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Marshall VK, Given CW, Given BA, Lehto RH, Sikorskii A. Factors affecting medication beliefs among patients newly prescribed oral oncolytic agents. J Psychosoc Oncol 2020; 40:62-79. [PMID: 33305993 DOI: 10.1080/07347332.2020.1855497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Prescribing oral oncolytic agents (OAs) for advanced cancers is increasing. AIMS To explore changes in medication beliefs and the effects of symptom severity, cognitive effectiveness and depressive symptoms on medication beliefs over 12 weeks. METHODS Secondary analysis of a randomized controlled trial, testing an intervention to promote symptom management and adherence [N = 230]. Questionnaires evaluated medication beliefs, symptom severity, depressive symptoms, and cognitive effectiveness. Linear mixed effects models were used for analyses. RESULTS OA Necessity beliefs increased over time (mean difference 0.0112, SE = 0.055, p 0.04). Concern beliefs did not change and were lower for advanced cancers (-0.193, SE = 0.067, p < 0.01).Depressive symptoms were related to decreased Necessity beliefs (-0.012, SE = 0.005, p = 0.02), but not Concern beliefs. Medication beliefs were not associated with symptom severity or cognitive effectiveness. CONCLUSION Patients with advanced cancer hold different medication beliefs compared to earlier staged cancers, lending insight into potential outcomes beyond adherence.
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Affiliation(s)
| | - Charles W Given
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
| | - Barbara A Given
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
| | - Rebecca H Lehto
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
| | - Alla Sikorskii
- College of Osteopathic Medicine, Department of Psychiatry Michigan State University, East Lansing, Michigan, USA
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Chang DW, Bressel M, Hansen C, Blinman P, Schofield P, Chua BH. Axillary dissection in sentinel lymph node positive breast cancer: Is the staging information worthwhile for patients? Asia Pac J Clin Oncol 2019; 17:e27-e34. [PMID: 31461222 DOI: 10.1111/ajco.13238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 08/04/2019] [Indexed: 12/18/2022]
Abstract
AIMS The Z0011 randomized trial demonstrated no significant difference in axillary recurrence rate or survival with or without axillary dissection in patients with a positive sentinel node biopsy. However, there is continuing controversy regarding the generalizability of its results, and axillary dissection provides additional pathologic staging information that may guide adjuvant therapy. Thus, axillary dissection after positive sentinel node biopsy is being further investigated in an actively recruiting randomized trial. We elicited patients' preferences for axillary dissection versus no axillary dissection after positive sentinel node biopsy for early breast cancer. METHODS Patients who had undergone axillary dissection after positive sentinel node biopsy as part of breast conserving therapy were provided with a validated, self-rated questionnaire. The questionnaire comprised two trade-off questions to determine the maximum chance of developing arm side-effects from axillary dissection to justify the benefit of additional axillary staging information. Social, demographic, and clinical details were collected. RESULTS Ninety-nine of the 126 eligible patients returned the questionnaire and 76 completed the trade-off assessment. The median age of participants was 62 years. The median numbers of sentinel and axillary nodes removed were 2 and 12, respectively. Forty-seven percent of participants had arm swelling or tenderness of any severity. Seventy-five percent of participants would have axillary dissection even if the chance of arm side-effects like they had experienced was 100%. CONCLUSION Most patients with early breast cancer preferred axillary dissection after positive sentinel node biopsy for the additional staging information even though there was no survival benefit from axillary dissection.
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Affiliation(s)
- David W Chang
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Radiation Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Children's Cancer Institute Australia, Lowy Cancer Research Centre, University of New South Wales, Kensington, New South Wales, Australia
| | - Mathias Bressel
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Carmen Hansen
- Mid North Coast Cancer Institute, Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia
| | - Prunella Blinman
- Concord Cancer Centre, Hospital Road, Concord, New South Wales, Australia
| | - Penelope Schofield
- Department of Psychology, and Iverson Health Innovation Research Institute Swinburne University, Melbourne, Victoria, Australia.,Behavioural Sciences Unit, Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Boon H Chua
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia.,University of New South Wales Medicine, University of New South Wales, Sydney, New South Wales, Australia
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de Mol M, Visser S, den Oudsten BL, Lodder P, van Walree N, Belderbos H, Aerts JG. Frequency of low-grade adverse events and quality of life during chemotherapy determine patients' judgement about treatment in advanced-stage thoracic cancer. Support Care Cancer 2019; 27:3563-3572. [PMID: 30690684 PMCID: PMC6660482 DOI: 10.1007/s00520-019-4659-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 01/16/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE In lung cancer, the preservation of well-being is warranted given the limited prognosis. Chemotherapy may negatively influence health-related quality of life (HRQoL) due to adverse events. However, patients' judgement about this negative impact is not well understood. We examined the relationship between expectations, feelings about side effects, and satisfaction with therapy and (HR)QoL in advanced-stage thoracic cancer and investigated which of these factors has the highest impact on (HR)QoL. METHODS Sixty-nine patients completed the Cancer Therapy Satisfaction Questionnaire (CTSQ), the World Health Organization Quality of Life-BREF (WHOQOL-BREF), and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). Multiple regression analyses were performed to investigate the relation of the CTSQ domains (i.e., expectations of therapy, feelings about side effects, satisfaction with therapy) with (HR)QoL and simple regression analyses to identify the factors of the CTSQ domain that was most often associated with (HR)QoL. RESULTS Feelings about side effects were associated with the (HR)QoL domain/scale scores (i.e., WHOQOL-BREF domains: β = 0.36 to 0.58; EORTC QLQ-C30 scales: β = 0.33 to 0.61) except social relationships of the WHOQOL-BREF. Low-grade adverse events were related to feelings about side effects (β = - 0.326; P = 0.007). CONCLUSIONS Patients experiencing negative feelings about side effects have worse (HR)QoL. Additional care should be provided to prevent low-grade adverse events.
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Affiliation(s)
- Mark de Mol
- Department of Pulmonary Diseases, Amphia Hospital, P.O. Box 90158, 4800 RK, Breda, The Netherlands
- Department of Pulmonary Diseases, Erasmus MC Cancer Institute, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Sabine Visser
- Department of Pulmonary Diseases, Amphia Hospital, P.O. Box 90158, 4800 RK, Breda, The Netherlands
- Department of Pulmonary Diseases, Erasmus MC Cancer Institute, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC-University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Brenda L den Oudsten
- Department of Medical and Clinical Psychology, Centre of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, P.O. Box 90151, 5000 LE, Tilburg, The Netherlands
| | - Paul Lodder
- Department of Medical and Clinical Psychology, Centre of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, P.O. Box 90151, 5000 LE, Tilburg, The Netherlands
- Department of Methodology and Statistics, Tilburg University, P.O. Box 90151, 5000 LE, Tilburg, The Netherlands
| | - Nico van Walree
- Department of Pulmonary Diseases, Amphia Hospital, P.O. Box 90158, 4800 RK, Breda, The Netherlands
| | - Huub Belderbos
- Department of Pulmonary Diseases, Amphia Hospital, P.O. Box 90158, 4800 RK, Breda, The Netherlands
| | - Joachim G Aerts
- Department of Pulmonary Diseases, Amphia Hospital, P.O. Box 90158, 4800 RK, Breda, The Netherlands.
- Department of Pulmonary Diseases, Erasmus MC Cancer Institute, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Marshall VK, Lehto RH, Given CW, Given BA, Sikorskii A. Conceptualisation of medication beliefs among patients with advanced cancer receiving oral oncolytic agents using a theory derivation approach. Eur J Cancer Care (Engl) 2019; 28:e12988. [PMID: 30656774 DOI: 10.1111/ecc.12988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/26/2018] [Accepted: 12/16/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This paper describes a derived model that provides a conceptual framework for understanding medication beliefs among patients with advanced cancer receiving oral oncolytic agents. METHODS Theory derivation was used to (a) examine the phenomenon of medication beliefs in cross-disciplinary research; (b) select a parent theory for derivation; (c) identify parent theory concepts and/or structure to use in derivation; and (d) redefine parent theory concepts and structure to create a derived model. RESULTS Medication beliefs are shaped by previous experiences, including cognitive and emotional factors, past health and illness encounters, and medication-taking behaviours. Medication beliefs are defined within a larger mental model of illness representation for which medication was prescribed. Individuals independently hold both positive and negative medication beliefs at the same time. This distinction is critical to understanding how dichotomous components of medication beliefs change over time as they are influenced by varying treatment-related factors. CONCLUSION This paper contributes to conceptual knowledge regarding the phenomenon of medication beliefs and their impact on health behaviour. Findings can support oncology interventions to improve patient outcomes including medication adherence.
