title: Factors Impacting Treatment Choice in the First-Line Treatment of Colorectal Cancer.
abstract: BACKGROUND
  To investigate the factors that affect the choice of 5-fluorouracil (5-FU) or its oral alternative, capecitabine, as first-line treatment in patients with colorectal cancer (CRC).
  
  
  METHODS
  Patients treated with 5-FU or capecitabine for CRC between January 1, 2011 and December 31, 2013 in a teaching hospital in the Sydney metropolitan area, Australia were identified using the hospital's database MOSAIQ®. The electronic medical record of each patient was manually reviewed to extract factors potentially affecting treatment choice. Logistic regression was used to assess which patient and/or treatment factors could explain the choice between 5-FU or capecitabine. Where it was available in the medical correspondence, the explicit reason for the choice made was extracted.
  
  
  RESULTS
  170 CRC patients were included; 119 on 5-FU, and 51 on capecitabine. The odds of receiving capecitabine as a first-line treatment were positively associated with giving patients a choice in the decision (OR = 17.51, 95% CI: 5.37-57.08). Qualitative data suggest treatment choices were motivated by convenience (oral administration) and tolerability. Time from diagnosis to treatment commencement (OR = 1.02 per month, 95% CI 1.00-1.04) was also found to be positively associated with the choice of capecitabine. The odds of being treated with capecitabine were lower for patients who lived further from the treating hospital (OR = 0.22, 95% CI 0.05-0.94).
  
  
  CONCLUSIONS
  This study suggests that patient choice, favoring oral capecitabine over i.v. 5-FU, was a key factor influencing first-line treatment for CRC in this cohort. To respect their autonomy, patients should be involved in the clinical decision making process.
authors.affiliation: Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands.
authors.forename: Lourens T
authors.initials: LT
authors.lastname: Bloem
authors.affiliation: Centre for Health Economics Research and Evaluation, University of Technology Sydney, Block D, Building 5, 1 Quay St, Haymarket, NSW 2007 Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: De Abreu Lourenço
authors.affiliation: Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, High St, Randwick, NSW 2031 Australia.
authors.forename: Melvin
authors.initials: M
authors.lastname: Chin
authors.affiliation: Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, High St, Randwick, NSW 2031 Australia.
authors.forename: Brett
authors.initials: B
authors.lastname: Ly
authors.affiliation: Centre for Health Economics Research and Evaluation, University of Technology Sydney, Block D, Building 5, 1 Quay St, Haymarket, NSW 2007 Australia.
authors.forename: Marion
authors.initials: M
authors.lastname: Haas
keywords: Colorectal cancer; Mode of administration; Patient involvement; Treatment choice