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Decision analysis using individual patient preferences to determine optimal treatment for localized prostate cancer
Author(s) -
Sommers Benjamin D.,
Beard Clair J.,
D'Amico Anthony V.,
Dahl Douglas,
Kaplan Irving,
Richie Jerome P.,
Zeckhauser Richard J.
Publication year - 2007
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.23028
Subject(s) - medicine , prostate cancer , prostate , decision analysis , cancer , oncology , medical physics , gynecology , statistics , mathematics
BACKGROUND Selecting treatment for clinically localized prostate cancer remains an ongoing challenge. Previous decision analyses focused on a hypothetical patient with average preferences, but preferences differ for clinically similar patients, implying that their optimal therapies may also differ. METHODS A decision model was constructed comparing 4 treatments for localized prostate cancer: 1) radical prostatectomy (RP); 2) external beam radiation (EB); 3) brachytherapy (BT); and 4) watchful waiting (WW). Published data were used regarding treatment success, side effects, and noncancer survival, and 156 men with prostate cancer were surveyed to elicit preferences in quality‐adjusted life years (QALYs). The clinical scenarios were determined (age, tumor grade, and prostate‐specific antigen [PSA]) for which variations in patient preferences led to different optimal treatments and those for which the optimal treatment was unaffected by preferences. RESULTS Patient preferences were critical in determining treatment for low‐risk cancers (Gleason score ≤6, PSA ≤10 ng/mL) and for patients aged 75 years and older. In younger patients with more aggressive tumors, RP and EB were always superior to WW or BT, regardless of preferences (average gain in quality‐adjusted life expectancy vs WW for a 60‐year‐old with a medium‐risk tumor = +1.4 years for RP and +1.7 for EB; for a high‐risk tumor = +2.1 years for RP and +2.4 for EB). BT was a reasonable option for low‐risk tumors at any age. WW was only reasonable for patients aged 70 and older with low‐risk tumors or those aged 80 years and older with medium‐risk tumors. Selecting treatment based on average preferences leads to suboptimal choices for 30% of patients. CONCLUSIONS The optimal treatment for prostate cancer depends on both the clinical scenario (patient age and tumor aggressiveness) and the patient's preferences. Decision analyses taking individualized preferences into account may be a useful adjunct in clinical decision‐making. Cancer 2007. © 2007 American Cancer Society.