Journal of Clinical Oncology, Vol 18, Issue 4
(February), 2000: 877
© 2000 American Society for Clinical Oncology
How Do Head and Neck Cancer Patients Prioritize Treatment Outcomes Before Initiating Treatment?
By Marcy A. List,
John Stracks,
Laura Colangelo,
Pamela Butler,
Natasha Ganzenko,
Donna Lundy,
Paula Sullivan,
Daniel Haraf,
Merrill Kies,
William Goodwin,
Everett E. Vokes
From the Departments of Medicine and Radiation and Cellular Oncology, and the Cancer Research Center, University of Chicago; Chicago Oral Cancer Center; Lurie Cancer Center Biostatistics Section, Health Services Research and Policy Studies, and Northwestern University Medical School, Northwestern University, Chicago, IL; and University of Miami, Miami, FL.
Address reprint requests to Marcy A. List, PhD, Associate Director, Cancer Control and Community Research, University of Chicago Cancer Research Center, 5841 S Maryland MC 1140, Chicago, IL 60637; email mlist{at}medicine.bsd.uchicago.edu
PURPOSE: To determine, pretreatment, how head and neck cancer (HNC) patients prioritize potential treatment effects in relationship to each other and to survival and to ascertain whether patients’ preferences are related to demographic or disease characteristics, performance status, or quality of life (QOL).
PATIENTS AND METHODS: One hundred thirty-one patients were assessed pretreatment using standardized measures of QOL (Functional Assessment of Cancer Therapy-Head and Neck) and performance (Performance Status Scale for Head and Neck Cancer). Patients were also asked to rank a series of 12 potential HNC treatment effects.
RESULTS: Being cured was ranked top priority by 75% of patients; another 18% ranked it second or third. Living as long as possible and having no pain were placed in the top three by 56% and 35% of patients, respectively. Items that were ranked in the top three by 10% to 24% of patients included those related to energy, swallowing, voice, and appearance. Items related to chewing, being understood, tasting, and dry mouth were placed in the top three by less than 10% of patients. Excluding the top three rankings, there was considerable variability in ratings. Rankings were generally unrelated to patient or disease characteristics, with the exception that cure and living were of slightly lower priority and pain of higher priority to older patients compared with younger patients.
CONCLUSION: The data suggest that, at least pretreatment, survival is of primary importance to patients, supporting the development of aggressive treatment strategies. In addition, results highlight individual variability and warn against making assumptions about patients’ attitudes vis-à-vis potential outcomes. Whether patients’ priorities will change as they experience late effects is currently under investigation.
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