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Affiliation(s)
| | - Rebecca H Lehto
- College of Nursing, Michigan State University, East Lansing, Michigan
| | - Charles W Given
- College of Nursing, Michigan State University, East Lansing, Michigan
| | - Barbara A Given
- College of Nursing, Michigan State University, East Lansing, Michigan
| | - Alla Sikorskii
- College of Medicine, Department of Psychiatry, Michigan State University, East Lansing, Michigan
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Marshall V, Given B. Factors Associated With Medication Beliefs in Patients With Cancer: An Integrative Review. Oncol Nurs Forum 2018; 45:508-526. [DOI: 10.1188/18.onf.508-526] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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6
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Mokhles S, Maat APWM, Aerts JGJV, Nuyttens JJME, Bogers AJJC, Takkenberg JJM. Opinions of lung cancer clinicians on shared decision making in early-stage non-small-cell lung cancer. Interact Cardiovasc Thorac Surg 2017; 25:278-284. [PMID: 28449093 DOI: 10.1093/icvts/ivx103] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 01/31/2017] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To investigate the opinions of lung cancer clinicians concerning shared decision making (SDM) in early-stage non-small-cell lung cancer patients. METHODS A survey was conducted among Dutch cardiothoracic surgeons and lung surgeons, pulmonologists and radiation oncologists. The opinions of clinicians on the involvement of patients in treatment decision making was assessed using a 1-5 Likert-type scale. Through open questions, we queried barriers to and drivers of SDM in clinical practice. Clinicians were asked to review 7 hypothetical cases and indicate which treatment strategy they would choose using a 1-7 Likert-type scale. RESULTS Twenty-six percent of surgeons, 20% of pulmonologists and 12% of radiation oncologists indicated that they always engage in SDM (16% missing; P-value = 0.10). Most respondents stated that, ideally, doctors and patients should decide together (surgeons 52%, pulmonologists 67% and radiation oncologists 35%; P-value = 0.005). Thirty percent of surgeons, 27% of pulmonologists and 44% of radiation oncologists indicated that doctors are not properly trained to implement SDM in clinical practice (P-value = 0.37). SDM may not always be feasible due to low patient education level and minimal knowledge about lung cancer. Wide variations in the clinicians' lung cancer treatment preferences were observed in the responses to the hypothetical cases. CONCLUSIONS In current clinical decision making in lung cancer treatment, a majority of clinicians agree that it is important to involve lung cancer patients in treatment decision making but that time constraints and the inability of some patients to make a weighted decision are important barriers. The observed variation in lung cancer treatment preferences among clinicians suggests that for most patients both surgery and radiotherapy are suitable options, and it underlines the sensitive nature of treatment choices in early-stage non-small-cell lung cancer.
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Affiliation(s)
- Sahar Mokhles
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, Netherlands
| | - Alex P W M Maat
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, Netherlands
| | | | - Joost J M E Nuyttens
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, Netherlands
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El Hage Chehade H, Wazir U, Mokbel K, Kasem A, Mokbel K. Do online prognostication tools represent a valid alternative to genomic profiling in the context of adjuvant treatment of early breast cancer? A systematic review of the literature. Am J Surg 2017. [PMID: 28622841 DOI: 10.1016/j.amjsurg.2017.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Decision-making regarding adjuvant chemotherapy has been based on clinical and pathological features. However, such decisions are seldom consistent. Web-based predictive models have been developed using data from cancer registries to help determine the need for adjuvant therapy. More recently, with the recognition of the heterogenous nature of breast cancer, genomic assays have been developed to aid in the therapeutic decision-making. METHODS We have carried out a comprehensive literature review regarding online prognostication tools and genomic assays to assess whether online tools could be used as valid alternatives to genomic profiling in decision-making regarding adjuvant therapy in early breast cancer. RESULTS AND CONCLUSIONS Breast cancer has been recently recognized as a heterogenous disease based on variations in molecular characteristics. Online tools are valuable in guiding adjuvant treatment, especially in resource constrained countries. However, in the era of personalized therapy, molecular profiling appears to be superior in predicting clinical outcome and guiding therapy.
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Affiliation(s)
| | - Umar Wazir
- The London Breast Institute, The Princess Grace Hospital, London, UK
| | - Kinan Mokbel
- The London Breast Institute, The Princess Grace Hospital, London, UK
| | - Abdul Kasem
- The London Breast Institute, The Princess Grace Hospital, London, UK
| | - Kefah Mokbel
- The London Breast Institute, The Princess Grace Hospital, London, UK
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Lin FPY, Pokorny A, Teng C, Dear R, Epstein RJ. Computational prediction of multidisciplinary team decision-making for adjuvant breast cancer drug therapies: a machine learning approach. BMC Cancer 2016; 16:929. [PMID: 27905893 PMCID: PMC5131452 DOI: 10.1186/s12885-016-2972-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 11/24/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Multidisciplinary team (MDT) meetings are used to optimise expert decision-making about treatment options, but such expertise is not digitally transferable between centres. To help standardise medical decision-making, we developed a machine learning model designed to predict MDT decisions about adjuvant breast cancer treatments. METHODS We analysed MDT decisions regarding adjuvant systemic therapy for 1065 breast cancer cases over eight years. Machine learning classifiers with and without bootstrap aggregation were correlated with MDT decisions (recommended, not recommended, or discussable) regarding adjuvant cytotoxic, endocrine and biologic/targeted therapies, then tested for predictability using stratified ten-fold cross-validations. The predictions so derived were duly compared with those based on published (ESMO and NCCN) cancer guidelines. RESULTS Machine learning more accurately predicted adjuvant chemotherapy MDT decisions than did simple application of guidelines. No differences were found between MDT- vs. ESMO/NCCN- based decisions to prescribe either adjuvant endocrine (97%, p = 0.44/0.74) or biologic/targeted therapies (98%, p = 0.82/0.59). In contrast, significant discrepancies were evident between MDT- and guideline-based decisions to prescribe chemotherapy (87%, p < 0.01, representing 43% and 53% variations from ESMO/NCCN guidelines, respectively). Using ten-fold cross-validation, the best classifiers achieved areas under the receiver operating characteristic curve (AUC) of 0.940 for chemotherapy (95% C.I., 0.922-0.958), 0.899 for the endocrine therapy (95% C.I., 0.880-0.918), and 0.977 for trastuzumab therapy (95% C.I., 0.955-0.999) respectively. Overall, bootstrap aggregated classifiers performed better among all evaluated machine learning models. CONCLUSIONS A machine learning approach based on clinicopathologic characteristics can predict MDT decisions about adjuvant breast cancer drug therapies. The discrepancy between MDT- and guideline-based decisions regarding adjuvant chemotherapy implies that certain non-clincopathologic criteria, such as patient preference and resource availability, are factored into clinical decision-making by local experts but not captured by guidelines.
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Affiliation(s)
- Frank P Y Lin
- Department of Oncology, St Vincent's Hospital, The Kinghorn Cancer Centre, 370 Victoria St, Darlinghurst, Sydney, Australia.
- Garvan Institute of Medical Research, Sydney, Australia.
- The University of New South Wales, Sydney, NSW, Australia.
| | - Adrian Pokorny
- Department of Oncology, St Vincent's Hospital, The Kinghorn Cancer Centre, 370 Victoria St, Darlinghurst, Sydney, Australia
| | - Christina Teng
- Department of Oncology, St Vincent's Hospital, The Kinghorn Cancer Centre, 370 Victoria St, Darlinghurst, Sydney, Australia
| | - Rachel Dear
- Department of Oncology, St Vincent's Hospital, The Kinghorn Cancer Centre, 370 Victoria St, Darlinghurst, Sydney, Australia
- The University of Sydney, Sydney, NSW, Australia
| | - Richard J Epstein
- Department of Oncology, St Vincent's Hospital, The Kinghorn Cancer Centre, 370 Victoria St, Darlinghurst, Sydney, Australia
- Garvan Institute of Medical Research, Sydney, Australia
- The University of New South Wales, Sydney, NSW, Australia
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Patients' and clinicians' preferences for adjuvant chemotherapy in endometrial cancer: an ANZGOG substudy of the PORTEC-3 intergroup randomised trial. Br J Cancer 2016; 115:1179-1185. [PMID: 27764842 PMCID: PMC5104894 DOI: 10.1038/bjc.2016.323] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/18/2016] [Accepted: 09/10/2016] [Indexed: 12/02/2022] Open
Abstract
Background: To determine the minimum survival benefits that patients, and their clinicians, judged sufficient to make adjuvant chemotherapy (ACT) worthwhile, in addition to pelvic radiotherapy, for women with high risk and advanced stage endometrial cancer. Methods: Eighty-three participants in the PORTEC-3 trial completed a time trade-off questionnaire before and after adjuvant therapy; 44 of their clinicians completed it once only. The questionnaire used four hypothetical scenarios including baseline survival times without ACT of 5 and 8 years, and baseline survival rates at 5 years without ACT of 50 and 65%. Results: Over 50% of patients judged an extra 1 year of survival time or an extra 5% in survival rate sufficient to make ACT worthwhile. Over 50% of clinicians judged an extra 1 year of survival time, or an extra 10% in survival rate, sufficient to make ACT worthwhile. Compared with patients, clinicians required similar survival time benefits (medians both 1 year, P=0.4), but larger survival rate benefits (medians 8.5% vs 5%, P=0.03), and clinicians' preferences varied less (IQR 0.5–1.5 years vs 0.4–2 years, P=0.0007; 5–10% vs 1–13%, P=0.004). Patients' preferences changed over time for the survival rate scenarios depending on whether they had ACT or not (change in median benefit - 3 months vs 2.5 months respectively, P=0.028). There were no strong predictors of patients' or clinicians' preferences. Conclusions: Patients and clinicians judged moderate survival benefits sufficient to make ACT worthwhile after pelvic radiotherapy for endometrial cancer. These benefits are larger than those judged sufficient by patients with breast or colon cancers, but similar to those judged sufficient by patients with lung or ovarian cancers.
