Do patients consider preoperative chemoradiation for primary rectal cancer worthwhile?

Abstract

BACKGROUND: The objective of this study was to elicit future patients' preferences for preoperative chemoradiation (pre‐CRT) for rectal cancer to determine whether patients' preferences are consistent with current treatment guidelines. METHODS: During a standardized interview, the treatment protocol, risks, benefits, and long‐term outcomes associated with 1) surgery alone (SA) and 2) pre‐CRT followed by surgery (CR + S) were described to healthy individuals, and a threshold task was performed. Each participant was asked which treatment option they would prefer when the risk of local recurrence was set initially at 15% for both options. If the participant indicated SA (which was expected), then the risk of local recurrence for CR + S was lowered systematically until the participant's preference changed from SA to CR + S. This threshold point represented the risk of local recurrence for pre‐CRT that the participant would require before they would choose treatment with pre‐CRT. RESULTS: Fifty individuals participated in the study, and the majority were well educated. Twenty‐seven of 50 participants (54%) required a risk of local recurrence with CR + S of ≤5% (ie, equivalent to an absolute risk reduction ≥10%) before they would choose treatment with pre‐CRT. Regression analysis did not identify any variables that were predictive of the participants' preferences. CONCLUSIONS: Participants seemed to highly value functional outcomes and seemed willing to accept a higher risk of local recurrence to achieve this. Therefore, developers of future guidelines may need to downgrade the use of pre‐CRT for all patients with stage II/III tumors from a guideline to an option. Cancer 2011. © 2011 American Cancer Society.