Patients' preferences for adjuvant chemotherapy in early-stage breast cancer: is treatment worthwhile?

When making decisions about adjuvant chemotherapy for early-stage breast ca ncer, costs and benefits of treatment should be carefully weighed. In this process, patients' preferences are of major importance. The objectives of t he present study were: (1) to determine the minimum benefits that patients need to find chemotherapy acceptable, and (2) to explore potential preferen ce determinants, namely: positive experience of the treatment, reconciliati on with the treatment decision, and demographic variables. Preferences were elicited from patients scheduled for adjuvant chemotherapy (chemotherapy g roup: n = 38) before (T-1), during (T-2), and 1 month after chemotherapy (T -3), and were compared to responses from patients not scheduled for chemoth erapy (no-chemotherapy group: n = 38). The patients were asked, for a hypot hetical situation, to indicate the minimum benefit (in terms of improved 5- year disease-free survival) to find adjuvant chemotherapy acceptable. In th e chemotherapy group, the median benefit was 1% at all 3 measurement points . In the no-chemotherapy group the attitude towards chemotherapy became mor e negative over time, although not statistically significantly so (T-1: 12% , T-2:(:) 15%, T-3: 15%, P = 0.10). At all measurement points, the patients in the chemotherapy group indicated that they would accept chemotherapy fo r significantly (P < 0.01) less benefit than the patients in the no-chemoth erapy group. Of the demographic variables, age was related to preferences, but only at T-2 and only in the no-chemotherapy group. The more positive at titude towards chemotherapy and the stability of preferences in the chemoth erapy group indicated that reconciliation with the treatment decision was a more important determinant of patients' preferences than positive experien ce of the treatment. (C) 2001 Cancer Research Campaign.