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Koskas M, Huchon C, Amant F. Characteristics and prognosis of patients with early-stage endometrial cancer who refuse adjuvant radiotherapy. Gynecol Oncol 2016; 141:428-433. [DOI: 10.1016/j.ygyno.2016.03.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 03/05/2016] [Accepted: 03/11/2016] [Indexed: 12/15/2022]
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Patient preferences for side effects associated with cervical cancer treatment. Int J Gynecol Cancer 2015; 24:1077-84. [PMID: 24905618 DOI: 10.1097/igc.0000000000000149] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess patient preferences regarding side effects associated with cervical cancer treatment. METHODS/MATERIALS The visual analog scale (VAS) and modified standard gamble (SG) were used to elicit preferences of women with no evidence of disease after primary treatment of cervical cancer. Higher scores on VAS and SG indicated more favorable ratings for a given health state. Health states (HS) included vaginal shortening, diarrhea, dietary changes, menopause, moderate nausea/vomiting, rectal bleeding, sexual dysfunction, and urinary self-catheterization. Descriptive statistics, Kruskal-Wallis, Mann-Whitney U, and Wilcoxon signed-ranks tests and correlation coefficients were used for statistical analysis. RESULTS Seventy-eight patients participated in the study. Median age was 44.1 years (range, 24.9-67.8 years). Median time since treatment completion was 31.2 months (range, 1.0-113.3 months). The HSs rated as most favorable by VAS were also rated as most favorable by SG. Increasing age was associated with higher VAS scores for menopause and vaginal shortening (P = 0.04 and 0.036). African Americans had higher VAS scores for dietary changes (P = 0.05), sexual dysfunction (P = 0.028), and diarrhea (P = 0.05) when compared with Hispanic and non-Hispanic white patients. Women receiving radiation had more favorable VAS scores for menopause compared with women undergoing radical hysterectomy (P = 0.05). Women receiving chemotherapy rated urinary self-catheterization less favorably by VAS score compared with those not receiving chemotherapy (P = 0.045). CONCLUSIONS Multiple demographic and clinical factors influence the severity of treatment-related adverse effects perceived by women surviving cervical cancer. A better understanding of factors influencing patient preferences regarding treatment side effects will allow providers to formulate care better tailored to the individual desires of each patient.
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Currie A, Askari A, Nachiappan S, Sevdalis N, Faiz O, Kennedy R. A systematic review of patient preference elicitation methods in the treatment of colorectal cancer. Colorectal Dis 2015; 17:17-25. [PMID: 25155838 DOI: 10.1111/codi.12754] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 06/19/2014] [Accepted: 06/27/2014] [Indexed: 12/29/2022]
Abstract
AIM This systematic review aimed to assess the use of patient preference in colorectal cancer treatment. Eliciting patient preference is important for shared decision-making in colorectal cancer treatment. The introduction of newer treatments, which balance quality of life and overall survival, makes this an important future focus. METHOD A systematic search strategy of MEDLINE, Embase, PsycINFO, CINAHL and the Cochrane Database for Systematic Reviews was undertaken to obtain relevant articles. Information regarding the type of patients included, preference instruments, study settings, outcomes and limitations was extracted. RESULTS The eight articles comprising this review each described an empirical study using a validated instrument to define patient preference for an aspect of colorectal cancer treatment. The evidence suggests that patients are prepared to trade significant reductions in life expectancy to avoid certain complications of colorectal surgery, particularly stoma formation. In the adjuvant setting, patients are prepared to risk significant treatment side effects to gain small potential increases in life expectancy and chance of survival. Where neoadjuvant or adjuvant treatment risks worsening function, however, patients generally forgo any potential increase in survival to improve bowel function and therefore quality of life. The only predictors of preference were tertiary education and previous cancer treatment. CONCLUSION Most patients judge a moderate survival benefit to be sufficient to make adjuvant therapy for colorectal cancer worthwhile, but they are willing to trade a potential reduction in life expectancy and survival to avoid certain unwanted surgical sequelae.
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Affiliation(s)
- A Currie
- St Mark's Hospital and Academic Institute, Harrow, Middlesex, UK
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Wong SF, Norman R, Dunning TL, Ashley DM, Lorgelly PK. A protocol for a discrete choice experiment: understanding preferences of patients with cancer towards their cancer care across metropolitan and rural regions in Australia. BMJ Open 2014; 4:e006661. [PMID: 25344489 PMCID: PMC4212188 DOI: 10.1136/bmjopen-2014-006661] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Medical decision-making in oncology is a complicated process and to date there are few studies examining how patients with cancer make choices with respect to different features of their care. It is also unknown whether patient choices vary by geographical location and how location could account for observed rural and metropolitan cancer differences. This paper describes an ongoing study that aims to (1) examine patient and healthcare-related factors that influence choices of patients with cancer; (2) measure and quantify preferences of patients with cancer towards cancer care using a discrete choice experiment (DCE) and (3) explore preference heterogeneity between metropolitan and rural locations. METHODS AND ANALYSIS A DCE is being conducted to understand how patients with cancer choose between two clinical scenarios accounting for different patient and healthcare-related factors (and levels). Preliminary qualitative research was undertaken to guide the development of an appropriate DCE design including characteristics that are important and relevant to patients with cancer. A fractional factorial design using the D-efficiency criteria was used to estimate interactions among attributes. Multinomial logistic regression will be used for the primary DCE analysis and to control for sociodemographic and clinical characteristics. ETHICS AND DISSEMINATION The Barwon Health Human Research Ethics Committee approved the study. Findings from the study will be presented in national/international conferences and peer-reviewed journals. Our results will form the basis of a feasibility study to inform the development of a larger scale study into preferences of patients with cancer and their association with cancer outcomes.
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Affiliation(s)
- Shu Fen Wong
- Department of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia
- Andrew Love Cancer Centre, Barwon Health, Geelong, Victoria, Australia
| | - Richard Norman
- School of Public Health, Curtin University, Perth, Western Australia, Australia
- Centre for Health Economics Research and Evaluation, University of Technology, Sydney, New South Wales, Australia
| | - Trisha L Dunning
- School of Nursing and Midwifery, Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - David M Ashley
- Department of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia
- Andrew Love Cancer Centre, Barwon Health, Geelong, Victoria, Australia
| | - Paula K Lorgelly
- Centre of Health Economics, Monash University, Melbourne, Victoria, Australia
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Iihara N, Nishio T, Goda T, Anzai H, Kagawa M, Houchi H, Kirino Y. Effect of endurance for adverse drug reactions on the preference for aggressive treatments in cancer patients. Support Care Cancer 2014; 23:1091-7. [PMID: 25294657 DOI: 10.1007/s00520-014-2439-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 09/09/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Cancer patients receiving chemotherapy will sometimes conceal their discomfort, but an excessive endurance for adverse drug reactions (ADRs) can lead to a poorer prognosis. The aim of this study was to clarify the association between ADR endurance and a preference of cancer patients for aggressive treatments. METHODS A cross-sectional study was undertaken of inpatients under 75 years of age receiving injectable systemic chemotherapy or oral chronic medications at hospitals in Japan. Subjects were asked to respond to a validated questionnaire to assess the extent of their ADR endurance and whether they would choose a novel, more aggressive therapy if their life expectancy was estimated at 2 years. RESULTS Study participants were separated into the chemotherapy group (n = 36) and the non-chemotherapy group (n = 78). In the chemotherapy group, patients who had moderate ADR endurance scores were more likely to choose the new therapy (0-33, 34-67, and 68-100 points: 0.0, 54.5, and 27.3 %; χ (2) test, p = 0.15). Additionally, every patient on long-term chemotherapy (≥3 years) had high ADR endurance scores but did not choose the new, riskier treatment. In the non-chemotherapy group, the proportion of those choosing the new therapy was linearly associated with higher ADR endurance scores (25.9, 38.2, and 64.7 %; p = 0.04). CONCLUSION Cancer patients may prefer aggressive therapies, even when self-estimations of ADR endurance are not very high, especially if they have been receiving chemotherapy for a short period of time. These patients should be observed with great caution.
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Affiliation(s)
- Naomi Iihara
- Kagawa School of Pharmaceutical Sciences, Tokushima Bunri University, 1314-1 Shido, Sanuki, Kagawa, 769-2193, Japan,
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Hamelinck VC, Bastiaannet E, Pieterse AH, Jannink I, van de Velde CJ, Liefers GJ, Stiggelbout AM. Patients’ preferences for surgical and adjuvant systemic treatment in early breast cancer: A systematic review. Cancer Treat Rev 2014; 40:1005-18. [DOI: 10.1016/j.ctrv.2014.06.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 06/12/2014] [Accepted: 06/13/2014] [Indexed: 01/26/2023]
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Treatment preferences and involvement in treatment decision making of patients with endometrial cancer and clinicians. Br J Cancer 2014; 111:674-9. [PMID: 24921911 PMCID: PMC4134490 DOI: 10.1038/bjc.2014.322] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 04/28/2014] [Accepted: 05/12/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Vaginal brachytherapy (VBT) in high-intermediate-risk endometrial cancer (EC) provides a significant reduction in the risk of local cancer recurrence, but without survival benefit and with increased mucosal atrophy. Five-year local control is estimated to be similar for VBT and a watchful waiting policy (WWP), in which patients receive VBT combined with external radiation in case of a recurrence. Our aim was to assess treatment preferences of EC patients and clinicians regarding VBT and WWP, and to evaluate their preferred and perceived involvement in treatment decision making. METHODS Interviews were held with 95 treated EC patients. The treatment trade-off method was used to assess the minimally desired benefit from VBT in local control. Patients' preferred and perceived involvement in decision making were assessed using a questionnaire. Seventy-seven clinicians completed a questionnaire assessing their minimally desired benefit and preferred involvement in decision making. RESULTS Minimally desired benefit of VBT was significantly lower for patients than for clinicians (median=0 vs 8%, P<0.001), for irradiated than for non-irradiated patients (median=0 vs 6.5%, P<0.001), and for radiation oncologists than for gynaecologists (median=4 vs 13%, P<0.001). Substantial variation existed within the groups of patients and clinicians. Participants preferred the patient and clinician to share in the decision about VBT. However, irradiated patients indicated low perceived involvement in actual treatment decision making. CONCLUSIONS We found variations between and within patients and clinicians in minimally desired benefit from VBT. However, the recurrence risk at which patients preferred VBT was low. Our results showed that patients consider active participation in decision making essential.
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Ralph AF, Ager B, Bell ML, Collins IM, Andrews L, Tucker K, O'Reilly N, Phillips KA, Butow P. Women's preferences for selective estrogen reuptake modulators: an investigation using the time trade-off technique. SPRINGERPLUS 2014; 3:264. [PMID: 26034659 PMCID: PMC4447717 DOI: 10.1186/2193-1801-3-264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 05/02/2014] [Indexed: 11/21/2022]
Abstract
Purpose Selective Estrogen Receptor Modulators (SERMs) reduce the risk of breast cancer for women at increased risk by 38%. However, uptake is extremely low and the reasons for this are not completely understood. The aims of this study were to utilize time trade-off methods to determine the degree of risk reduction required to make taking SERMs worthwhile to women, and the factors associated with requiring greater risk reduction to take SERMs. Methods Women at increased risk of breast cancer (N = 107) were recruited from two familial cancer clinics in Australia. Participants completed a questionnaire either online or in pen and paper format. Hierarchical multiple linear regression analysis was used to analyze the data. Results Overall, there was considerable heterogeneity in the degree of risk reduction required to make taking SERMs worthwhile. Women with higher perceived breast cancer risk and those with stronger intentions to undergo (or who had undergone) an oophorectomy required a smaller degree of risk reduction to consider taking SERMs worthwhile. Conclusion Women at increased familial risk appear motivated to consider SERMs for prevention. A tailored approach to communicating about medical prevention is essential. Health professionals could usefully highlight the absolute (rather than relative) probability of side effects and take into account an individual’s perceived (rather than objective) risk of breast cancer.
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Affiliation(s)
- Angelique F Ralph
- School of Psychology, University of Sydney, Sydney, New South Wales 2006 Australia
| | - Brittany Ager
- School of Psychology, University of Sydney, Sydney, New South Wales 2006 Australia
| | - Melanie L Bell
- School of Psychology, University of Sydney, Sydney, New South Wales 2006 Australia ; Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, New SouthWales 2006 Australia ; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona 85724 USA
| | - Ian M Collins
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, East Melbourne, Victoria 3002 Australia
| | - Lesley Andrews
- Hereditary Cancer Clinic, Prince of Wales Hospital, 147 Barker Street, Randwick, New South Wales 2031 Australia
| | - Kathy Tucker
- Hereditary Cancer Clinic, Prince of Wales Hospital, 147 Barker Street, Randwick, New South Wales 2031 Australia
| | - Nicole O'Reilly
- School of Psychiatry, University of New South Wales, Randwick, New South Wales 2031 Australia
| | - Kelly-Anne Phillips
- Sir Peter MacCallum Dept. of Oncology, The University of Melbourne, Parkville, Victoria 3010 Australia
| | - Phyllis Butow
- School of Psychology, University of Sydney, Sydney, New South Wales 2006 Australia ; Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, New SouthWales 2006 Australia ; Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), University of Sydney, Sydney, New South Wales 2006 Australia
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Koehler M, Koehler K, Koenigsmann M, Kreutzmann N, Fischer T, Frommer J. Beyond diagnosis: subjective theories of illness in adult patients with acute myeloid leukemia. Hematology 2013; 16:5-13. [DOI: 10.1179/102453311x12902908411599] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Michael Koehler
- Department of Hematology/OncologyUniversity Hospital of Magdeburg, Germany
| | - Katharina Koehler
- Department of Psychosomatic Medicine and PsychotherapyUniversity Hospital of Magdeburg, Germany
| | - Michael Koenigsmann
- Department of Hematology/OncologyUniversity Hospital of Magdeburg, Germany
- Specialty Practice for Hematology and OncologyHannover, Germany
| | - Nicole Kreutzmann
- Department of Hematology/OncologyUniversity Hospital of Magdeburg, Germany
| | - Thomas Fischer
- Department of Hematology/OncologyUniversity Hospital of Magdeburg, Germany
| | - Joerg Frommer
- Department of Psychosomatic Medicine and PsychotherapyUniversity Hospital of Magdeburg, Germany
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Jorgensen ML, Young JM, Solomon MJ. Adjuvant chemotherapy for colorectal cancer: age differences in factors influencing patients' treatment decisions. Patient Prefer Adherence 2013; 7:827-34. [PMID: 24003305 PMCID: PMC3755704 DOI: 10.2147/ppa.s50970] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Older colorectal cancer patients are significantly less likely than younger patients to receive guideline-recommended adjuvant chemotherapy. Previous research has indicated that patient refusal of treatment is a contributing factor. This study aimed to identify potential barriers to adjuvant chemotherapy use in older patients by examining the associations between patient age, factors influencing chemotherapy treatment decisions, and preferences for information and decision-making involvement. PATIENTS AND METHODS Sixty-eight patients who underwent surgery for colorectal cancer in Sydney, Australia, within the previous 24 months completed a self-administered survey. RESULTS Fear of dying, health status, age, quality of life, and understanding treatment procedures and effects were significantly more important to older patients (aged ≥65 years) than younger patients in deciding whether to accept chemotherapy (all P < 0.05). Reducing the risk of cancer returning and physician trust were important factors for all patients. Practical barriers such as traveling for treatment and cost were rated lowest. Older patients preferred less information and involvement in treatment decision making than younger patients. However, 60% of the older group wanted detailed information about chemotherapy, and 83% wanted some involvement in decision making. Those preferring less information and involvement still rated many factors as important in their decision making, including understanding treatment procedures and effects. CONCLUSION A range of factors appears to influence patients' chemotherapy decision making, including, but not limited to, survival benefits and treatment toxicity. For older patients, balancing the risks and benefits of treatment may be made more complex by the impact of emotional motivators, greater health concerns, and conflicts between their need for understanding and their information and decision-making preferences. Through greater understanding of perceived barriers to treatment and unique motivators for treatment choice, physicians may be better able to support older patients to make informed decisions about their care.
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Affiliation(s)
- Mikaela L Jorgensen
- Surgical Outcomes Research Centre (SOuRCe), Sydney School of Public Health, University of Sydney and Sydney Local Health District, NSW, Australia
- Cancer Epidemiology and Services Research (CESR), Sydney School of Public Health, University of Sydney, NSW, Australia
- Correspondence: Mikaela L Jorgensen, Cancer Epidemiology and Services Research (CESR), Queen Elizabeth II Research Institute (D02), University of Sydney, NSW 2006, Australia, Tel +61 2 9036 5419, Fax +61 2 9515 3222, Email
| | - Jane M Young
- Surgical Outcomes Research Centre (SOuRCe), Sydney School of Public Health, University of Sydney and Sydney Local Health District, NSW, Australia
- Cancer Epidemiology and Services Research (CESR), Sydney School of Public Health, University of Sydney, NSW, Australia
| | - Michael J Solomon
- Surgical Outcomes Research Centre (SOuRCe), Sydney School of Public Health, University of Sydney and Sydney Local Health District, NSW, Australia
- Discipline of Surgery, University of Sydney, NSW, Australia
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Shaffer VA, Merkle EC, Fagerlin A, Griggs JJ, Langa KM, Iwashyna TJ. Chemotherapy was not associated with cognitive decline in older adults with breast and colorectal cancer: findings from a prospective cohort study. Med Care 2012; 50:849-55. [PMID: 22683591 PMCID: PMC3444668 DOI: 10.1097/mlr.0b013e31825a8bb0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study tested 2 hypotheses: (1) chemotherapy increases the rate of cognitive decline in breast and colorectal cancer patients beyond what is typical of normal aging and (2) chemotherapy results in systematic cognitive declines when compared with breast and colorectal cancer patients who did not receive chemotherapy. SUBJECTS Data came from personal interviews with a prospective cohort of patients with breast (n=141) or colorectal cancer (n=224) with incident disease drawn from the nationally representative Health and Retirement Study (1998-2006) with linked Medicare claims. MEASURES The 27-point modified Telephone Interview for Cognitive Status was used to assess cognitive functioning, focusing on memory and attention. We defined the smallest clinically significant change as 0.4 points per year. RESULTS We used Bayesian hierarchical linear models to test the hypotheses, adjusting for multiple possible confounders. Eighty-eight patients were treated with chemotherapy; 277 were not. The mean age at diagnosis was 75.5. Patients were followed for a median of 3.1 years after diagnosis, with a range of 0 to 8.3 years. We found no differences in the rates of cognitive decline before and after diagnosis for patients who received chemotherapy in adjusted models (P=0.86, one-sided 95% posterior intervals lower bound: 0.09 worse after chemotherapy), where patients served as their own controls. Moreover, the rate of cognitive decline after diagnosis did not differ between patients who had chemotherapy and those who did not (P=0.84, one-sided 95% posterior intervals lower bound: 0.11 worse for chemotherapy group in adjusted model). CONCLUSIONS There was no evidence of cognitive decline associated with chemotherapy in this sample of older adults with breast and colorectal cancer.
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Affiliation(s)
- Victoria A Shaffer
- Department of Health Sciences, School of Health Professions, University of Missouri, Columbia, MO 65221-4290, USA.
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Blinman P, King M, Norman R, Viney R, Stockler MR. Preferences for cancer treatments: an overview of methods and applications in oncology. Ann Oncol 2012; 23:1104-1110. [PMID: 22234737 DOI: 10.1093/annonc/mdr559] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This review provides cancer clinicians and researchers with an overview of methods for assessing preferences, with examples and recommendations for their application in oncology. Decisions about cancer treatments involve trade-offs between their relative benefits and harms. An individual's preference for a cancer treatment reflects their evaluation of the relative benefits and harms in comparison with a given alternative or alternatives. Methods of preference assessment include the ranking or rating scale, standard gamble (SG), time trade-off (TTO), visual analogue scale, discrete choice experiment (DCE), and multi-attribute utility instrument (MAUI). The choice of method depends on the purpose of preference assessment; the ranking or rating scale, SG, TTO, and DCEs are best suited to clinical decisions, whereas MAUIs are best suited to health policy decisions. Knowledge of patients' preferences for cancer treatments can better inform clinical decisions about patient management by enabling the tailoring of decisions to individual patients' values, attitudes, and priorities and health policy decisions through economic evaluations of cancer treatments and their suitability for coverage by health payers.
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Affiliation(s)
- P Blinman
- NHMRC Clinical Trials Centre, University of Sydney, Sydney.
| | - M King
- Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, University of Sydney, Sydney
| | - R Norman
- Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney (UTS), Sydney
| | - R Viney
- Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney (UTS), Sydney
| | - M R Stockler
- NHMRC Clinical Trials Centre, University of Sydney, Sydney; Sydney Cancer Centre, Royal Prince Alfred and Concord Hospitals, Sydney, Australia
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[Surviving the initial phase: subjective theories of illness in patients suffering from acute leukaemia at the end of initial inpatient treatment]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2011; 57:141-56. [PMID: 21626478 DOI: 10.13109/zptm.2011.57.2.141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Studies concentrating on the temporal dependence of subjective concepts during oncological treatment are underrepresented. Subjective interpretation contexts develop in the course of illness. The study focuses on the ideal-typical gestalt of these contents. METHODS In a follow-up study on coping, 12 patients with acute leukaemia (AL) were interviewed using a semistructured interview at the end of initial inpatient treatment. Using qualitative methodology, we inductively developed categories and assigned them to formal main categories. RESULTS The following categories were developed: causal uncertainty as burden; discrepancy between subjective and objective assessment of degree of threat; knowledge of disease: conflict between information-seeking and information-avoiding behavior; dominance of medical approach to treatment; pursuit of normality; defense of emotions; orientation to workflows on the ward; adjustment as a coping strategy; positive attitude as a resource; life between hope and fear; limited future; latent fear of death. CONCLUSION Themes of coping with the disease become visible. Some of these contents are tacit and latent, although of high subjective relevance to the patient. Their consideration could improve the patient-physician relationship.
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Decisions for lung cancer chemotherapy: the influence of physician and patient factors. Support Care Cancer 2011; 19:1261-6. [DOI: 10.1007/s00520-011-1176-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 04/25/2011] [Indexed: 11/25/2022]
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Lung cancer clinicians’ preferences for adjuvant chemotherapy in non-small-cell lung cancer: What makes it worthwhile? Lung Cancer 2011; 72:213-8. [DOI: 10.1016/j.lungcan.2010.08.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Revised: 07/30/2010] [Accepted: 08/08/2010] [Indexed: 10/19/2022]
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Wood ME, Fama TA, Ashikaga T, Muss HB. Discrepancy between preference and actual adjuvant therapy for breast cancer. Clin Breast Cancer 2011; 10:398-403. [PMID: 20920985 DOI: 10.3816/cbc.2010.n.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Pretreatment preferences for adjuvant therapy were examined and compared with actual treatment received. PATIENTS AND METHODS Before definitive surgery, women with node-negative breast cancer were asked to indicate their preference for adjuvant therapy in response to 3 different clinical scenarios. The scenarios provided precise risk, benefit, and side effect information with low-, moderate-, or high-risk risk of death from breast cancer. Contingency table and Spearman rank correlation coefficients were used to examine associations. Kruskal-Wallis rank sum tests were used for group comparisons, with the Friedman rank sum test being used for correlated samples. RESULTS A total of 75 women enrolled between February 2002 and April 2005; 24% were aged > 65 years. After definitive surgery, 21% of women had ductal carcinoma in situ, and 89% had receptor-positive disease. There was a significant correlation between risk of recurrence and aggressiveness of treatment preferred (P < .001). After surgical staging, the high-risk group received more aggressive treatment compared with the low-risk group (P = .004). In the 51 women with invasive receptor-positive tumors, there was a significant difference (P = .002) in aggressiveness of treatment received based on risk of recurrence. Only 45% of the women received what they had preferred for the level of their risk before surgery. Women were more likely to receive a less aggressive therapy than they preferred initially (P = .0002). CONCLUSION This study is among the first to correlate pretreatment preference for therapy with the actual therapy received. Less than half of women received their indicated preference before definitive surgery, with most women receiving less aggressive therapy. Future studies will need to examine this discrepancy.
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Affiliation(s)
- Marie E Wood
- Department of Medicine, University of Vermont, Burlington, VT 05405.
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Information needs, decisional regret and satisfaction of older and younger adults with acute myeloid leukemia. J Geriatr Oncol 2010. [DOI: 10.1016/j.jgo.2010.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Estimation of an optimal chemotherapy utilisation rate for lung cancer: An evidence-based benchmark for cancer care. Lung Cancer 2010; 69:307-14. [DOI: 10.1016/j.lungcan.2009.11.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 11/24/2009] [Accepted: 11/29/2009] [Indexed: 11/21/2022]
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Blinman P, Alam M, Duric V, McLachlan SA, Stockler MR. Patients’ preferences for chemotherapy in non-small-cell lung cancer: A systematic review. Lung Cancer 2010; 69:141-7. [DOI: 10.1016/j.lungcan.2010.05.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 05/02/2010] [Indexed: 12/15/2022]
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Hitomi J, Kubota K, Ogawa Y, Hamada N, Murata Y, Nishioka A. Non-surgical therapy and radiologic assessment of stage I breast cancer treatment with novel enzyme-targeting radiosensitization: Kochi Oxydol-Radiation Therapy for Unresectable Carcinomas, type II (KORTUC II). Exp Ther Med 2010; 1:769-775. [PMID: 22993600 DOI: 10.3892/etm.2010.123] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 07/09/2010] [Indexed: 01/22/2023] Open
Abstract
The new enzyme-targeting radiosensitization treatment, Kochi Oxydol-Radiation Therapy for Unresectable Carcinomas, type II (KORTUC II), markedly enhances the radiotherapeutic effect of treatment for various types of locally advanced malignant neoplasms. Patients who had declined surgical treatment and systemic chemotherapy, as well as a total of 14 stage I breast cancer patients, were enrolled. A maximum of 6 ml of KORTUC II was injected into tumor tissue twice a week under ultrasonographic guidance, immediately prior to each administration of radiation therapy. The median observation period was 21.6 months with a range of 4-48 months, and the therapy was well tolerated. Contrast-enhanced magnetic resonance imaging and [(18)F]-fluorodeoxyglucose positron emission computed tomography revealed that all primary breast tumors completely responded, and none of the subjects experienced local recurrence during the observation period. Ultrasonography depicted tumor-like findings in 2/14 cases after therapy. The intratumoral flow signal on color-Doppler sonography was positive in 4/14 cases before therapy, and the signal disappeared from all cases after therapy. The absence of a flow signal after therapy suggested that the tumor-like findings on ultrasonography were from scar tissue. Excellent local control based on accurate radiological evaluation implies that KORTUC II has the potential to replace surgery as a therapeutic option for stage I breast cancer. Precise evaluation by various radiological modalities helped to gage the success of this therapy.
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Affiliation(s)
- Jiro Hitomi
- Department of Radiology, Kochi Medical School, Kochi University, Kochi 783-8505, Japan
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Adjuvant chemotherapy for early colon cancer: What survival benefits make it worthwhile? Eur J Cancer 2010; 46:1800-7. [DOI: 10.1016/j.ejca.2009.12.032] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 12/22/2009] [Accepted: 12/22/2009] [Indexed: 11/18/2022]
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In Reply. Oncologist 2009. [DOI: 10.1634/theoncologist.2008-0242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Coping with illness and subjective theories of illness in adult patients with haematological malignancies: systematic review. Crit Rev Oncol Hematol 2008; 69:237-57. [PMID: 19004639 DOI: 10.1016/j.critrevonc.2008.09.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Revised: 07/25/2008] [Accepted: 09/17/2008] [Indexed: 11/21/2022] Open
Abstract
In parallel to development of individualised antineoplastic treatment, scientific interest in patients' subjective theories of illness (STOI) has emerged in the oncological community. STOI depend decisively on patients' information about their disease. Coping with illness is dependent from the individual situation and context, and it is generally modulated by patients' STOI. The purpose is fivefold: (1) to provide a thorough literature review about coping and about STOI in adult haematological patients, (2) to survey through which indicators the topics were operationalized in studies, (3) to clarify the kind of coherence between these two topics, (4) to explicate the interaction between STOI and other variables, and (5) to verify the clinical relevance of both topics. We searched 19 electronic databanks for English biomedical literature manuscripts (1995-2008) on this subject. Twenty-six studies met our criteria and varied in haematological entity, treatment concept, sample size and methodological design. We conclude that a subjective-individual regulation of patient's mental stability during a cytotoxic chemotherapy is important. Successful coping strategies develop not only based on objective, but also subjective evaluation mechanisms. We deduce consequences for doctor-patient communication and psychosocial care in haematology. The newly developed process model of subjective regulation in cancer patients, in general, views the oncological treatment process as a procedural mental evaluation.
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Decision making and quality of life in the treatment of cancer: a review. Support Care Cancer 2008; 17:117-27. [DOI: 10.1007/s00520-008-0505-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2008] [Accepted: 09/04/2008] [Indexed: 10/21/2022]
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Bossema ER, Marijnen CAM, Baas-Thijssen MCM, van de Velde CJH, Stiggelbout AM. Evaluation of the treatment tradeoff method in rectal cancer patients: is surgery preference related to outcome utilities? Med Decis Making 2008; 28:888-98. [PMID: 18519887 DOI: 10.1177/0272989x08317013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The treatment tradeoff method (TTM) has been developed specifically for decision making at the level of the individual patient. The task is tailored to the clinical decision problem at hand and may therefore be more relevant to patients than methods of outcome valuation. Despite its wide use in oncology research, few methodological studies regarding validity have been conducted. OBJECTIVE AND METHODS The present study evaluates the validity of the TTM in rectal cancer patients who had undergone either 1 of 2 surgery types: 1 requiring a permanent stoma (stoma group) and 1 involving a postoperative risk of fecal incontinence (no-stoma group). The authors relate the surgery preference scores to the utilities of the 2 main surgery outcome states as well as to their utility difference. RESULTS Surgery preference was more strongly associated with the utility difference (r > 0.54 in the total patient group) than with the utilities of the surgery outcome states per se (r < 0.44 in the total patient group). In the stoma group, surgery preference was especially related to the utility of incontinence and in the no-stoma group especially to the utility of a permanent stoma. CONCLUSIONS Patients indeed use their valuations of treatment outcomes states, especially those they are less familiar with, in determining their preference for one treatment over another. In clinical practice, the TTM may be used to obtain an indication of the treatment preference of an individual patient and may also be helpful to detect patients' motives to choose one treatment over another.
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Affiliation(s)
- Ercolie R Bossema
- Department of Clinical Oncology, Leiden University Medical Center, the Netherlands
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Di Costanzo F, Doni L. Adjuvant therapy in colon cancer: which treatment in 2005? Ann Oncol 2008; 16 Suppl 4:iv69-73. [PMID: 15923433 DOI: 10.1093/annonc/mdi911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- F Di Costanzo
- Medical Oncology Unit, Department of Oncology, University Hospital Careggi, Florence, Italy.
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Gray R, Barnwell J, McConkey C, Hills RK, Williams NS, Kerr DJ. Adjuvant chemotherapy versus observation in patients with colorectal cancer: a randomised study. Lancet 2007; 370:2020-9. [PMID: 18083404 DOI: 10.1016/s0140-6736(07)61866-2] [Citation(s) in RCA: 928] [Impact Index Per Article: 54.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of the QUASAR trial was to determine the size and duration of any survival benefit from adjuvant chemotherapy for patients with colorectal cancer at low risk of recurrence, for whom the indication for such treatment is unclear. METHODS After apparently curative resections of colon or rectal cancer, 3239 patients (2963 [91%] with stage II [node negative] disease, 2291 [71%] with colon cancer, median age 63 [IQR 56-68] years) enrolled between May, 1994, and December, 2003, from 150 centres in 19 countries were randomly assigned to receive chemotherapy with fluorouracil and folinic acid (n=1622) or to observation (with chemotherapy considered on recurrence; n=1617). Chemotherapy was delivered as six 5-day courses every 4 weeks or as 30 once-weekly courses of intravenous fluorouracil (370 mg/m2) with high-dose (175 mg) L-folinic acid or low-dose (25 mg) L-folinic acid. Until 1997, levamisole (12 courses of 450 mg over 3 days repeated every 2 weeks) or placebo was added. After 1997, patients who were assigned to receive chemotherapy were given fluorouracil and low-dose folinic acid only. The primary outcome was all-cause mortality. Analyses were done by intention to treat. This trial is registered with the International Clinical Trial Registry, number ISRCTN82375386. FINDINGS At the time of analysis, 61 (3.8%) patients in the chemotherapy group and 50 (3.1%) in the observation group had missing follow-up. After a median follow-up of 5.5 (range 0-10.6) years, there were 311 deaths in the chemotherapy group and 370 in the observation group; the relative risk of death from any cause with chemotherapy versus observation alone was 0.82 (95% CI 0.70-0.95; p=0.008). There were 293 recurrences in the chemotherapy group and 359 in the observation group; the relative risk of recurrence with chemotherapy versus observation alone was 0.78 (0.67-0.91; p=0.001). Treatment efficacy did not differ significantly by tumour site, stage, sex, age, or chemotherapy schedule. Eight (0.5%) patients in the chemotherapy group and four (0.25%) in the observation group died from non-colorectal cancer causes within 30 weeks of randomisation; only one of these deaths was deemed to be possibly chemotherapy related. INTERPRETATION Chemotherapy with fluorouracil and folinic acid could improve survival of patients with stage II colorectal cancer, although the absolute improvements are small: assuming 5-year mortality without chemotherapy is 20%, the relative risk of death seen here translates into an absolute improvement in survival of 3.6% (95% CI 1.0-6.0).
