Daniel Polsky1, Nancy L Keating, Jane C Weeks, Kevin A Schulman. 1. Division of General Internal Medicine, Department of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA. polsky@mail.med.upenn.edu
Abstract
BACKGROUND: Multiple treatment options exist for many medical conditions. The extent to which physicians should involve the patient in the choice the treatment to be delivered is not well understood. OBJECTIVE: To test the impact of breast cancer treatment choice on patients' health state preferences. DESIGN AND SETTING: A cohort from 29 hospitals (primarily referral centers) in Massachusetts, Texas, Washington DC, and New York. Subjects were surveyed at 5 months, 1 year, and 2 years following surgery and asked whether they had a choice in the type of treatment received. SUBJECTS: Women age 67 or older treated in 1996 to 1997 for localized breast cancer (n = 683). MEASURES: Patient preferences for current health state, assessed with patient valuations using the visual analogue scale (VAS) from the EuroQol instrument and with general public valuations using the Health Utilities Index (HUI), and 1-year medical costs. RESULTS: For the adjusted analysis at 5 months, the adjusted mean VAS score was 78.7 for women who reported a choice and 75.3 for women who reported no choice, a difference of 3.4 (P = 0.03). The difference in the HUI score was 3.6 (P= 0.10) and the difference in the 1-year medical costs was -4363 dollars (P = 0.01). There were no statistically significant differences at the 1-year and 2-year interviews. CONCLUSIONS: A woman's perception of choice of surgical treatment for breast cancer is associated with a short-term benefit on her preference of health state, suggesting choice helps with recovery, but does not provide long-term benefits.
BACKGROUND: Multiple treatment options exist for many medical conditions. The extent to which physicians should involve the patient in the choice the treatment to be delivered is not well understood. OBJECTIVE: To test the impact of breast cancer treatment choice on patients' health state preferences. DESIGN AND SETTING: A cohort from 29 hospitals (primarily referral centers) in Massachusetts, Texas, Washington DC, and New York. Subjects were surveyed at 5 months, 1 year, and 2 years following surgery and asked whether they had a choice in the type of treatment received. SUBJECTS:Women age 67 or older treated in 1996 to 1997 for localized breast cancer (n = 683). MEASURES: Patient preferences for current health state, assessed with patient valuations using the visual analogue scale (VAS) from the EuroQol instrument and with general public valuations using the Health Utilities Index (HUI), and 1-year medical costs. RESULTS: For the adjusted analysis at 5 months, the adjusted mean VAS score was 78.7 for women who reported a choice and 75.3 for women who reported no choice, a difference of 3.4 (P = 0.03). The difference in the HUI score was 3.6 (P= 0.10) and the difference in the 1-year medical costs was -4363 dollars (P = 0.01). There were no statistically significant differences at the 1-year and 2-year interviews. CONCLUSIONS: A woman's perception of choice of surgical treatment for breast cancer is associated with a short-term benefit on her preference of health state, suggesting choice helps with recovery, but does not provide long-term benefits.
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