Gita Thanarajasingam1, Ethan Basch2, Carolyn Mead-Harvey3, Antonia V Bennett2, Gina L Mazza3, Gisela Schwab4, Jessica Roydhouse5, Lauren J Rogak6, Amylou C Dueck3. 1. Division of Hematology, Mayo Clinic, Rochester, MN, USA. Electronic address: thanarajasingam.gita@mayo.edu. 2. Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA. 3. Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA. 4. Exelixis Inc, South San Francisco, CA, USA. 5. Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia and Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA. 6. Memorial Sloan Kettering Cancer Center, Department of Epidemiology and Biostatistics, New York, NY, USA.
Abstract
OBJECTIVES: Asking "Was it worth it?" (WIWI) potentially captures the patient perception of a treatment's benefit weighed against its harms. This exploratory analysis evaluates the WIWI questionnaire as a metric of patients' perspectives on the worthwhileness of cancer treatment. METHODS: A 3-item WIWI questionnaire was assessed at end of treatment in patients with cancer on the COMET-2 trial (NCT01522443). WIWI items were evaluated to determine their association with quality of life (QOL), treatment duration, end-of-treatment reason, patient-reported adverse events (AEs), and disease response. RESULTS: A total of 65 patients completed the questionnaire; 40 (62%), 16 (25%), and 9 (14%) patients replied yes, uncertain, and no to "Was it worthwhile for you to receive the cancer treatment given in this study?" (item 1), respectively; 39 (60%), 12 (18%), and 14 (22%) to "If you had to do it over again, would you choose to have this cancer treatment?"; and 40 (62%), 14 (22%), and 11 (17%) to "Would you recommend this cancer treatment to others?" Patients responding yes to item 1 remained on treatment longer than those responding uncertain or no (mean 23.0 vs 11.3 weeks, P<.001). Patients responding uncertain/no to item 1 discontinued treatment because of AEs more frequently than those responding yes (36% vs 7.5%, P=.004) and demonstrated meaningful decline in QOL from baseline (-2.5 vs -0.2 mean change, P<.001). Associations between WIWI responses and most patient-reported AEs or treatment efficacy did not reach statistical significance. CONCLUSIONS: Patients who responded affirmatively on WIWI items remained on therapy longer, were less likely to stop treatment because of AEs, and demonstrated superior QOL. The WIWI may inform clinical practice, oncology research, and value frameworks.
OBJECTIVES: Asking "Was it worth it?" (WIWI) potentially captures the patient perception of a treatment's benefit weighed against its harms. This exploratory analysis evaluates the WIWI questionnaire as a metric of patients' perspectives on the worthwhileness of cancer treatment. METHODS: A 3-item WIWI questionnaire was assessed at end of treatment in patients with cancer on the COMET-2 trial (NCT01522443). WIWI items were evaluated to determine their association with quality of life (QOL), treatment duration, end-of-treatment reason, patient-reported adverse events (AEs), and disease response. RESULTS: A total of 65 patients completed the questionnaire; 40 (62%), 16 (25%), and 9 (14%) patients replied yes, uncertain, and no to "Was it worthwhile for you to receive the cancer treatment given in this study?" (item 1), respectively; 39 (60%), 12 (18%), and 14 (22%) to "If you had to do it over again, would you choose to have this cancer treatment?"; and 40 (62%), 14 (22%), and 11 (17%) to "Would you recommend this cancer treatment to others?" Patients responding yes to item 1 remained on treatment longer than those responding uncertain or no (mean 23.0 vs 11.3 weeks, P<.001). Patients responding uncertain/no to item 1 discontinued treatment because of AEs more frequently than those responding yes (36% vs 7.5%, P=.004) and demonstrated meaningful decline in QOL from baseline (-2.5 vs -0.2 mean change, P<.001). Associations between WIWI responses and most patient-reported AEs or treatment efficacy did not reach statistical significance. CONCLUSIONS: Patients who responded affirmatively on WIWI items remained on therapy longer, were less likely to stop treatment because of AEs, and demonstrated superior QOL. The WIWI may inform clinical practice, oncology research, and value frameworks.
Authors: Amylou C Dueck; Tito R Mendoza; Sandra A Mitchell; Bryce B Reeve; Kathleen M Castro; Lauren J Rogak; Thomas M Atkinson; Antonia V Bennett; Andrea M Denicoff; Ann M O'Mara; Yuelin Li; Steven B Clauser; Donna M Bryant; James D Bearden; Theresa A Gillis; Jay K Harness; Robert D Siegel; Diane B Paul; Charles S Cleeland; Deborah Schrag; Jeff A Sloan; Amy P Abernethy; Deborah W Bruner; Lori M Minasian; Ethan Basch Journal: JAMA Oncol Date: 2015-11 Impact factor: 31.777
Authors: N I Cherny; R Sullivan; U Dafni; J M Kerst; A Sobrero; C Zielinski; E G E de Vries; M J Piccart Journal: Ann Oncol Date: 2015-05-30 Impact factor: 32.976
Authors: Matthew Smith; Johann De Bono; Cora Sternberg; Sylvestre Le Moulec; Stéphane Oudard; Ugo De Giorgi; Michael Krainer; Andries Bergman; Wolfgang Hoelzer; Ronald De Wit; Martin Bögemann; Fred Saad; Giorgio Cruciani; Antoine Thiery-Vuillemin; Susan Feyerabend; Kurt Miller; Nadine Houédé; Syed Hussain; Elaine Lam; Jonathan Polikoff; Arnulf Stenzl; Paul Mainwaring; David Ramies; Colin Hessel; Aaron Weitzman; Karim Fizazi Journal: J Clin Oncol Date: 2016-07-11 Impact factor: 44.544
Authors: Ethan M Basch; Mark Scholz; Johann S de Bono; Nicholas Vogelzang; Paul de Souza; Gavin Marx; Ulka Vaishampayan; Saby George; James K Schwarz; Emmanuel S Antonarakis; Joseph M O'Sullivan; Arash Rezazadeh Kalebasty; Kim N Chi; Robert Dreicer; Thomas E Hutson; Amylou C Dueck; Antonia V Bennett; Erica Dayan; Milan Mangeshkar; Jaymes Holland; Aaron L Weitzman; Howard I Scher Journal: Eur Urol Date: 2018-12-04 Impact factor: 20.096