Skip to main content

Advertisement

Log in

Preference values associated with stage III colon cancer and adjuvant chemotherapy

  • Published:
Quality of Life Research Aims and scope Submit manuscript

Abstract

Purpose

To elicit preference values for health states associated with Stage III colon cancer (CRC) and to explore the effect of neuropathy associated with current adjuvant treatment.

Methods

We used time trade-off (TTO) techniques to elicit preferences from 49 CRC patients and 49 community members. We elicited preferences for 7 health states: remission; adjuvant therapy with no, mild, moderate, and severe neuropathy; metastatic stable; and metastatic progressive disease. Mean TTO values were adjusted for the covariates age, education, and current health.

Results

Patients’ adjusted mean TTO value for remission was 0.83; adjuvant chemotherapy health states ranged from 0.48 to 0.61. Significant differences were observed for both patient and community groups between TTO for remission and all adjuvant health states (P < 0.001), and between adjuvant therapy with no neuropathy and metastatic health states (P ≤ 0.001). Across all health states, patients’ values were on average 0.12 higher than community members (P < 0.05).

Conclusions

The findings highlight the trade-offs between the disutility of adjuvant treatment, the higher utility of remission, and the severe utility loss during metastatic disease. The preference values obtained from this study will be useful for informing patients’ treatment decisions and payer cost-utility analyses of adjuvant treatment for colon cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Jemal, A., Siegel, R., Ward, E., Murray, T., Xu, J., & Thun, M. J. (2007). Cancer statistics, 2007. CA: A Cancer Journal for Clinicians, 57, 43–66.

    Article  Google Scholar 

  2. National Comprehensive Cancer Network. (2005). Clinical practice guideline in oncology—Colon cancer (v.2.2006).

  3. Ramsey, S. D. (2007). How should we pay the piper when he’s calling the tune? On the long-term affordability of cancer care in the United States. Journal of Clinical Oncology, 25, 175–179.

    Article  PubMed  Google Scholar 

  4. Schrag, D. (2004). The price tag on progress—Chemotherapy for colorectal cancer. NEJM, 351(4), 317–319.

    Article  CAS  PubMed  Google Scholar 

  5. Twelves, C., Wong, A., Nowacki, M. P., Abt, M., Burris, H., 3rd, Carrato, A., et al. (2005). Capecitabine as adjuvant treatment for stage III colon cancer. NEJM, 352(26), 2696–2704.

    Article  CAS  PubMed  Google Scholar 

  6. André, T., Boni, C., Mounedji-Boudiaf, L., Navarro, M., Tabernero, J., Hickish, T., et al. (2004). Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. NEJM, 350(23), 2343–2351.

    Article  PubMed  Google Scholar 

  7. Gold, M. R., Siegel, J. E., Russel, L. B., & Weinstein, M. C. (Eds.). (1996). Cost-effectiveness in health and medicine. New York: Oxford University Press.

    Google Scholar 

  8. National Institute for Clinical Excellence. (2004). Guide to the methods of technology appraisal.

  9. National Institute for Clinical Excellence. (2005). Social value judgements. Guidelines for the institute and its advisory bodies.

  10. Brown, M. L., Nayfield, S. G., & Shibley, L. M. (1994). Adjuvant therapy for stage III colon cancer: Economic returns to research and cost-effectiveness of treatment. Journal of the National Cancer Institute, 86(6), 424–430.

    Article  CAS  PubMed  Google Scholar 

  11. Kievit, J., & van de Velde, C. J. (1990). Utility and cost of carcinoembryonic antigen monitoring in colon cancer follow-up evaluation. A Marhov analysis. Cancer, 65(11), 2580–2587.

    Article  CAS  PubMed  Google Scholar 

  12. Smith, R. D., Hall, J., & Gurney, H. (1993). A cost-utility approach to the use of 5-fluorouracil and levamisole as adjuvant chemotherapy for Dukes’ C colonic carcinoma. Medical Journal of Australia, 158(5), 319–322.

    CAS  PubMed  Google Scholar 

  13. Dominitz, J. A., & Provenzale, D. (1997). Patient preferences and quality of life associated with colorectal cancer screening. The American Journal of Gastroenterology, 92(12), 2171–2178.

    CAS  PubMed  Google Scholar 

  14. Boyd, N. F., Sutherland, H. J., Heasman, K. Z., Tritchler, D. L., & Cummings, B. J. (1990). Whose utilities for decision analysis? Medical Decision Making, 10(1), 58–67.

    Article  CAS  PubMed  Google Scholar 

  15. Norum, J., Vonen, B., Olsen, J. A., & Revhaug, A. (1997). Adjuvant chemotherapy (5-fluorouracil and levamisole) in Dukes’ B and C colorectal carcinoma. A cost-effectiveness analysis. Annals of Oncology, 8(1), 65–70.