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Abstract
The impact of improved treatments for the management of hormone-sensitive breast cancer extends beyond clinical responses. Thanks to appropriate literature and access to the internet, patient awareness of treatment options has grown and patients are now, in many cases, able to engage their oncologists in informed conversations regarding treatment and what to expect in terms of efficacy and safety. Indeed, patients realize that although there is no cure for metastatic disease, treatment can greatly reduce the risk of progression and in the adjuvant setting, where treatment is administered with a curative intent, current treatment options reduce the risk of relapse. The approval of letrozole throughout the breast cancer continuum has provided patients with many reassuring options. The improvement in outcome with letrozole is achieved without a detrimental effect on overall quality of life. Adverse events such as hot flushes, arthralgia, vaginal dryness, and potential osteoporosis are most significant from the patient's perspective, and it is important that caregivers pay attention to patients experiencing these events, as they can impact compliance unless effectively explained and managed. The major benefits of letrozole are to improve prospects for long-term survivorship in the adjuvant setting and to delay progression and the need for chemotherapy in the metastatic setting.
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Affiliation(s)
- Nadia Harbeck
- Frauenklinik der Technischen Universität München, Ismaninger Strasse 22, Münich, 81675 Germany
| | - Renate Haidinger
- Frauenklinik der Technischen Universität München, Ismaninger Strasse 22, Münich, 81675 Germany
- Brustkrebs Deutschland e.V., Charles-de-Gaulle-Str. 6, Münich, 81737 Germany
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Clinical epidemiology of breast cancer in the elderly. Eur J Cancer 2007; 43:2242-52. [PMID: 17870517 DOI: 10.1016/j.ejca.2007.08.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2007] [Revised: 07/31/2007] [Accepted: 08/01/2007] [Indexed: 12/27/2022]
Abstract
Breast cancer will increasingly become a disease affecting the lives of older women, especially in more developed countries, the prevalence rising up to 7% over age 70 in the near future. A review of the population-based literature and an analysis of the data of the Eindhoven Cancer Registry and European data regarding the diagnosis, treatment and prognosis showed that the proportion with unstaged and advanced disease (stages III and IV) is higher among elderly patients compared to younger ones and that their treatment is generally less aggressive, although the proportion receiving chemotherapy is increasing since the early 1990s. Disease specific (or relative) survival of elderly breast cancer patients is generally lower and the prevalence of serious (life expectancy affecting) co-morbidity is higher (>50% in patients over age 70). Because of large individual variations in physical and mental conditions, limited evidence from RCTs and personal preferences prevailing in the decision-making process, treatment of older breast cancer patients seems difficult to fit into guidelines. Therefore, alternative research strategies are needed to understand and improve the care for the elderly breast cancer population, such as descriptive (registry-based) studies and a qualitative, individual-based approach.
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Butt Z, Wagner LI, Beaumont JL, Paice JA, Straus JL, Peterman AH, Carro G, Von Roenn JH, Shevrin D, Cella D. Longitudinal screening and management of fatigue, pain, and emotional distress associated with cancer therapy. Support Care Cancer 2007; 16:151-9. [PMID: 17609992 DOI: 10.1007/s00520-007-0291-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2007] [Accepted: 06/12/2007] [Indexed: 11/29/2022]
Abstract
GOALS OF WORK Fatigue, pain, and emotional distress are common symptoms among patients with cancer. We sought to learn about patient perceptions of these symptoms and their treatment. MATERIALS AND METHODS At a baseline assessment and two monthly follow-up assessments, we asked a diverse sample of patients with solid tumor or lymphoma (N = 99) about their fatigue, pain and distress, their treatment for these symptoms, and their satisfaction with treatment via standardized questionnaires and semistructured interviews. MAIN RESULTS In this observational study, patients reported fatigue, pain, emotional distress, and general quality of life at expected levels. Across all assessments, at least half of our sample experienced at least some fatigue, pain, or distress. On the whole, patients and providers do communicate about these concerns, and at least 75% of patients found these discussions helpful when they occurred. CONCLUSIONS Improved symptom identification and communication may optimize the detection of those at risk of morbidity and decreased quality of life because of excess symptom burden.
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Affiliation(s)
- Zeeshan Butt
- Center on Outcomes, Research and Education (CORE), Evanston Northwestern Healthcare, Evanston, IL 60201, USA.
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Blank T, Graves K, Sepucha K, Llewellyn-Thomas H. Understanding treatment decision making: contexts, commonalities, complexities, and challenges. Ann Behav Med 2007; 32:211-7. [PMID: 17107293 DOI: 10.1207/s15324796abm3203_6] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The diagnosis of cancer sets off a cascade of complex decisions at a time when patients feel vulnerable and distressed. Although clinical decisions used to follow one standard, many guidelines now outline several options and include explicit recognition of the need to incorporate patients' preferences to determine the most appropriate treatment. PURPOSE The purpose of this article is to provide a brief overview of empirical studies about cancer patients' treatment-related decision making, to highlight the areas of congruence and divergence in that empirical literature, and then to generate a framework that points to future interventions and research. METHODS Through a group discussion with a range of experts in the field, we generated a framework for the critical treatment decisions and key issues within those decisions. Then, we reviewed the literature describing the experiences of cancer patients and evaluating interventions designed to improve the quality of treatment decisions. RESULTS We identified four major differences that influence decision making across cancers and across individuals with the same diagnosis. We also identified four common themes across situations and people. There is considerable evidence that decision aids can improve the quality of decisions across a range of diseases, although the data for cancer treatment decision making are limited. Other interventions such as navigation-skill training are promising but have little evidence of benefit for cancer decisions. CONCLUSIONS There are many opportunities for behavioral research to extend and contribute to the understanding and improvement of cancer treatment decision making. Some key areas in need of research include developing taxonomies of disease and patient characteristics and increasing understanding of the lived experiences of cancer survivors, of the influence of time and timing, of the relationship of information and preferences, and of participation in randomized clinical trials.
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Affiliation(s)
- Thomas Blank
- Human Development and Family Studies, University of Connecticut, Storrs, CT 06269-2058, USA.
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Bramlette TB, Lawson DH, Washington CV, Veledar E, Johns BR, Brisman SF, Abramova L, Chen SC. Interferon Alfa-2b or not 2b? Significant differences exist in the decision-making process between melanoma patients who accept or decline high-dose adjuvant interferon Alfa-2b treatment. Dermatol Surg 2007; 33:11-6. [PMID: 17214673 DOI: 10.1111/j.1524-4725.2007.33001.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients with thick (Breslow>4 mm) primary melanoma and/or regional nodal metastasis have a high risk of tumor recurrence. High-dose adjuvant interferon (IFN) alfa-2b offers<or=10% improvement in relapse-free survival and overall survival with significant toxicity. OBJECTIVE The objective was to determine which prognostic factors and patient characteristics are significant in the decision to undergo IFN therapy. METHODS Of 781 patients who underwent sentinel lymph node (SLN) biopsy, 135 of 781 (17.3%) had positive SLN or thick melanomas and were informed of a >/=50% risk of recurrence/disease-related mortality and offered IFN. Telephone surveys delineated reasons behind patients' decisions to accept IFN. RESULTS Acceptors, 60 of 135 (45%), decided to take IFN alfa-2b whereas 75 of 135 (55%) declined. Being female (OR, 2.4; 95% CI, 1.17-5.03; p=.017) and positive SLN status (OR, 2.2; 95% CI, 1.01-4.97; p=.048) were strongly associated with patients who chose IFN. Acceptors of IFN were younger, more influenced by physicians, and less affected by depression and side effect profile (p<.05 for all). Decliners were more concerned by strained relationships with family and social life (p<.05). CONCLUSIONS Gender and positive SLN were predictive of high-risk melanoma patients' acceptance of IFN treatment. Physician insight into melanoma patients' therapeutic decision-making process can guide patients through this difficult disease.
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Affiliation(s)
- Tracy B Bramlette
- Department of Dermatology, Winship Cancer Institue, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
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Interferon Alfa-2b or Not 2b? Significant Differences Exist in the Decision-Making Process between Melanoma Patients Who Accept or Decline High-Dose Adjuvant Interferon Alfa-2b Treatment. Dermatol Surg 2007. [DOI: 10.1097/00042728-200701000-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Stiggelbout AM, Jansen SJT, Otten W, Baas-Thijssen MCM, van Slooten H, van de Velde CJH. How important is the opinion of significant others to cancer patients’ adjuvant chemotherapy decision-making? Support Care Cancer 2006; 15:319-25. [PMID: 17120070 DOI: 10.1007/s00520-006-0149-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2006] [Accepted: 08/17/2006] [Indexed: 10/23/2022]
Abstract
GOALS Decisions regarding adjuvant chemotherapy are difficult, since value tradeoffs are involved. Little is known about the importance of the significant others in patients' decision-making regarding adjuvant treatment. We surveyed patients with breast and colorectal cancer about the importance they assigned to the opinions of their significant others and assessed correlates of these importance scores. MATERIALS AND METHODS One hundred and twenty-three patients rated on a five-point scale how much they cared about the opinion of six significant others. MAIN RESULTS Most important was the opinion of their treating specialist, followed by that of their partner, children, other family, friends, and colleagues. Women assigned higher scores to the opinion of their children, younger patients to that of their specialist, and patients who were about to undergo chemotherapy to that of their family. Patients with breast cancer and patients without paid employment assigned slightly more importance to the opinion of their partner. CONCLUSIONS Information on the influence of significant others may help clinicians when involving patients in treatment decision-making and discussing patients' treatment preferences.
