Abstract
Medical treatment of cancer often entails a trade-off between outcomes of two different attributes: quality of life (QOL) and length of life (LL). This process of weighing advantages and disadvantages seems to be influenced by different factors. The main purposes of this study were (a) to investigate the relative importance of different factors on the trade-off and (b) to explore the relationship between these importance ratings and personal characteristics. We asked 199 patients with cancer to indicate to what degree they consider a number of factors to be of importance if they had to choose between two treatment modallties that differ in their expected outcomes concerning QOL and LL. The seven factors were their age at the time of decision, having a partner, having children, inability to work due to side-effects of the treatment, the nature of the side-effects, disease-related life expectancy and baseline QOL. The results indicate that six of the seven factors were of considerable to great importance when a treatment choice had to be made. The negative effects of treatment on the ability to work did not seem to be a very important consideration. Patient age and education were positively associated with importance ratings.
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Loomes G, McKenzie L. The use of QALY's in health care decision making. Soc Sci Med 1989; 28: 299–308.
Mehrez A, Gafni A. Quality-adjusted life years, utility theory, and healthy-years equivalents. Med Decis Making 1989; 9: 142–149.
Selai CE, Rosser RM. Good quality quality? Some methodological issues. J Roy Soc Med 1993; 86: 440–443.
LaPuma J, Lawlor EF. Quality-adjusted life-years. Ethical implications for physicians and policy-makers. JAMA 1990; 263: 2917–2921.
Danford DA. QALY's: their ethical implications. JAMA 1990; 264: 2503.
Kaplan RM, Ganiats TG. QALY's: their ethical implications. JAMA 1990; 264: 2502–2503.
LaPuma J. QALY's: their ethical implications. JAMA 1990; 264: 2503–2504.
Spiegelhalter DJ, Gore SM, Fitzpatrick R, et al. Quality of life measures in health care. III: resource allocation. Br Med J 1992; 305: 1205–1209.
Sackett DL, Torrance GW. The utility of different health states as perceived by the general public. J Chron Dis 1978; 31: 697–704.
Coates A, Abraham S, Kaye SB, et al. On the receiving end—patient perception of the side-effects of cancer chemotherapy. Eur J Cancer Clin Oncol 1983; 19: 203–208.
Pliskin J, Shephard DS, Weinstein MC. Utility functions for life years and health status. Oper Res 1980; 28: 206–224.
Williams A. Economics of coronary artery bypass. Br Med J 1985; 291: 326–329.
Donaldson C, Atkinson A, Bond J. Should QALYs be programme-specific? J Health Econ 1988; 7: 239–257.
Hall J, Gerard K, Salkeld G, et al. A cost utility analysis of mammography screening in Australia. Soc Sci Med 1992; 34: 993–1004.
O'Conner A. Effects of framing and level of probability on patients' preferences for cancer chemotherapy. J Clin Epidemiol 1989; 42: 119–126.
Llewellyn-Thomas HA, Sutherland HJ. Procedures for value assessment. Recent Adv Nurs 1987; 17: 169–185.
Llewellyn-Thomas HA, Thiel EC, McGreal MJ. Cancer patients' evaluations of their current health states: the influence of expectations, comparisons, actual health status, and mood. Med Decis Making 1992; 12: 115–122.
Froberg DG, Kane RL. Methodology for measuring health-state preferences—IV: Progress and research agenda. J Clin Epidemiol 1989; 42: 675–685.
Nord E. The significance of contextual factors in valuing health states. Health Policy 1989; 13: 189–198.
Torrance GW. Utility approach to measuring health-related quality of life. J Chron Dis 1987; 40: 593–600.
Sutherland HJ, Llewellyn-Thomas H, Boyd NF, et al. Attitudes toward survival, the concept of ‘maximal endurable time’. Med Dec Making 1982; 2: 299–309.
Berglund G, Bolund C, Fornander T, et al. Late effects of adjuvant chemotherapy and postoperative on quality of life among breast cancer patients. Eur J Cancer 1991; 27: 1075–1081.
Goldhirsch A, Gelber RD, Castiglione M. Adjuvant therapy of breast cancer. Eur J Cancer 1991; 27: 389–399.
Levine MN, Guyatt GH, Gent M, et al. Quality of life in stage II breast cancer: an instrument for clinical trials. J Clin Oncol 1988; 6: 1798–1810.
Sutherland HJ, Lockwood GA, Boyd NF. Rating of the importance of quality of life variables: therapeutic implications for patients with metastatic breast cancer. J Clin Epidemiol 1990; 43: 661–666.
Kiebert GM, de Haes JCJM, Kievit J, et al. Effect of peri-operative chemotherapy on the quality of patients with early breast cancer. Eur J Cancer 1990; 26: 1038–1042.
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Supported by the Dutch Cancer Society (Project IKW 90-13).
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Kiebert, G.M., Stiggelbout, A.M., Kievit, J. et al. Choices in oncology: factors that influence patients' treatment preference. Qual Life Res 3, 175–182 (1994). https://doi.org/10.1007/BF00435382
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DOI: https://doi.org/10.1007/BF00435382