Understanding patients' values and preferences regarding early stage lung cancer treatment decision making
Menée aux Etats-Unis auprès de 114 patients atteints d'un cancer du poumon de stade précoce (âge moyen : 70 ans), cette étude analyse, dans le cadre du processus de prise de décision thérapeutique, leurs préférences concernant une radiothérapie stéréotaxique et une résection chirurgicale
Introduction : With advances in treatments among patients with lung cancer, it is increasingly important to understand patients’ values and preferences to facilitate shared decision making. Methods : Prospective, multicenter study of patients with treated stage I lung cancer at time of study participation which occurred 4–6 months after treatment. Value clarification and discrete choice methods were used to elicit participants’ values and treatment preferences regarding stereotactic body radiation therapy (SBRT) and surgical resection using only treatment attributes. Results : Among 114 participants, mean age was 70 years (Standard Deviation = 7.9), 65% were male, 68 (60%) received SBRT and 46 (40%) received surgery. More participants valued independence and quality of life (QOL) as “most important” compared to survival or cancer recurrence. Most participants (83%) were willing to accept lung cancer treatment with a 2% chance of periprocedural death for only one additional year of life. Participants also valued independence more than additional years of life as most (86%) were unwilling to accept either permanent placement in a nursing home or being limited to a bed/chair for four additional years of life. Surprisingly, treatment discordance was common as 49% of participants preferred the alternative lung cancer treatment than what they received. Conclusions : Among participants with early stage lung cancer, maintaining independence and QOL were more highly valued than survival or cancer recurrence. Participants were willing to accept high periprocedural mortality, but not severe deficits affecting QOL when considering treatment. Treatment discordance was common among participants who received SBRT or surgery. Understanding patients’ values and preferences regarding treatment decisions is essential to foster shared decision making and ensure treatment plans are consistent with patients’ goals. Clinicians need more resources to engage in high quality communication regarding lung cancer treatment
Lung Cancer 2019