PATIENT PREFERENCE FOR HIGH OR LOW-DOSE RATE BRACHYTHERAPY IN CARCINOMA OF THE CERVIX

High and low dose rate are two competing methods of brachytherapy. Exi sting data do not support choosing one method over the other for treat ing carcinoma of the uterine cervix. Arguments include clinical effica cy, monetary cost, radiation safety, and patient preference. There are no published data on patient preference. We developed a questionnaire to elicit patient preference and to measure its strength. Subjects re ceived descriptions of both treatment options and their probable outco mes. We elicited preference for one low or three high dose rate fracti ons, and for two low or five high dose rate fractions, assuming both m ethods to be isoeffective. Strength of initial preference was measured by asking subjects how much of a change, in either the chances for cu re or the chances for toxicity, would make them change preference. The questionnaire was completed by female staff at our centre (n = 90), b y a group of previously treated patients (n = 18), and by a group of n ewly diagnosed patients (n = 20). When both methods were assumed to be isoeffective, only 34% of the 38 patients preferred three fractions o f high dose rate to one fraction of low dose rate. However, when high dose rate was assumed to be 2% more curative, or 6% less toxic, a simp le majority of 50% then said they would prefer high dose rate. Both pr eference and strength of preference for low dose rate were significant ly associated with a greater travelling distance for treatments. Age, marital status, family structure, education, employment, and family in come were not associated. In summary, a majority of our patients prefe rred low dose rate brachytherapy. Preference changed predictably with differences in fraction numbers, efficacy, toxicity, and travelling di stance.