Patients’ preferences for adjuvant chemotherapy for breast cancer: What makes it worthwhile in a Latin American population?

Abstract

e16524 Background: Adjuvant chemotherapy (AC) for breast cancer (BC) improves survival, but is associated with toxicity and can be inconvenient for patients (pts). Previous studies conducted in non-Latin American populations have shown that many women with BC who had already experienced AC consider negligible benefits sufficient to make it worthwhile. Methods: We carried out 101 interviews with consecutive consenting pts who had completed AC for BC from 3 to 60 months before. The study was conducted from April/2010 to January/2011. All patients answered the Portuguese version of WHOQOL-BREF. The primary end point of the study was the minimum survival benefit that would make AC worthwhile. This was considered as a dichotomous variable (one day vs. more than one day). Data was obtained by instructing pts to choose an option in a scale varying from one day to ten years of survival benefit. To check for consistency, 15 randomly selected pts answered the questionnaire a second time 3-7 months after the first interview. The prevalence ratio (PR) for the primary endpoint was calculated via Robust Poisson regression, considering socio-demographic (e.g., age), clinical (e.g. stage) and treatment (surgery, chemotherapy) aspects, as well as the physical, psychological, social and environmental domains of WHOQOL-BREF. Results: Mean age of the pts was 55.42 years (SD 11.75). AC was considered worthwhile for a gain of just one more day of life by 82 (81.2%) pts. Those in the superior quartile of the physical domain of WHOQOL-BREF (p = 0.02) and not grading chemotherapy as a very unpleasant experience (p = 0.03) were more likely to accept a gain of just one day for the AC. Preferences were not associated with: time between the end of the AC and the interview (p = 0.89), presence of dependants (p = 0.64), node positive status (p = 0.80) or having a friend or relative who died from cancer (p = 0.14). The kappa coefficient among the 15 repeated interviews was 0.67 for the primary endpoint. Conclusions: It is impressive that more than 81% of Brazilian women treated in a public reference cancer center considered AC worthwhile even for a gain of just one more day in their lives. The finding was confirmed in the repeated interviews.