BREAST-CANCER PATIENTS ATTITUDES ABOUT RATIONING POSTLUMPECTOMY RADIATION-THERAPY - APPLICABILITY OF TRADE-OFF METHODS TO POLICY-MAKING

Purpose: Along with evidence, clinical policies must take patients' va lues into account, Particularly where evidence is limited and where as sumptions of utility-maximizing behavior may not be valid, new methods such as tradeoff techniques (TOTs), which allow elicitation of patien ts' treatment alternatives, might be useful in policy Formulation, We used TOTs to assess breast cancer patients' attitudes toward two clini cal policies designed to ration adjuvant postlumpectomy breast radiati on therapy, Methods: Cross-sectional interviews were performed in a te rtiary cancer center, A total of 102 patients were presented with info rmation about the side effects and benefits associated with two hypoth etical decisions: (1) willingness to receive treatment elsewhere to sh orten the wait for radiation therapy, and (2) foregoing radiation ther apy in the face of small marginal benefits. For each scenario, a TOT w as used to identify the maximal acceptable wait time (MAWT) for therap y and the benefit threshold at which the patient would forego therapy. Associations of clinical and demographic factors with these decisions were determined by regression analysis. Results: Patients would be wi lling to wait, on average, 7 weeks before wanting to leave their city for radiation therapy, less than the 13-week delay our patients actual ly faced. Older patients were less willing to wait (P = .013); 46% of patients would not give up radiation therapy, even in the face of no s tated benefit, Willingness to give up radiation therapy was predicted by willingness to accept delay (odds ratio [OR], 1.84; 95% confidence interval [CI], 1.05 to 3.37) and being employed (OR, 2.61; 95% CII 1.0 8 to 6.54), patients with larger tumors were less willing to give up r adiation therapy (OR, 0.57; 95% CI, 0.31 to 0.97). Conclusion: Even in difficult decisions such as rationing postlumpectomy breast cancer ra diation therapy, TOTs can inform policy formulation by indicating the distributions of patients' preferences. (C) 1997 by American Society o f Clinical Oncology.