SURVEILLANCE VERSUS ADJUVANT CHEMOTHERAPY IN STAGE-I NONSEMINOMATOUS TESTICULAR CANCER - A DECISION-ANALYSIS

In stage I non-seminomatous testicular cancer, the decision between su rveillance and adjuvant chemotherapy rests heavily upon the valuation of quality of life. Decision analysis was used to assess at what relap se rate adjuvant chemotherapy is preferred when patients' and clinicia ns' valuations are considered. Probabilities were obtained from the li terature and from experts. Valuations of the disease states were obtai ned from patients (n = 68) and clinicians (n = 50). Results from the m odel were compared with a treatment preference question, asking for th e relapse rate directly. Adjuvant chemotherapy was preferred at relaps e rates above 50% when patient valuations were used. The valuations of the disease states had a strong impact on the decision. Using clinici an valuations, adjuvant chemotherapy was preferred at relapse rates ab ove 73%. The relapse rates from the treatment preference question were lower: 46% for patients and 35% for clinicians. The results indicate that when patient preferences are accounted for, adjuvant chemotherapy should be considered more often. Copyright (C) 1996 Elsevier Science Ltd