title: Patient preference and decision-making for initiating metastatic colorectal cancer medical treatment.
abstract: OBJECTIVE
  Some medical treatment for metastatic colorectal cancer (CRC) may have marginal survival benefit, but cause toxicities. The purpose of this study is to determine metastatic CRC patients' tradeoffs in making a decision to undergo new medical treatment.
  
  
  METHODS
  We conducted a survey of patients with a diagnosis of advanced CRC who were currently receiving or completed one chemotherapy regimen. First, patients were asked to rate the importance of 15 medical treatment-related adverse events that may arise as a consequence of chemotherapy or biological therapy in their treatment decision-making. Then, the patient identified his or her top five most important events and solicited preferences in hypothetical metastatic CRC treatment vignettes using the standard gamble technique.
  
  
  RESULTS
  A total of 107 patients responded to the survey. From the list of medical treatment-related adverse events, patients identified clinically serious ones such as stroke, heart attack, and gastrointestinal perforation as the most important in their medical treatment decision-making, yet placed lower willingness to tolerate symptom-related events such as pain, fatigue, and depression. Generally, patients who were older, stage III versus IV and who had prior radiotherapy, lower educational attainment, and lower household income (all p <0.05) were less willing to tolerate any medical treatment-related adverse events after adjusting for other demographic and clinical characteristics.
  
  
  CONCLUSIONS
  Variations in patients' willingness to tolerate different treatment-related adverse events underscore the need for improved communications between physicians and patients about the risks and benefits of their medical treatment, which helps make a more personalized decision for metastatic CRC treatment.
authors.affiliation: Department of Oncology, Georgetown University, Washington, DC, USA. zf54@georgetown.edu.|Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA. zf54@georgetown.edu.
authors.forename: Alex Z
authors.initials: AZ
authors.lastname: Fu
authors.affiliation: Department of Oncology, Georgetown University, Washington, DC, USA.|Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA.
authors.forename: Kristi D
authors.initials: KD
authors.lastname: Graves
authors.affiliation: Department of Oncology, Georgetown University, Washington, DC, USA.|Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA.
authors.forename: Roxanne E
authors.initials: RE
authors.lastname: Jensen
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA.
authors.forename: John L
authors.initials: JL
authors.lastname: Marshall
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Formoso
authors.affiliation: Department of Oncology, Georgetown University, Washington, DC, USA.|Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA.
authors.forename: Arnold L
authors.initials: AL
authors.lastname: Potosky
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000523:psychology; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D057240:Patient Preference / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014836:Volition
keywords: Metastatic colorectal cancer; Patient preference; Standard gamble; Tradeoff; Treatment decision-making