Patient preferences for adjuvant interferon alfa-2b treatment

Purpose: Although trials of adjuvant interferon alfa-2b (IFN alpha -2b) in high-risk melanoma patients suggest improvement in disease-free survival, i t is unclear whether treatment offers improvement in overall survival. Wide spread use of adjuvant IFN alpha -2b has been tempered by its significant t oxicity. To quantify the trade-offs between IFN alpha -2b toxicity and surv ival, we assessed patient utilities for health states associated with IFN t herapy. Utilities are measures of preference for a particular health state on a scale of 0 (death) to 1 (perfect health). Patients and Methods: We assessed utilities for health states associated wi th adjuvant IFN among 107 low-risk melanoma patients using the standard gam ble technique. Health states described four IFN alpha -2b Sb toxicity scena rios and the following three posttreatment outcomes: disease-free health an d melanoma recurrence (with or without IFN alpha -2b) leading to cancer dea th. We also asked patients the improvement in 5-year disease-free survival they would require to tolerate IFN. Results: Utilities for melanoma recurrence with or without IFN alpha -2b we re significantly lower than utilities for all IFN alpha -2b toxicities but were not significantly different from each other. At least half of the pati ents were willing to tolerate mild-moderate and severe IFN alpha -2b toxici ty for 4% and 10% improvements, respectively, in 5-year disease free surviv al. Conclusion: On average, patients rate quality of life with melanoma recurre nce much lower than even severe IFN alpha- 2b toxicity. These results sugge st that recurrence-free survival is highly valued by patients. The utilitie s measured in our study can be applied directly to quality-of-life determin ations in clinical trials of adjuvant IFN alpha -2b to measure the net bene fit of therapy. (C) 2001 by American Society of Clinical Oncology.