Preferences for chemotherapy in patients with advanced non-small cell lung cancer: descriptive study based on scripted interviews

BMJ 1998;317:771-775 ( 19 September )

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Preferences for chemotherapy in patients with advanced non-small cell lung cancer: descriptive study based on scripted interviews

Gerard Silvestri, assistant professor, ^a Robert Pritchard, assistant professor, ^b H Gilbert Welch, associate professor. ^c

^a Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC 29425-2220, USA, ^b Section of Hematology/Oncology, Department of Veterans Affairs Medical Center, White River Junction, VT 05009, USA, ^c VA Outcomes Group (111B), Department of Veterans Affairs Medical Center, White River Junction, VT 05009, USA

Correspondence to: Dr Silvestri gerard_silvestri{at}smtpgw.musc.edu

Objective: To determine how patients with lung cancer value the trade off between the survival benefit of chemotherapyand itstoxicities.
Design: Scripted interviews that included three hypothetical scenarios. Each scenario described the same patient withmetastatic non-small cell lung cancer with an expected survivalof 4 months without treatment. Subjects were asked to indicatethe minimum survival benefit required to accept the side effectsof chemotherapy in the first two scenarios (mild toxicity andsevere toxicity). In the third scenario, subjects were asked tochoose between chemotherapy and supportive care when the benefitof chemotherapy was either to prolong life by 3 months or to palliatesymptoms.
Subjects: 81 patients previously treated with cis-platinum based chemotherapy for advanced non-small cell lung cancer.
Main outcome measure: Survival threshold for acceptingchemotherapy.
Results: The minimum survival threshold for accepting the toxicity of chemotherapy varied widely in patients. Severalpatients would accept chemotherapy for a survival benefit of 1week, while others would not choose chemotherapy even for a survivalbenefit of 24 months. The median survival threshold for acceptingchemotherapy was 4.5 months for mild toxicity and 9 months forsevere toxicity. When given the choice between supportive careand chemotherapy only 18 (22%) patients chose chemotherapy fora survival benefit of 3 months; 55 (68%) patients chose chemotherapyif it substantially reduced symptoms without prolonginglife.
Conclusions: Patients' willingness to accept chemotherapy for the treatment of metastatic lung cancer varies widely.Many would not choose chemotherapy for its likely survival benefitof 3 months but would if it improved quality of life. The conflictbetween these patients' preferences and the care they previouslyreceived has several explanations, one being that some patientshad not received the treatment they would have chosen had theybeen fullyinformed.

Key messages

The median survival of patients with metastatic non-small cell lung cancer is improved by about 3 months with the addition of chemotherapy
Lung cancer patients who had had chemotherapy were interviewed in this study to learn about their treatment preferences with a range of survival benefits
Several patients would choose chemotherapy for a survival benefit of as little as 1 week, while others would not choose chemotherapy even when offered a survival benefit of 24 months
Most patients would not choose chemotherapy for its likely survival benefit of 3 months, but would if it improved quality of life
Some patients with lung cancer may not be getting the treatment they would choose were they fully informed

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Guyatt, G. H., Sinclair, J., Cook, D. J., Glasziou, P., for the Evidence-Based Medicine Working Group and, (1999). Users' Guides to the Medical Literature: XVI. How to Use a Treatment Recommendation. JAMA 281: 1836-1843 [Abstract] [Full text]
(1998). Patient Preferences for Chemotherapy in Advanced Non-Small-Cell Lung Cancer. JWatch General 1998: 4-4 [Full text]