PREFERENCES FOR CHEMOTHERAPY IN PATIENTS WITH ADVANCED NONSMALL CELL LUNG-CANCER - DESCRIPTIVE STUDY BASED ON SCRIPTED INTERVIEWS

Objective: To determine how patients with lung cancer value the trade off between the survival benefit of chemotherapy and its toxicities. D esign: Scripted interviews that included three hypothetical scenarios. Each scenario described the same patient with metastic non-small cell lung cancer with an expected survival of 4 months without treatment. Subjects were asked to indicate the minimum survival benefit required to accept the side effects of chemotherapy in the first two scenarios (mild toxicity and severe toxicity). In the third scenario, subjects w ere asked to choose between chemotherapy and supportive care when the benefit of chemotherapy was either to prolong life by 3 months or to p alliate symptoms. Subjects: 81 patients previously treated with cis-pl atinum based chemotherapy for advanced non-small cell lung cancer. Mai n outcome measure: Survival threshold for accepting chemotherapy. Resu lts: The minimum survival threshold for accepting the toxicity of chem otherapy varied widely in patients. Several patients would accept chem otherapy fur a survival benefit of 1 week, while others Many would not choose chemotherapy even for a survival benefit of 24 months. The med ian survival threshold for accepting chemotherapy was 4.5 months for m ild toxicity and 9 months for severe toxicity. When given the choice b etween supportive care and chemotherapy only 18 (22%) patients chose c hemotherapy for a survival benefit of 3 months; 55 (68%) patients chos e chemotherapy if it substantially reduced symptoms without prolonging life. Conclusions: Patients' willingness to accept chemotherapy for t he treatment of metastatic lung cancer varies widely Many would not ch oose chemotherapy for its likely survival benefit of 3 months but woul d if it improved quality of life. The conflict between these patients' preferences and the care they previously received has several explana tions, one being that some patients had not received the treatment the y would have chosen had they been fully informed.