Abstract
4050 Background: ACT improves disease-free and overall survival at the expense of toxicities and inconvenience. We sought the minimum survival gains patients judged necessary to make ACT worthwhile and factors associated with their judgments. A secondary aim was to compare a self-administered questionnaire (PACT-Q) with a validated, scripted interview (PACT-I). Methods: All 123 subjects completed the PACT-Q; a subset of 100 also completed the PACT-I. The order of administration (PACT-I or PACT-Q first) was randomized. Subjects rated how troubled they were by various aspects of health related quality of life (HRQL) during ACT (from 0 = none at all, 10 = worst I can imagine). Associations between preferences and characteristics of the patient, disease, treatment and HRQL during ACT were assessed with linear regression after normal score transformation. Concordance of the PACT-I and PACT-Q was assessed with the intraclass correlation coefficient (ICC) and t-tests. Results: The median age was 65y (range 19–86), 52% were female and 70% had positive nodes. ACT was 5-FU alone in 73%, 5-FU + oxaliplatin in 12%, and was completed 1–3 years earlier in 52%. Over 70% of patients judged an additional 3 months in survival time or 1% in survival rate sufficient to make ACT worthwhile. Tertiary education was the only factor associated with preferences (larger benefits needed to make ACT worthwhile, p=0.01). The most troublesome aspects of HRQL during ACT (mean) were: fatigue (5.2), nausea (3.8), altered sense of taste (3.7), thought of having treatment (3.6) and diarrhoea (3.5), but none of these were significantly associated with patients’ preferences. Concordance between the PACT-I and PACT-Q was high (ICCs from 0.71–0.82), but the PACT-I gave higher values than the PACT-Q for scenarios with a better prognosis (p=0.04, 0.02). Few thought that answering the questionnaire was hard (10%) or stressful (6%) and most were glad they took part (91%). About half rated the interview and questionnaire ‘about the same’ on ease of understanding (44%), clarity (47%), and stressfulness (60%). Conclusions: Most subjects judged small benefits sufficient to make ACT worthwhile. The PACT-Q is a valid and acceptable way of eliciting preferences for adjuvant chemotherapy. No significant financial relationships to disclose.
Published Version
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