Survival benefit needed to undergo chemotherapy

Patient and physician preferences

Ines Vaz-Luis, Anne O'Neill, Karen Sepucha, Kathy Miller, Emily Baker, Chau T. Dang, Donald W. Northfelt, Eric P. Winer, George W. Sledge, Bryan Schneider, Ann H. Partridge

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

BACKGROUND: Published studies have suggested that most patients with early stage breast cancer are willing, for modest survival benefits, to receive 6 months of adjuvant cyclophosphamide, methotrexate, and 5-fluorouracil, an older regimen that is used infrequently today. We examined preferences regarding the survival benefit needed to justify 6 months of a contemporary chemotherapy regimen. METHODS: The Eastern Cooperative Oncology Group Protocol 5103 was a phase 3 trial that randomized breast cancer patients to receive standard adjuvant doxorubicin, cyclophosphamide, and paclitaxel with either bevacizumab or placebo. Serial surveys to assess quality of life were administered to patients enrolled between January 1, 2010, and June 8, 2010. Survival benefit needed to justify 6 months of chemotherapy by patients was collected at the 18-month assessment. A parallel survey was sent to physicians who had enrolled patients in the study. RESULTS: Of 519 patients who had not withdrawn at a time point earlier than 18 months, 87.8% responded to this survey. A total of 175 physicians participated. We found considerable variation in patient preferences, particularly for modest survival benefits: for 2 months of benefit, 57% would consider 6 months of chemotherapy, whereas 96% of patients would consider 6 months of chemotherapy for 24 months. Race and education were associated with the choices. Physicians who responded were less likely to accept chemotherapy for modest benefit. CONCLUSIONS: Among patients who received contemporary adjuvant chemotherapy in a randomized controlled trial, we found substantial variation in preferences regarding benefits that justified undergoing chemotherapy. Differences between patients' and physicians' choices were also apparent. Eliciting preferences regarding risks and benefits of adjuvant chemotherapy is critical. Cancer 2017;123:2821–28.

Original languageEnglish (US)
Pages (from-to)2821-2828
Number of pages8
JournalCancer
Volume123
Issue number15
DOIs
StatePublished - Aug 1 2017

Fingerprint

Patient Preference
Physicians
Drug Therapy
Survival
Adjuvant Chemotherapy
Cyclophosphamide
Breast Neoplasms
Paclitaxel
Methotrexate
Fluorouracil
Doxorubicin
Randomized Controlled Trials
Placebos
Quality of Life
Education

Keywords

  • breast neoplasms
  • drug therapy
  • patients
  • physicians
  • quality of life

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Vaz-Luis, I., O'Neill, A., Sepucha, K., Miller, K., Baker, E., Dang, C. T., ... Partridge, A. H. (2017). Survival benefit needed to undergo chemotherapy: Patient and physician preferences. Cancer, 123(15), 2821-2828. https://doi.org/10.1002/cncr.30671

Survival benefit needed to undergo chemotherapy : Patient and physician preferences. / Vaz-Luis, Ines; O'Neill, Anne; Sepucha, Karen; Miller, Kathy; Baker, Emily; Dang, Chau T.; Northfelt, Donald W.; Winer, Eric P.; Sledge, George W.; Schneider, Bryan; Partridge, Ann H.

In: Cancer, Vol. 123, No. 15, 01.08.2017, p. 2821-2828.

Research output: Contribution to journalArticle

Vaz-Luis, I, O'Neill, A, Sepucha, K, Miller, K, Baker, E, Dang, CT, Northfelt, DW, Winer, EP, Sledge, GW, Schneider, B & Partridge, AH 2017, 'Survival benefit needed to undergo chemotherapy: Patient and physician preferences', Cancer, vol. 123, no. 15, pp. 2821-2828. https://doi.org/10.1002/cncr.30671
Vaz-Luis I, O'Neill A, Sepucha K, Miller K, Baker E, Dang CT et al. Survival benefit needed to undergo chemotherapy: Patient and physician preferences. Cancer. 2017 Aug 1;123(15):2821-2828. https://doi.org/10.1002/cncr.30671
Vaz-Luis, Ines ; O'Neill, Anne ; Sepucha, Karen ; Miller, Kathy ; Baker, Emily ; Dang, Chau T. ; Northfelt, Donald W. ; Winer, Eric P. ; Sledge, George W. ; Schneider, Bryan ; Partridge, Ann H. / Survival benefit needed to undergo chemotherapy : Patient and physician preferences. In: Cancer. 2017 ; Vol. 123, No. 15. pp. 2821-2828.
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abstract = "BACKGROUND: Published studies have suggested that most patients with early stage breast cancer are willing, for modest survival benefits, to receive 6 months of adjuvant cyclophosphamide, methotrexate, and 5-fluorouracil, an older regimen that is used infrequently today. We examined preferences regarding the survival benefit needed to justify 6 months of a contemporary chemotherapy regimen. METHODS: The Eastern Cooperative Oncology Group Protocol 5103 was a phase 3 trial that randomized breast cancer patients to receive standard adjuvant doxorubicin, cyclophosphamide, and paclitaxel with either bevacizumab or placebo. Serial surveys to assess quality of life were administered to patients enrolled between January 1, 2010, and June 8, 2010. Survival benefit needed to justify 6 months of chemotherapy by patients was collected at the 18-month assessment. A parallel survey was sent to physicians who had enrolled patients in the study. RESULTS: Of 519 patients who had not withdrawn at a time point earlier than 18 months, 87.8{\%} responded to this survey. A total of 175 physicians participated. We found considerable variation in patient preferences, particularly for modest survival benefits: for 2 months of benefit, 57{\%} would consider 6 months of chemotherapy, whereas 96{\%} of patients would consider 6 months of chemotherapy for 24 months. Race and education were associated with the choices. Physicians who responded were less likely to accept chemotherapy for modest benefit. CONCLUSIONS: Among patients who received contemporary adjuvant chemotherapy in a randomized controlled trial, we found substantial variation in preferences regarding benefits that justified undergoing chemotherapy. Differences between patients' and physicians' choices were also apparent. Eliciting preferences regarding risks and benefits of adjuvant chemotherapy is critical. Cancer 2017;123:2821–28.",
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AU - Baker, Emily

AU - Dang, Chau T.

AU - Northfelt, Donald W.

AU - Winer, Eric P.

AU - Sledge, George W.

AU - Schneider, Bryan

AU - Partridge, Ann H.

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