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Patient Preferences for Adjuvant Interferon Alfa-2b Treatment

From the Departments of Health Evaluation Sciences, Internal Medicine, and Surgery, University of Virginia Health System, Charlottesville, VA; Center for Outcomes and Policy Research, Dana-Farber Cancer Institute; Department of Dermatology and Division of Hematology/Oncology, Massachusetts General Hospital; and Division of Hematology/Oncology, Beth Israel Deaconess Medical Center; Harvard Medical School, Boston, MA; Division of Medical Oncology at University of Pittsburgh, Pittsburgh, PA; and Laboratory for Medical Decision Sciences, Washington University, School of Medicine, St Louis, MO.

Address reprint requests to Kerry Laing Kilbridge, MD, Department of Health Evaluation Sciences, University of Virginia Health System, HSC P.O. Box 800821, Charlottesville, VA 22908-0821; email: kk4h{at}virginia.edu

PURPOSE: Although trials of adjuvant interferon alfa-2b (IFN-2b) in high-risk melanoma patients suggest improvement in disease-free survival, it is unclear whether treatment offers improvement in overall survival. Widespread use of adjuvant IFN-2b has been tempered by its significant toxicity. To quantify the trade-offs between IFN-2b toxicity and survival, we assessed patient utilities for health states associated with IFN therapy. Utilities are measures of preference for a particular health state on a scale of 0 (death) to 1 (perfect health).

PATIENTS AND METHODS: We assessed utilities for health states associated with adjuvant IFN among 107 low-risk melanoma patients using the standard gamble technique. Health states described four IFN-2b toxicity scenarios and the following three posttreatment outcomes: disease-free health and melanoma recurrence (with or without IFN-2b) leading to cancer death. We also asked patients the improvement in 5-year disease-free survival they would require to tolerate IFN.

RESULTS: Utilities for melanoma recurrence with or without IFN-2b were significantly lower than utilities for all IFN-2b toxicities but were not significantly different from each other. At least half of the patients were willing to tolerate mild-moderate and severe IFN-2b toxicity for 4% and 10% improvements, respectively, in 5-year disease-free survival.

CONCLUSION: On average, patients rate quality of life with melanoma recurrence much lower than even severe IFN-2b toxicity. These results suggest that recurrence-free survival is highly valued by patients. The utilities measured in our study can be applied directly to quality-of-life determinations in clinical trials of adjuvant IFN-2b to measure the net benefit of therapy.

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