PATIENT PREFERENCES FOR TREATMENT OF METASTATIC BREAST-CANCER - A STUDY OF WOMEN WITH EARLY-STAGE BREAST-CANCER

Purpose: The purpose of this study was to elicit preferences for the t reatment of metastatic breast cancer in women with early-stage breast cancer who were given hypothetical treatment scenarios. We predicted t hat quality of life, demographic, and treatment variables would have a n impact on patient preferences.Patients and Methods: One hundred fift een patients with stage 1-IIIA breast cancer were interviewed. All pat ients had either mastectomy or lumpectomy plus radiotherapy as primary treatment. Sixty-seven (58%) had prior adjuvant chemotherapy. Patient s were given four clinical scenarios that described a woman with metas tatic breast cancer who was stared to have a life expectancy of 18 mon ths. Side effects of the treatment options were systematically varied from low (hormonal therapy) to life-threatening (high-dose experimenta l therapy) and were consistent with common clinical situations. Patien ts were asked to select which treatment, with its associated toxicity, they would accept and prefer for a 50% chance of specified increments in life expectancy, ie, 5 years, 18 months, 1 year, 6 months, 1 month , and 1 week. Results: Quality of life at the time of interview, previ ous chemotherapy treatment, and degree of difficulty of previous treat ments did not predict patient preferences. The greater the toxicity po tential of the treatment, the less likely patients were to accept the treatment, although approximately 15% of patients would prefer high-ri sk treatment for os little as 1 month of added life expectancy. Betwee n 34% and 82% of patients would prefer different therapies for a 6-mon th addition to life expectancy, whereas almost all patients would acce pt treatment for a 5-year increase in length of survival. Younger pati ents were more willing to assume the risks of treatment for a small in crease in life expectancy. Of note, between 54% and 78% of patients wo uld elect to start the different treatments even without symptoms rela ted to metastatic disease. Moreover, 76% of patients would prefer stan dard treatment or an experimental agent to reduce symptoms or pain, ev en if such treatment did not prolong life. Additionally, only 10% of p atients would allow randomization to a clinical trial comparing high-d ose with standard chemotherapy. Participation in the study was not dis tressing to most patients. Conclusion: Patients showed clear preferenc es for specific treatments for metastatic disease when given hypotheti cal scenarios. There was a wide range of patient preferences for treat ment based on risk-benefit assessment, but a substantial percentage of patients would accept the risk of major toxicity for minimal increase in overall survival. J Clin Oncol 13:858-868. (C) 1995 by American So ciety of Clinical Oncology.