title: Patient preferences regarding prophylactic cranial irradiation: A discrete choice experiment.
abstract: In patients with non-small cell lung cancer (NSCLC) treated with chemoradiotherapy (CRT), prophylactic cranial irradiation (PCI) is not standard practice. This study determined patient preferences for PCI with respect to survival benefit, reduction in brain metastases (BM) and acceptable toxicity.
  
  
  
  A Discrete Choice Experiment was completed pre- and post-treatment. Patients made 15 hypothetical choices between two alternative PCI treatments described by four attributes: amount of life gained, chance of BM, ability to care for oneself, and loss of memory. Participants also chose between PCI and no PCI.
  
  
  
  54 and 46 surveys were completed pre- and post-treatment. The most important attributes pre-treatment were: a survival benefit >6months, of 3-6months, avoiding severe problems with memory and self-care, avoiding quite a bit of difficulty with memory and maximally reducing BM recurrence. Post-treatment, BM reduction became more important. 90% of patients would accept PCI for a survival benefit >6months, with a maximal reduction in BM even if severe memory/self-care problems occurred. With a 10% reduction in BM and mild problems with memory and self-care 70% of patients pre- (90% post-treatment) would accept PCI for a survival benefit of 1-3months, and 52% pre- (78% post-treatment) for no survival benefit.
  
  
  
  Improvement in survival is the most important attribute of PCI with patients willing to accept significant toxicity for maximum survival and less toxicity for less survival benefit. BM reduction became more important after treatment. The majority of patients would accept PCI for no survival benefit and a reduction in BM.
authors.affiliation: Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia; School of Medicine, University of Queensland, Australia. Electronic address: Margot.Lehman@health.qld.gov.au.
authors.forename: Margot
authors.initials: M
authors.lastname: Lehman
authors.affiliation: School of Medicine, University of Queensland, Australia; Department of Radiation Oncology, Radiation Oncology Centres, Mater Private Hospital Springfield, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Gorayski
authors.affiliation: Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia.
authors.forename: Susanne
authors.initials: S
authors.lastname: Watson
authors.affiliation: Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia.
authors.forename: Desiree
authors.initials: D
authors.lastname: Edeling
authors.affiliation: Department of Radiation Oncology, Radiation Oncology Centres, Gold Coast University Hospital, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Jackson
authors.affiliation: Norwich Medical School, University of East Anglia, UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Whitty
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000517:prevention & control* / Q000556:secondary*; D002289:Carcinoma, Non-Small-Cell Lung / Q000532:radiotherapy*; D016371:Cranial Irradiation / Q000379:methods; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D057240:Patient Preference
keywords: Lung cancer; Patient preferences; Prophylactic cranial irradiation