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Affiliation(s)
- A M Stiggelbout
- Department of Medical Decision Making, Leiden University Medical Center, P.O. Box 9600, 2300, Leiden, The Netherlands.
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Locadia M, van Grieken RA, Prins JM, de Vries HJC, Sprangers MAG, Nieuwkerk PT. Patients’ Preferences regarding the Timing of Highly Active Antiretroviral Therapy Initiation for Chronic Asymptomatic HIV-1 Infection. Antivir Ther 2006. [DOI: 10.1177/135965350601100309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective In patients with a chronic asymptomatic HIV-1 infection and >200 CD4+ T-cells/μl, the optimal timing of highly active antiretroviral therapy (HAART) initiation is unclear. It involves a trade-off between a potentially reduced risk of mortality, when started earlier in the course of infection, and an earlier exposure to pill burden and potential toxicities. We investigated patients’ preferences for immediate HAART initiation relative to delaying HAART for 1 year. Methods Consecutive patients were asked for their preference during an interview. A hypothetical difference in 3-year mortality risk between both options was systematically varied between 0% and 10% to determine the threshold at which preference would switch to HAART initiation. Results About 30% of patients preferred HAART initiation even if the mortality risk would be equal for both options. Almost 25% always preferred delaying HAART even if this would result in a 10% greater mortality risk. Most treatment guidelines recommend delaying HAART >350 CD4+ T-cells/μl However, at a risk difference between starting and delaying HAART that corresponds with this CD4+ T-cell count, about 50% would prefer to start HAART immediately. Most guidelines recommend starting HAART below 200 CD4+ T-cells/μl However, at a risk difference between both options corresponding with this CD4+ T-cell count, about 40% preferred delaying HAART. Conclusions We found large variation in patients’ preferences. Some patients were more inclined to initiate HAART earlier than the recommended guidelines, whereas others were more inclined to delay HAART. These findings emphasize the need for shared decision-making when deciding on the most optimal timing of HAART initiation in chronic asymptomatic HIV-1 infection.
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Affiliation(s)
- Mirjam Locadia
- Department of Medical Psychology, Academic Medical Center, Amsterdam, Netherlands
| | - Rosa A van Grieken
- Department of Medical Psychology, Academic Medical Center, Amsterdam, Netherlands
| | - Jan M Prins
- Department of Internal Medicine, Academic Medical Center, Amsterdam, Netherlands
| | - Henry JC de Vries
- Department of Dermatology, Academic Medical Center, Amsterdam, Netherlands
- Division of Infectious Diseases, Municipal Health Service, Amsterdam, Netherlands
| | - Mirjam AG Sprangers
- Department of Medical Psychology, Academic Medical Center, Amsterdam, Netherlands
| | - Pythia T Nieuwkerk
- Department of Medical Psychology, Academic Medical Center, Amsterdam, Netherlands
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Blazeby JM, Wilson L, Metcalfe C, Nicklin J, English R, Donovan JL. Analysis of clinical decision-making in multi-disciplinary cancer teams. Ann Oncol 2006; 17:457-60. [PMID: 16322114 DOI: 10.1093/annonc/mdj102] [Citation(s) in RCA: 160] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Management decisions for patients with cancer are frequently taken within the context of a multi-disciplinary team (MDT). There is little known, however, about decision-making at team meetings and whether MDT decisions are all implemented. This study evaluated team decision-making in upper gastrointestinal cancer. Consecutive MDT treatment decisions were recorded for patients with oesophageal, gastric, pancreatic and peri-ampullary tumours. Implementation of MDT decisions was investigated by examining hospital records. Where decisions were implemented it was recorded as concordant and discordant if the decision changed. Reasons for changes in MDT decisions were identified. 273 decisions were studied and 41 (15.1%) were discordant (not implemented), (95% confidence interval 11.1-20.0%). Looking at the reasons for discordance, 18 (43.9%) were due to co-morbid health issues, 14 (34.2%) related to patient choice and 8 (19.5%) decisions changed when more clinical information was available. For one discordant decision, the reason was not apparent. Discordant decisions were more frequent for patients with pancreatic or gastric carcinoma as compared to oesophageal cancer (P = 0.001). Results show that monitoring concordance between MDT decisions and final treatment implementation is useful to inform team decision-making. For upper gastrointestinal cancer, MDTs require more information about co morbid disease and patient choice to truly optimize the implementation of multi-disciplinary expertise.
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Affiliation(s)
- J M Blazeby
- Department of Social Medicine, Canynge Hall, University of Bristol, Bristol, UK.
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Duric VM, Butow PN, Sharpe L, Boyle F, Beith J, Wilcken NRC, Heritier S, Coates AS, John Simes R, Stockler MR. Psychosocial factors and patients' preferences for adjuvant chemotherapy in early breast cancer. Psychooncology 2006; 16:48-59. [PMID: 16856128 DOI: 10.1002/pon.1045] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE Many women who have had adjuvant chemotherapy for early breast cancer judge small benefits sufficient to make it worthwhile despite significant side effects and inconvenience. The rationality of these preferences has been questioned. We sought to better understand such preferences by assessing associations between preferences and psychosocial factors, and by asking women who judged negligible benefits sufficient to explain why. METHODS We recruited 83 consecutive consenting women who had completed adjuvant chemotherapy for early breast cancer 3-34 months earlier. Preferences were elicited during a structured, scripted interview using four sets of validated, hypothetical trade-off scenarios about the possible benefits of adjuvant chemotherapy on survival times (5 and 15 years) and rates (65 and 85% at 5 years). Women completed questionnaires measuring anxiety, depression, optimism, quality and quantity of social support, and illness perceptions. RESULTS More than half the women judged benefits of 1 day or 0.1% sufficient to make adjuvant chemotherapy worthwhile. The most important factors in multivariable models were whether the woman had dependants and number of non-specific symptoms attributed to breast cancer and adjuvant chemotherapy since completing treatment. The proportion of variance explained was modest. Preferences were not associated with: scores for anxiety, optimism, and perceived quality and quantity of social support. Explanations for judging negligible benefits sufficient included minimising regret, parenting concerns, doubts about the information provided and feeling that they had no choice. CONCLUSIONS Preferences were highly variable and influenced by women's unique circumstances and attitudes, but not by their anxiety or optimism scores.
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Affiliation(s)
- Vlatka M Duric
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia.
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Hurley KE, Chapman PB. Helping Melanoma Patients Decide Whether to Choose Adjuvant High‐Dose Interferon‐α2b. Oncologist 2005; 10:739-42. [PMID: 16249355 DOI: 10.1634/theoncologist.10-9-739] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
High-dose interferon-alpha2b is a U.S. Food and Drug Administration-approved adjuvant treatment for stage III melanoma, and yet, because of its limited efficacy and well-known toxicity, it is not universally accepted by patients and oncologists. In this paper, we evaluate the benefits and risks of adjuvant high-dose interferon-alpha2b and try to provide a framework to help oncologists guide patients trying to decide whether to undergo adjuvant high-dose interferon therapy.
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Affiliation(s)
- Karen E Hurley
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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Sparano JA, Fazzari MJ, Childs G. Clinical application of molecular profiling in breast cancer. Future Oncol 2005; 1:485-96. [PMID: 16556025 DOI: 10.2217/14796694.1.4.485] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Breast cancer is the leading type of cancer and second leading cause of cancer death in women. Breast cancer mortality has declined over the past 10 years largely due to early detection by mammographic screening, but also in part due to the increasing use of adjuvant hormonal therapy and chemotherapy. Indications for adjuvant chemotherapy have now expanded to include women who are at low risk of recurrence, resulting in overtreatment of most women to benefit a few, particularly those with favorable clinical features. New techniques have been evaluated that identify specific molecular signatures that may more accurately predict prognosis than clinical features, and that may also identify individuals who are more likely to benefit from endocrine therapy and/or chemotherapy. This review will focus on the clinical applications of these novel techniques reported to date, and how this may lead to the incorporation of molecular diagnostics into clinical practice. Two prospective, multicenter, multinational Phase III trials evaluating tumor genomic profiling in breast cancer are currently in development, and will be initiated within the forthcoming year. The completion of these important studies will represent the first step toward integrating molecular profiling into treatment selection for adjuvant therapy in breast cancer.
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Affiliation(s)
- Joseph A Sparano
- Montefiore-Einstein Cancer Center, Albert Einstein College of Medicine, Room 47, 1825 Eastchester Road, 2 South, Bronx, NY 10461, USA.
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