title: Differences in attitude toward adjuvant chemotherapy between colorectal cancer survivors and the medical staff of Japanese hospitals.
abstract: BACKGROUND
  Adding oxaliplatin to fluorouracil-based chemotherapy can improve the survival of patients with stage III colorectal cancer by approximately 20 %. Reportedly, cancer patients are much more likely to prefer chemotherapy than medical professionals, although there is only a very small chance of achieving benefits from treatment. However, chronic neurotoxicity may be long lasting after the administration of oxaliplatin-based chemotherapy. This study aimed to evaluate potential side effects and differences in attitude between colorectal cancer patients and medical staff regarding the risk-benefit trade-offs of chemotherapy.
  
  
  METHODS
  Relapse-free colorectal cancer patients who received adjuvant chemotherapy, doctors, and nurses were surveyed using a questionnaire regarding the side effects of chemotherapy and hypothetical clinical scenarios to quantify gains in the risk of relapse that were deemed necessary to make chemotherapy worthwhile.
  
  
  RESULTS
  Responses were obtained from 147 patients, 54 doctors, and 84 nurses. Of these, 39 % of patients and 85 % of doctors replied that moderate side effects of adjuvant chemotherapy were worthwhile to achieve an absolute gain in the risk of relapse of 10 % from a baseline of 40 %. More severe side effects, as reported by colorectal cancer patients, were not associated with the larger gains necessary to make treatment worthwhile. Seven percent of patients treated with oxaliplatin, 40 % of doctors, and 43 % of nurses replied that side effects associated with oxaliplatin-based chemotherapy were severe.
  
  
  CONCLUSIONS
  Doctors should consider potential heterogeneity in side effects and attitudes regarding the risk-benefit balance of adjuvant chemotherapy, and that patient perspectives should enhance shared decision-making.
authors.affiliation: Department of Clinical Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan, yukiya.narita@aichi-cc.jp.
authors.forename: Yukiya
authors.initials: Y
authors.lastname: Narita
authors.forename: Hiroya
authors.initials: H
authors.lastname: Taniguchi
authors.forename: Koji
authors.initials: K
authors.lastname: Komori
authors.forename: Kenya
authors.initials: K
authors.lastname: Kimura
authors.forename: Takashi
authors.initials: T
authors.lastname: Kinoshita
authors.forename: Azusa
authors.initials: A
authors.lastname: Komori
authors.forename: Motoo
authors.initials: M
authors.lastname: Nomura
authors.forename: Shigenori
authors.initials: S
authors.lastname: Kadowaki
authors.forename: Daisuke
authors.initials: D
authors.lastname: Takahari
authors.forename: Takashi
authors.initials: T
authors.lastname: Ura
authors.forename: Masashi
authors.initials: M
authors.lastname: Andoh
authors.forename: Kei
authors.initials: K
authors.lastname: Muro
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects / Q000523:psychology; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000523:psychology*; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology; D008875:Middle Aged; D009726:Nurses / Q000523:psychology; D009944:Organoplatinum Compounds / Q000009:adverse effects* / Q000627:therapeutic use; D000077150:Oxaliplatin; D011379:Prognosis; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin