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Predictors of patient preferences and treatment choices for localized prostate cancer†
Article first published online: 14 AUG 2008
Copyright © 2008 American Cancer Society
Volume 113, Issue 8, pages 2058–2067, 15 October 2008
How to Cite
Sommers, B. D., Beard, C. J., D'Amico, A. V., Kaplan, I., Richie, J. P. and Zeckhauser, R. J. (2008), Predictors of patient preferences and treatment choices for localized prostate cancer. Cancer, 113: 2058–2067. doi: 10.1002/cncr.23807
We are grateful to Drs. Michael Barry and Al Mulley for suggestions on study design, Dr. John Ayanian and 3 anonymous reviewers for insightful comments, and Dr. Douglas Dahl for patient recruitment.
- Issue published online: 3 OCT 2008
- Article first published online: 14 AUG 2008
- Manuscript Accepted: 21 MAY 2008
- Manuscript Revised: 19 MAY 2008
- Manuscript Received: 11 MAR 2008
- National Science Foundation
- Harvard MD/PhD Program in the Social Sciences
- prostate cancer;
- patient preferences;
- quality-adjusted life year;
- health states
Little is known regarding how patients select treatment for localized prostate cancer. This study examined determinants of patients' preferences for health states related to prostate cancer, and assessed whether preferences and/or other factors predict treatment choices.
A survey of 167 patients with newly diagnosed localized prostate cancer was conducted in 4 academic medical practices from 2004 to 2007. The authors assessed demographic and health factors, and used a time-tradeoff method to elicit preferences in the form of quality-adjusted life years (QALYs) regarding health states related to prostate cancer. Linear regressions identified predictors of preferences (in QALYs) for erectile dysfunction (ED), urinary incontinence, rectal/bowel symptoms, and metastatic prostate cancer. Linear probability models identified predictors of treatment choice.
Patient preferences were affected by a range of behavioral, demographic, and health factors. For example, sexually active men reported significantly lower QALYs for living with ED, and men with family members who died of cancer reported lower QALYs for metastatic disease. The strongest predictor of treatment was the type of physician seen (radiation oncology vs urology) at the time of the survey. Age and tumor grade also were found to be strongly predictive of treatment. In general, QALYs were not found to predict treatment choice.
Patient preferences, as reported in QALYs, are shaped by reasonable behavioral and demographic influences. However, actual treatment choices appear to bear little relation to these patient preferences, and instead demonstrate a strong association with clinician specialty. More attention to variation in preferences among patients, as well as the use of decision-support technologies, may enable physicians to facilitate more optimal individualized treatment choices for patients with prostate cancer. Cancer 2008. © 2008 American Cancer Society.