    Article  CAS  PubMed  Google Scholar 

  16. Ness, R. M., Holmes, A. M., Klein, R., & Dittus, R. (1999). Utility valuations for outcome states of colorectal cancer. American Journal of Gastroenterology, 94(6), 1650–1657.

    Article  CAS  PubMed  Google Scholar 

  17. Ramsey, S., Andersen, M. R., Etzioni, R., Moinpour, C., Peacock, S., Potosky, A., et al. (2000). Quality of life in survivors of colorectal carcinoma. Cancer, 88(6), 1294–1303.

    Article  CAS  PubMed  Google Scholar 

  18. Ramsey, S. D., Berry, K., & Etzioni, R. (2002). Lifetime cancer-attributable cost of care for long-term survivors of colorectal cancer. American Journal of Gastroenterology, 97(2), 440–445.

    Article  PubMed  Google Scholar 

  19. Lloyd, A., de Jonge, P., Doyle, S., Walker, M., & Cohen, C. (2006). Developing health state descriptions for metastatic colorectal cancer: A qualitative study. Value in Health, 9(3), A115.

    Google Scholar 

  20. Shaw, J. W., Johnson, J. A., & Coons, S. J. (2005). US valuation of the EQ-5D health states: Development and testing of the D1 model. Medical Care, 43(3), 203–220.

    Article  PubMed  Google Scholar 

  21. Salomon, J., & Murray, C. J. L. (2004). A multi-method approach to measuring health-state valuations. Health Economics, 13, 281–290.

    Article  PubMed  Google Scholar 

  22. Torrance, G. W. (1987). Utility approach to measuring health-related quality of life. Journal of Chronic Diseases, 40(6), 593–600.

    Article  CAS  PubMed  Google Scholar 

  23. Furlong, W., Feeny, D., & Torrance, G. W., et al. (1990). Guide to design and development of health-state utility instrumentation. McMaster University Working paper 90–99.

  24. Stalmeier, P. F., Goldstein, M. K., Holmes, A. M., Lenert, L., Miyamoto, J., Stiggelbout, A. M., et al. (2001). What should be reported in a methods section on utility assessment? Medical Decision Making, 21, 200–207.

    CAS  PubMed  Google Scholar 

  25. Lenert, L. A., Cher, D. J., Goldstein, M. K., Bergen, M. R., & Garber, A. (1998). The effect of search procedures on utility elicitations. Medical Decision Making, 18(1), 76–83.

    Article  CAS  PubMed  Google Scholar 

  26. Elkin, E. B., Cowen, M. E., Cahill, D., Steffel, M., & Kattan, M. W. (2004). Preference assessment method affects decision-analytic recommendations: A prostate cancer treatment example. Medical Decision Making, 24, 504–510.

    Article  PubMed  Google Scholar 

  27. Torrance, G. W., Feeny, D., & Furlong, W. (2001). Visual analog scales: Do they have a role in the measurement of preferences for health states? Medical Decision Making, 21, 329–334.

    CAS  PubMed  Google Scholar 

  28. Dolan, P., & Kahneman, D. (2008). Interpretations of utility and their implications for the valuation of health. The Econmic Journal, 118, 215–234.

    Google Scholar 

  29. Smith, M. D., Drummond, M., & Brixner, D. (2009). A different approach to health state valuation. Value in Health, 12(S1), S16–S17.

    Google Scholar 

  30. Grothey, A. (2005). Clinical management of oxaliplatin-associated neurotoxicity. Clinical Colorectal Cancer, 5(Suppl 1), S38–S46.

    Article  CAS  PubMed  Google Scholar 

  31. Stiggelbout, A. M., & de Haes, J. C. (2001). Patient preference for cancer therapy: An overview of measurement approaches. Journal of Clinical Oncology, 19(1), 220–230.

    CAS  PubMed  Google Scholar 

  32. van Osch, S. V., Wakker, P. P., van den Hout, W. B., & Stiggelbout, A. M. (2004). Correcting biases in standard gamble and time tradeoff utilities. Medical Decision Making, 24, 511–517.

    Article  PubMed  Google Scholar 

  33. Martin, A. J., Glasziou, P. P., Simes, R. J., & Lumley, T. (2000). A comparison of standard gamble, time trade-off, and adjusted time trade-off scores. International Journal of Technology Assessment in Health Car, 16(1), 137–147.

    Article  CAS  Google Scholar 

  34. Read, J. L., Quinn, R. J., Berwick, D. M., Fineberg, H. V., & Weinstein, M. C. (1984). Preferences for health outcomes: Comparison of assessment methods. Medical Decision Making, 4, 315–329.

    Article  CAS  PubMed  Google Scholar 

  35. Jansen, S. J. T., Kievit, J., Nooij, M., & Stiggelbout, A. M. (2001). Stability of patients’ preferences for chemotherapy: The impact of experience. Medical Decision Making, 21(4), 295–306.

