: Jane T
authors.initials: JT
authors.lastname: Kolimaga
authors.forename: Leah L
authors.initials: LL
authors.lastname: Zullig
authors.forename: Jane C
authors.initials: JC
authors.lastname: Weeks
authors.forename: John Z
authors.initials: JZ
authors.lastname: Ayanian
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Kahn
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Ganz
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Catalano
authors.forename: Dee W
authors.initials: DW
authors.lastname: West
authors.forename: Dawn
authors.initials: D
authors.lastname: Provenzale
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D003625:Data Collection; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008495:Medical Oncology; D010166:Palliative Care; D057240:Patient Preference; D011446:Prospective Studies