USING A TREATMENT-TRADEOFF METHOD TO ELICIT PREFERENCES FOR THE TREATMENT OF LOCALLY ADVANCED NON-SMALL-CELL LUNG-CANCER

The study was designed to evaluate a treatment-tradeoff method for its potential in helping lung cancer patients make treatment decisions. A treatment-tradeoff interview was conducted to determine how patients weighed potential survival benefits against the potential toxicities o f different treatment options: 1) low-dose versus high-dose radiothera py, and 2) high-dose radiotherapy versus combination chemo-radiotherap y. Fifty-six patients who had experienced cancer and 20 clinic staff p articipated; twenty of these participants repeated the interview in an assessment of response consistency. The treatment-tradeoff method pro ved feasible: all staff and 53 of the 56 patients were able to complet e the process. A wide range of threshold scores across participants wa s observed for both tradeoffs. Sixty percent of the patients would acc ept the more toxic combination therapy over high-dose radiotherapy if the former offered a 10% absolute improvement in three-year survival. The method also proved reliable: test-retest correlations were high (t au ranged from 0.7 to 0.87 and r from 0.82 to 0.94) and test-retest me an score differences were low (1.3-4.2). The most clinically useful me asure of consistency was a ''preference consistency'' index, which rev ealed that most patients declared the same treatment preference at tes t and retest. The authors conclude that, while there is great interind ividual variability in willingness to accept aggressive treatments for lung cancer, patients' values can be consistently elicited with the t radeoff method. The method has potential for clinical application in d ecision making and for health-care policy development.