    CAS  PubMed  Google Scholar 

  36. Gabriel, S. E., Kneeland, T. S., Melton, L. J., Moncur, M. M., Ettinger, B., & Tosteson, A. N. (1999). Health-related quality of life in economic evaluations for osteoporosis: Whose values should we use? Medical Decision Making, 19(2), 141–148.

    Article  CAS  PubMed  Google Scholar 

  37. Patrick, D. L., Starks, H. E., Cain, K. C., Uhlmann, R. F., & Pearlman, R. A. (1994). Measuring preferences for health states worse than death. Medical Decision Making, 14, 9–18.

    Article  CAS  PubMed  Google Scholar 

  38. Robinson, A., & Spencer, A. (2006). Exploring challenges to TTO utilities: Valuing states worse than dead. Health Economics, 15, 393–402.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to thank the patients and community members who participated in the study. We are grateful to the clinical staff at the participating centers, whose support made this study possible: Dr. Heinz Lenz, Dr. Syma Iqbal, Taline Khoukaz, and Marie Seitz, at USC Norris Cancer Center; Dr. Joel Bernstein; Ellie Flores and the clinicians at Pacific Oncology; and Dr. Sabrina Wallach and Dawn Huckabone.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jennie H. Best.

Appendix 1: health state descriptions

Appendix 1: health state descriptions

Description for adjuvant chemotherapy, no neuropathy

You are receiving intravenous treatment at the hospital or clinic for a few hours one or two times every 2 weeks. You take medication to prevent nausea and diarrhea from the treatment. You still have some nausea and/or diarrhea for 3 or 4 days after each treatment.

You feel tired for a few days after your treatment. You have some trouble caring for yourself (e.g., washing or dressing).

You have cutback considerably your time with friends and family. You spend less time on work, hobbies, and other activities.

Descriptions for mild, moderate, or severe neuropathy would be placed here for specific adjuvant therapy health states with mild, moderate, or severe neuropathy (see below).

You are mildly fearful or anxious about your disease or death. You occasionally have trouble sleeping.

Description for adjuvant chemotherapy, mild neuropathy

You have sensations of pins and needles and numbness in your hands, but you have no difficulty holding items, buttoning shirts, or writing. You have numbness in your feet, but you continue to walk without any difficulty. You are uncomfortable drinking or handling cold objects.

Description for adjuvant chemotherapy, moderate neuropathy

You have sensations of pins and needles and numbness in your hands that makes it difficult to button shirts, write, or pick up or hold a fork, knife or coins. You have numbness in your feet that gives you a sensation of walking on pebbles and makes you feel clumsy when you walk. You are uncomfortable drinking or handling cold objects.

Description for adjuvant chemotherapy, severe neuropathy

You have sensations of pins and needles and numbness in your hands that makes you unable to button shirts, write, or pick up or hold a fork, knife or coins. You have numbness in your feet that makes it very difficult to walk or drive. You are uncomfortable drinking or handling cold objects.

Description for remission

  • You occasionally have diarrhea.

  • You occasionally feel mildly fatigued.

  • You have no difficulty caring for yourself.

  • You have no difficulty doing your usual activities (e.g., work, hobbies, visiting with family and friends).

  • You are mildly anxious about your disease recurring. You occasionally have difficulty sleeping.

Description for metastatic stable disease

You are receiving intravenous treatment at the hospital or clinic for a few hours one or two times every 2 weeks. You take medication to prevent nausea and diarrhea. You still have some nausea and/or diarrhea for 3 or 4 days after each treatment. Your appetite has decreased and you have lost a little weight.

You occasionally feel moderately fatigued. You have some trouble caring for yourself (e.g., washing, cooking). You are concerned about becoming reliant on others.

You feel tired when visiting with family and friends. You have difficulty concentrating. You spend less time on work, hobbies, and other activities.

You worry about your condition progressing. You are feeling anxious or depressed and you have trouble sleeping. You worry about how long you might have left to live.

Description for metastatic progressive disease

You are receiving intravenous treatment at the hospital or clinic for a few hours one or two times every 2 weeks. You take medication to prevent nausea and diarrhea. You still have moderate nausea and/or diarrhea for 3 or 4 days after each treatment. You occasionally vomit. You have lost your appetite and you have lost a noticeable amount of weight.

You often feel very fatigued. You have trouble caring for yourself (e.g., washing, cooking). You have become reliant on others.

Visiting with family and friends is exhausting. You have difficulty concentrating. You have had to give up work, hobbies, and other activities.

You worry a lot about your condition. You are feeling depressed and you frequently have trouble sleeping. You worry about how long you might have left to live.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Best, J.H., Garrison, L.P., Hollingworth, W. et al. Preference values associated with stage III colon cancer and adjuvant chemotherapy. Qual Life Res 19, 391–400 (2010). https://doi.org/10.1007/s11136-010-9589-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-010-9589-5

Keywords

Navigation