Preferences for adjuvant chemotherapy in an Anzgog substudy of the portec-3 intergroup randomized controlled trial of adjuvant chemotherapy in high risk endometrial cancer.

Abstract

Aims To determine the minimum survival benefits that patients, and their doctors, judged sufficient to make ACT worthwhile, in addition to pelvic radiotherapy, in high risk endometrial cancer. Methods 83 of 122 ANZ patients in PORTEC-3, and 44 of their doctors, completed a time tradeoff questionnaire to determine the minimum survival benefits they judged sufficient to make ACT worthwhile. The questionnaire used 4 hypothetical scenarios based on survival times without ACT of 5 years and 8 years, and survival rates at 5 years without ACT of 50% and 65%. Patients completed the questionnaire after randomisation but before any adjuvant treatment. Results Over 50% of patients judged an extra 1 year of survival time (beyond 5 years or 8 years without ACT) or an extra 5% in survival rate (beyond 50% or 65% without ACT) sufficient to make ACT worthwhile. Over 50% of doctors judged an extra 1 year of survival time or an extra 10% in survival rates sufficient to make ACT worthwhile. Doctors' preferences, compared with patients' preferences, had the same median survival time benefit (1 year, p=0.4) but larger median survival rate benefit (8.5% v 5%, p=0.03), and varied over a smaller range (IQR's, 0.5-1.5 years v 0.4-2 years, P=0.0007; 5%-10% v 1-13%, P=0.004). There were no strong predictors of preferences. Conclusion Patients and doctors judged moderate survival benefits sufficient to make ACT worthwhile after pelvic radiotherapy for high risk endometrial cancer. These benefits are larger than those judged sufficient by patients for breast or colon cancers, but similar to those for lung or ovarian cancers.