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.
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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.
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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
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You occasionally have diarrhea.
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You occasionally feel mildly fatigued.
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You have no difficulty caring for yourself.
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You have no difficulty doing your usual activities (e.g., work, hobbies, visiting with family and friends).
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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.
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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
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DOI: https://doi.org/10.1007/s11136-010-9589-5