title: Patients' and doctors' preferences for adjuvant chemotherapy in resected non-small-cell lung cancer: What makes it worthwhile?
abstract: BACKGROUND
  Adjuvant chemotherapy (ACT) in non-small-cell lung cancer (NSCLC) improves overall survival, but the benefits must be weighed against its harms. We sought to determine the survival benefits that patients and their doctors judged sufficient to make ACT in NSCLC worthwhile.
  
  
  METHODS
  122 patients completed a self-administered questionnaire at baseline and 6 months (before & after ACT, if they had it); 82 doctors completed the questionnaire once only. The time trade-off method was used to determine the minimum survival benefits judged sufficient in four hypothetical scenarios. Baseline survival times were 3 years & 5 years and baseline survival rates (at 5 years) were 50% & 65%.
  
  
  RESULTS
  At baseline, the median benefits judged sufficient by patients were an extra 9 months (Interquartile range (IQR) 1-12 months) beyond 3 years & 5 years and an extra 5% (IQR 0.1-10%) beyond 50% & 65%. At 6 months (n=91), patients' preferences had the same median benefit (9 months & 5%) but varied more (IQRs 0-18 months & 0-15%) than at baseline. Factors associated with judging smaller benefits sufficient were deciding to have ACT (P=0.01, 0.02) and better well-being (P=0.01, 0.006) during ACT. Doctors' preferences, compared with patients' preferences, had similar median benefits (9 months & 5%) but varied less (IQR 6-12 months versus 1-12 months, P<0.001; 5%-10% versus 0.1-10%, P<0.001).
  
  
  CONCLUSIONS
  Most patients and doctors judged moderate survival benefits sufficient to make ACT in NSCLC worthwhile, but the preferences of doctors varied less than those of patients. Doctors should endeavour to elicit patients' preferences during discussions about ACT in NSCLC.
authors.affiliation: Concord Repatriation General Hospital, Sydney, Australia. Electronic address: prunella.blinman@sswahs.nsw.gov.au.
authors.forename: Prunella
authors.initials: P
authors.lastname: Blinman
authors.affiliation: The Prince Charles Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia.
authors.forename: Brett
authors.initials: B
authors.lastname: Hughes
authors.affiliation: Nepean Cancer Care, Sydney, Australia.
authors.forename: Catherine
authors.initials: C
authors.lastname: Crombie
authors.affiliation: Auckland City Hospital, Auckland, New Zealand.
authors.forename: Tim
authors.initials: T
authors.lastname: Christmas
authors.affiliation: NHMRC Clinical Trials Centre, University of Sydney, Australia.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Hudson
authors.affiliation: NHMRC Clinical Trials Centre, University of Sydney, Australia.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Veillard
authors.affiliation: NHMRC Clinical Trials Centre, University of Sydney, Australia.
authors.forename: Nick
authors.initials: N
authors.lastname: Muljadi
authors.affiliation: Sir Charles Gairdner Hospital, Perth, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Millward
authors.affiliation: St Vincent's Hospital, Melbourne, Australia.
authors.forename: Gavin
authors.initials: G
authors.lastname: Wright
authors.affiliation: Nepean Cancer Care, Sydney, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Flynn
authors.affiliation: The Prince Charles Hospital, Brisbane, Australia.
authors.forename: Morgan
authors.initials: M
authors.lastname: Windsor
authors.affiliation: Concord Repatriation General Hospital, Sydney, Australia; NHMRC Clinical Trials Centre, University of Sydney, Australia.
authors.forename: Martin
authors.initials: M
authors.lastname: Stockler
authors.affiliation: St Vincent's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia.
authors.forename: Sue-Anne
authors.initials: SA
authors.lastname: McLachlan
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D017060:Patient Satisfaction; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016019:Survival Analysis
keywords: Adjuvant chemotherapy; Decision-making; Non-small-cell lung cancer; Preferences