Elsevier

The Lancet Oncology

Volume 2, Issue 11, November 2001, Pages 691-697
The Lancet Oncology

Review
Patients' preferences for adjuvant chemotherapy in early breast cancer: a review of what makes it worthwhile?

https://doi.org/10.1016/S1470-2045(01)00559-9Get rights and content

Summary

Adjuvant chemotherapy for early breast cancer improves survival but is unpleasant and inconvenient. Women and clinicians need information about the magnitude of survival benefits considered sufficient to make the side-effects and inconvenience worthwhile. We sought studies that quantified the minimum required survival benefit by asking women who had experienced adjuvant chemotherapy. Four studies involving 512 women were appraised and summarised. All studies referred to chemotherapy given between 1980 and 1996, but the methods varied widely, especially the way in which women were recruited and questioned. However, the results were remarkably consistent. Most women said that small improvements in survival were sufficient to make adjuvant chemotherapy worthwhile. Women with dependants, social support, and milder side-effects judged smaller benefits worthwhile. Age, education, employment, and income status were not predictive of the women's responses. Optimum decision-making about the relative benefit of adjuvant chemotherapy requires upto-date information from women receiving current chemotherapy and supportive regimens.

Section snippets

Findings

Four studies involving 512 women from Australia, USA, and Italy were published between 1992 and 2000. The baseline characteristics of the women, their disease, and treatment are summarised in Table 1. Most of the women had chemotherapy during the late 1980s and early 1990s. The distributions of age, disease stage, and treatment types reflect the use of adjuvant chemotherapy during this time. Most women were younger than 60 years, were married, and had at least a high-school education. About

Minimum worthwhile benefits

The minimum benefits considered sufficient to make adjuvant chemotherapy worthwhile are summarised in Table 3 and illustrated in Figures 2 and 3. All studies except the one by Zimmermann and colleagues asked questions framed in terms of extra months of life expectancy. All studies asked questions framed in terms of improvements in the percentage chances of survival or cure.

Additional life expectancy of six monthswas considered sufficient to make adjuvant chemotherapy worthwhile by 52% of women,

Predictors of preferences

All four studies explored characteristics that might predict or influence the minimum benefit considered worthwhile. These analyses are summarised in Table 4. Each study assessed different features, and even if the same one was being assessed (eg side-effects) the way it was ascertained was quite different.

Patients' support was the only demographic characteristic associated with elicited preferences. Women who were living with and supporting dependants considered smaller benefits worthwhile,9

Discussion

In these four studies women who had experienced adjuvant chemotherapy for early breast cancer were asked what survival benefit was needed to make it worthwhile. Simes and Coates' study was specifically designed to address this question;9 the other studies sought this information as a secondary objective. All the women in Simes' study received the same adjuvant chemotherapy (oral CMF) for stage II breast cancer during the 1980s. Lindley and colleagues' study did not specify the kinds of

Conclusions

The minimum benefit needed to make the side-effects and inconvenience of treatment worthwhile is a key element in clinical decision-making. The judgments of women who have experienced chemotherapy offer unique insights to women and clinicians facing decisions about adjuvant chemotherapy. The available data indicate that most women who have experienced adjuvant chemotherapy for early breast cancer consider small benefits sufficient to make it worthwhile. Information is needed from women who have

Search strategy and selection criteria

MEDLINE, EMBASE, CANCERLIT, and reference lists were searched for studies that assessed the preferences of women for adjuvant chemotherapy in early breast cancer. The following search terms were used: ‘explode breast neoplasms’ and ‘explode antineoplastic agents’, and the text words ‘early or adjuvant’ and ‘preference or utility or attitude or expectation’.

Studies were included if they quantified the magnitude of benefits considered sufficient to make adjuvant chemotherapy for early

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