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Title: Survival gains needed to offset persistent adverse treatment effects in localised prostate cancer
Authors: King MT; Viney R; Smith DP; Hossain I; Street D; Fowler S; Berry MP; Stockler M; Cozzi P; Savage E; Stricker P; Ward J; Armstrong BK
Categories: Cancer Type - Prostate Cancer
Early Detection, Diagnosis, and Prognosis - Resources and Infrastructure
Keywords: Australia; survival; therapy; cancer; diagnosis; economics; prostate; Prostatectomy; psychology; radiotherapy; Research
Year: 2012
Journal Title: British Journal of Cancer
Volume: 106
Issue: 4
Page number start: 638
Page number end: 645
Abstract: Background:Men diagnosed with localised prostate cancer (LPC) face difficult choices between treatment options that can cause persistent problems with sexual, urinary and bowel function. Controlled trial evidence about the survival benefits of the full range of treatment alternatives is limited, and patients views on the survival gains that might justify these problems have not been quantified.Methods:A discrete choice experiment (DCE) was administered in a random subsample (n=357, stratified by treatment) of a population-based sample (n=1381) of men, recurrence-free 3 years after diagnosis of LPC, and 65 age-matched controls (without prostate cancer). Survival gains needed to justify persistent problems were estimated by substituting side effect and survival parameters from the DCE into an equation for compensating variation (adapted from welfare economics).Results:Median (2.5, 97.5 centiles) survival benefits needed to justify severe erectile dysfunction and severe loss of libido were 4.0 (3.4, 4.6) and 5.0 (4.9, 5.2) months. These problems were common, particularly after androgen deprivation therapy (ADT): 40 and 41% overall (n=1381) and 88 and 78% in the ADT group (n=33). Urinary leakage (most prevalent after radical prostatectomy (n=839, mild 41%, severe 18%)) needed 4.2 (4.1, 4.3) and 27.7 (26.9, 28.5) months survival benefit, respectively. Mild bowel problems (most prevalent (30%) after external beam radiotherapy (n=106)) needed 6.2 (6.1, 6.4) months survival benefit.Conclusion:Emerging evidence about survival benefits can be assessed against these patient-based benchmarks. Considerable variation in trade-offs among individuals underlines the need to inform patients of long-term consequences and incorporate patient preferences into treatment decisions
Programme: Health Services Research
Division: Cancer Research Division
Funding Body: This research was funded by the Australian Commonwealth Department of Veterans Affairs Project Grant 240400 and National Health and Medical Research Council of Australia Project Grant 387700. MK is supported by the Australian Government through Cancer Australia. The input of RV, ES and DS was supported by National Health and Medical Research Council Program Grant 254202.
DOI: 10.1038/bjc.2011.552
Appears in Collections:Research Articles

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