PATIENT PREFERENCES FOR INTERFERON-ALFA IN MULTIPLE-MYELOMA

Purpose: Interferon alfa treatment in multiple myeloma marginally impr oves relapse-free and overall survival, Often it does so of the expens e of toxicity and financial cost, If patients are unwilling or enable to participate in the decision of whether to initiate such treatment, known patient preferences can serve as guidelines for the physician, W e interviewed myeloma patients in the United States to obtain informat ion that might facilitate medical decision-making. Patients and Method s: Three hundred fifty-five myeloma patients throughout the United Sta tes were interviewed by telephone. Without identifying interferon alfa as the treatment agent, interviewers described potential adverse effe cts, financial cost, and self-injection procedures. The potential bene fits of four treatment choices, derived from a meta-analysis of publis hed data, were presented as gains in remission rate (+10%), remission duration (an additional 4 and 7 months, respectively, for induction an d maintenance treatment), and overall survival (an additional 3 and 6 months, respectively, for induction and maintenance treatment), Patien ts' choices for or against use of the unidentified substance were reco rded, and interferon was subsequently disclosed as the treatment. The profiles of patients making different choices were determined using mu ltivariate regression techniques. Results: Approximately half of the p atients accepted the unidentified treatment if remission and/or surviv al improved by at least 6 months. Accepters were younger and more like ly to have used interferon. Of patients who rejected the unidentified treatment, 25% to 50% would have been willing to accept it if the bene fits were greater than or equal to 12 months. Test/retest reliability of all choices, determined in 36 cancer patients, was 0.896. Conclusio n: In multiple myeloma, interferon therapy and, by inference, other tr eatments with comparable features are acceptable to approximately half of the patients if a 6-month gain in relapse-free or overall survival can be expected. (C) 1997 by American Society of Clinical Oncology.