Patients not rarely have a difficu...

Patients not rarely have a difficult time deciding between the many treatment options for nonmetastatic prostate cancer. a certain treatment options can produce intolerable and emotionally devastating side efficiencys yet extend life expectancy beyond what other treatment options can. To make an informed choice of treatment option, patients ne to determine what is more important to them and their families. Sculpher and colleagues used the technique of discrete choice experimentation to elicit patient prioritys for the most common nonmetastatic prostate cancer therapies.

The authors initially interviewed 14 men with nonmetastatic prostate cancer to identify first note of the scale attributes that would be incorporated into a larger thought The key attributes were identified as diarrhea, very warm flushes, breast swelling or tendernes bottom level, sex drive, ability to maintain an erection for sexual activity, life expectancy, and out-of-pocket costs These eight attributes were used as the basis of a questionnaire and structur interview proffered to 180 men with nonmetastatic prostate cancer who had received or had not at any time received anti-androgen therapy.

single 129 men completed the interview, during which the men were neared with scenarios that required them to pitch upon between a series of paired treatment options. They were given standardized information about the anticipated consequences and side effect profiles of each treatment option.

The average age of the participants was 70 years. At diagnosis, 58 percent of the men had T scores of 1 or 2 The researchers calculated coefficients for all of the attributes, showing patient estimations for different scenarios (e.g., side drifts and success rates of aggressive treatments; side events and success rates of conservative treatments). Then they calculated by what means much life expectancy men were willing to trade opposite to to improve specific symptoms. Patients placed high value upon energy levels by being willing to forgo three month of life expectancy in exchange for "pep" In addition, they were willing to forgo 19 and 18 month of life expectancy to avoid breast swelling and usual diarrhea, respectively. Men younger than 70 years were significantly transactioned about problems in maintaining an erection and were willing to give up 18 month of life expectancy to avoid these moot points (by contrast, men older than 70 years were willing to give up 09 months)

The authors judge that patients perceive some side drifts of prostate cancer therapy as being more significant than others and that the priorities of men younger than 70 years differ from the priorities of those older than 70 years. The authors encourage physicians to use personalized approaches to help patients with prostate cancer make informed treatment choices.

ANNE D WALLING, MD

Sculpher M et al. Patients' estimations for the management of non-metastatic prostate cancer: discrete choice experiment. BMJ February 14 2004;328:382-5

COPYRIGHT 2004 American Academy of Family Physicians

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