Women's Preferences for Hypofractionated Radiation Therapy for Treatment of Early-Stage Breast Cancer: A Discrete Choice Experiment

Abstract

IntroductionThe primary treatment recommended for early-stage breast cancer is breast conserving surgery followed by external beam radiation therapy of the whole breast. Previously radiation therapy for early-stage breast cancer was given using more fractions over longer durations. Guidelines support treatments with fewer fractions over a shorter time (hypofractionated radiation therapy-HFRT). This study aimed to understand women's preferences for different features of treatments for early-stage breast cancer. MethodsA discrete choice experiment (DCE) with 12 choice tasks was conducted, describing the treatments by: extent of surgery, duration of radiation treatment, need to relocate for treatment, local side effects, changes in breast appearance, costs, and difficulty with daily activities during and after treatment. Participants were women with breast cancer and from the general population. Mixed logit analyses were conducted and trade-offs between attributes estimated. Results420 respondents completed the DCE. The relative importance of attributes varied by respondent characteristics; the most influential attribute for younger women was type of surgery (breast conserving surgery); type of surgery did not influence older women's preferences. Shorter treatment duration, avoiding relocation, fewer local side effects, and less difficulty with daily activities all positively influenced treatment preference. Younger women were willing to accept 32-40 days of radiation treatment before a treatment that included mastectomy was potentially acceptable. Conclusionattributes of treatment such as duration, need for relocation, side effects and impacts on normal daily activities during and after treatment significantly influenced women's preference for treatment, including surgery. Our findings have the potential for real impact for patients and services including supporting one on one clinical discussions, supporting program and patient resource development, and by informing service funding, organisation and delivery.