Patient willingness to undergo chemotherapy and thoracic radiotherapy for locally advanced non-small cell lung cancer
Takashi Hirose 1, Toshimitsu Yamaoka 1, Tsukasa Ohnishi 1, Tomohide Sugiyama 1, Sojiro Kusumoto 1, Takao Shirai 1, Kentaro Okuda 1, Tohru Ohmori 2, Mitsuru Adachi 1
1The First Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
2Institute of Molecular Oncology, Showa University School of Medicine, Tokyo, Japan
Objectives: To determine how Japanese patients with lung cancer weigh the chance of cure and potential survival against the potential toxicity of different treatment strategies for locally advanced non-small cell lung cancer (NSCLC).
Methods: We used a questionnaire describing a hypothetical situation involving locally advanced NSCLC. Seventy-three patients with lung cancer who had received chemotherapy and a control group of 120 patients without cancer were asked to state the minimal benefit that would make two hypothetical treatments acceptable.
Results: Patients with lung cancer were significantly more likely than were patients without cancer to accept either intensive or less-intensive chemoradiotherapy for a potentially small benefit for chance of cure and response but not cure. The percentages of patients who would accept intensive or less-intensive chemoradiotherapy to prolong survival did not differ significantly between the two groups. When the chance of cure was 20%, 56 and 64% of patients with lung cancer were willing to receive intensive and less-intensive chemoradiotherapy, respectively. If their lives were prolonged by 6 months, 20 and 30% of patients with lung cancer would choose to receive intensive and less-intensive chemoradiotherapy, respectively. The chance of cure and the survival advantage that patients require for accepting chemoradiotherapy varied widely. No factors were associated with the choice of chemoradiotherapy in patients with lung cancer.
Conclusions: Physicians must consider the substantial range of attitudes to chemoradiotherapy among patients when selecting treatment and give patients opportunities to be included in the treatment-selection process.