TRADING TREATMENT TOXICITY FOR SURVIVAL IN LOCALLY ADVANCED NONSMALL CELL LUNG-CANCER

Purpose: To determine how patients weigh potential survival benefits a gainst the potential toxicity of different treatment strategies for lo cally advanced non-small cell lung cancer (NSCLC), Specifically, we we re interested in what improvement in survival probability patients wou ld want to have before accepting more toxic therapy. Patients and Meth ods: Fifty-six outpatients who herd experienced lung cancer (n = 22) o r prostate cancer (n = 34), and 20 clinic nurses and radiation therapy technologists participated. A treatment trade-off interview was condu cted with each participant that compared low-dose versus high-dose rad iotherapy and high-dose radiotherapy versus combination chemo-radiothe rapy. Preferences for treatments were assessed by systematically incre asing the hypothetical survival advantage of the more toxic treatment until the person reached his or her threshold for choosing the more to xic treatment, Results: A wide range of thresholds was observed for bo th groups. The distributions of survival advantage thresholds for sung cancer and prostate cancer patients were not significantly different but were generally lower thresholds than those declared by staff. If t he 3-year survival advantage wets 10%, 60% of patients and 15% of staf f would consider combination therapy over high-dose radiotherapy, With in patients, apparent willingness to consider more toxic treatments wa s not significantly related to age, sex, education, or preferred role in decision making, The treatment trade-off method had good test-retes t reliability, Conclusion: There is great interindividual variability in willingness to accept aggressive treatments for locally advanced NS CLC, When choosing NSCLC treatment, each patient should be provided wi th comprehensive information about the options so that he or she may e xpress his or her preferences should he or she wish to participate in the decision. (C) 1997 by American Society of Clinical Oncology.