Survival benefit needed to undergo chemotherapy: Patient and physician preferences.
BACKGROUND
Published studies have suggested that most patients with early stage breast cancer are willing, for modest survival benefits, to receive 6 months of adjuvant cyclophosphamide, methotrexate, and 5-fluorouracil, an older regimen that is used infrequently today. We examined preferences regarding the survival benefit needed to justify 6 months of a contemporary chemotherapy regimen.


METHODS
The Eastern Cooperative Oncology Group Protocol 5103 was a phase 3 trial that randomized breast cancer patients to receive standard adjuvant doxorubicin, cyclophosphamide, and paclitaxel with either bevacizumab or placebo. Serial surveys to assess quality of life were administered to patients enrolled between January 1, 2010, and June 8, 2010. Survival benefit needed to justify 6 months of chemotherapy by patients was collected at the 18-month assessment. A parallel survey was sent to physicians who had enrolled patients in the study.


RESULTS
Of 519 patients who had not withdrawn at a time point earlier than 18 months, 87.8% responded to this survey. A total of 175 physicians participated. We found considerable variation in patient preferences, particularly for modest survival benefits: for 2 months of benefit, 57% would consider 6 months of chemotherapy, whereas 96% of patients would consider 6 months of chemotherapy for 24 months. Race and education were associated with the choices. Physicians who responded were less likely to accept chemotherapy for modest benefit.


CONCLUSIONS
Among patients who received contemporary adjuvant chemotherapy in a randomized controlled trial, we found substantial variation in preferences regarding benefits that justified undergoing chemotherapy. Differences between patients' and physicians' choices were also apparent. Eliciting preferences regarding risks and benefits of adjuvant chemotherapy is critical. Cancer 2017;123:2821-28. © 2017 American Cancer Society.
Dana-Farber Cancer Institute, Boston, Massachusetts.
Ines
http://orcid.org/0000-0002-7194-2260
I
Vaz-Luis
Dana-Farber Cancer Institute, Boston, Massachusetts.
Anne
A
O'Neill
Massachusetts General Hospital, Boston, Massachusetts.
Karen
K
Sepucha
Indiana University Simon Cancer Center, Indianapolis, Indiana.
Kathy D
KD
Miller
Dana-Farber Cancer Institute, Boston, Massachusetts.
Emily
E
Baker
Memorial Sloan Kettering Cancer Center, New York, New York.
Chau T
CT
Dang
Mayo Clinic, Scottsdale, Arizona.
Donald W
DW
Northfelt
Dana-Farber Cancer Institute, Boston, Massachusetts.
Eric P
EP
Winer
Indiana University Simon Cancer Center, Indianapolis, Indiana.
George W
GW
Sledge
Indiana University Simon Cancer Center, Indianapolis, Indiana.
Bryan
B
Schneider
Dana-Farber Cancer Institute, Boston, Massachusetts.
Ann H
AH
Partridge
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D000068258:Bevacizumab / Q000008:administration & dosage; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D017326:Clinical Trials, Phase III as Topic; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008408:Mastectomy; D015412:Mastectomy, Segmental; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage; D057240:Patient Preference; D010820:Physicians; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D015996:Survival Rate; D047368:Tumor Burden
D000068258:Bevacizumab; D004317:Doxorubicin; D003520:Cyclophosphamide; D017239:Paclitaxel
breast neoplasms; drug therapy; patients; physicians; quality of life