BACKGROUND: The objective of this study was to elicit future patients' preferences for preoperative chemoradiation (pre-CRT) for rectal cancer to determine whether patients' preferences are consistent with current treatment guidelines. METHODS: During a standardized interview, the treatment protocol, risks, benefits, and long-term outcomes associated with 1) surgery alone (SA) and 2) pre-CRT followed by surgery (CR + S) were described to healthy individuals, and a threshold task was performed. Each participant was asked which treatment option they would prefer when the risk of local recurrence was set initially at 15% for both options. If the participant indicated SA (which was expected), then the risk of local recurrence for CR + S was lowered systematically until the participant's preference changed from SA to CR + S. This threshold point represented the risk of local recurrence for pre-CRT that the participant would require before they would choose treatment with pre-CRT. RESULTS: Fifty individuals participated in the study, and the majority were well educated. Twenty-seven of 50 participants (54%) required a risk of local recurrence with CR + S of ≤ 5% (ie, equivalent to an absolute risk reduction ≥ 10%) before they would choose treatment with pre-CRT. Regression analysis did not identify any variables that were predictive of the participants' preferences. CONCLUSIONS: Participants seemed to highly value functional outcomes and seemed willing to accept a higher risk of local recurrence to achieve this. Therefore, developers of future guidelines may need to downgrade the use of pre-CRT for all patients with stage II/III tumors from a guideline to an option.
BACKGROUND: The objective of this study was to elicit future patients' preferences for preoperative chemoradiation (pre-CRT) for rectal cancer to determine whether patients' preferences are consistent with current treatment guidelines. METHODS: During a standardized interview, the treatment protocol, risks, benefits, and long-term outcomes associated with 1) surgery alone (SA) and 2) pre-CRT followed by surgery (CR + S) were described to healthy individuals, and a threshold task was performed. Each participant was asked which treatment option they would prefer when the risk of local recurrence was set initially at 15% for both options. If the participant indicated SA (which was expected), then the risk of local recurrence for CR + S was lowered systematically until the participant's preference changed from SA to CR + S. This threshold point represented the risk of local recurrence for pre-CRT that the participant would require before they would choose treatment with pre-CRT. RESULTS: Fifty individuals participated in the study, and the majority were well educated. Twenty-seven of 50 participants (54%) required a risk of local recurrence with CR + S of ≤ 5% (ie, equivalent to an absolute risk reduction ≥ 10%) before they would choose treatment with pre-CRT. Regression analysis did not identify any variables that were predictive of the participants' preferences. CONCLUSIONS:Participants seemed to highly value functional outcomes and seemed willing to accept a higher risk of local recurrence to achieve this. Therefore, developers of future guidelines may need to downgrade the use of pre-CRT for all patients with stage II/III tumors from a guideline to an option.
Authors: Erin D Kennedy; Marko Simunovic; Kartik Jhaveri; Richard Kirsch; Jim Brierley; Sébastien Drolet; Carl Brown; Patrick M Vos; Wei Xiong; Tony MacLean; Selliah Kanthan; Peter Stotland; Simon Raphael; Gil Chow; Catherine A O'Brien; Charles Cho; Cathy Streutker; Raimond Wong; Selina Schmocker; Sender Liberman; Caroline Reinhold; Neil Kopek; Victoria Marcus; Alexandre Bouchard; Caroline Lavoie; Stanislas Morin; Martine Périgny; Ann Wright; Katerina Neumann; Sharon Clarke; Nikhilesh G Patil; Thomas Arnason; Lara Williams; Robin McLeod; Gina Brown; Alex Mathieson; Amandeep Pooni; Nancy N Baxter Journal: JAMA Oncol Date: 2019-07-01 Impact factor: 31.777
Authors: M Kunneman; A H Pieterse; A M Stiggelbout; R A Nout; M Kamps; L C H W Lutgens; J Paulissen; O J A Mattheussens; R F P M Kruitwagen; C L Creutzberg Journal: Br J Cancer Date: 2014-06-12 Impact factor: 7.640