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Review of Determinants of Patients’ Preferences for Adjuvant Therapy in Cancer

From the Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands

Address reprint requests to Sylvia J.T. Jansen, PhD, Department of Medical Decision Making, J10-S, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands; e-mail: s.j.t.jansen{at}lumc.nl

PURPOSE: Many studies have determined cancer patients’ preferences for adjuvant therapy, for example, by asking patients the extent of benefit they would need in order to accept the therapy. However, little is known about the determinants that influence these preferences. Our research goal was to explore which determinants underlie patients’ preferences by means of a literature review.

METHODS: PubMed searches were conducted to identify studies in which cancer patients’ preferences for adjuvant therapy had been elicited by means of a treatment preference instrument. Twenty-three papers were evaluated with regard to reported relationships between preferences and potential determinants. A total of 40 determinants were recorded and classified into one of seven categories: (1) treatment-related determinants, (2) sociodemographic characteristics and current quality of life, (3) clinical characteristics, (4) measurement instrument-related determinants, (5) time-related determinants, (6) cognitive/affective determinants, and (7) specialist-related determinants.

RESULTS: The benefit and toxicity of treatment, experience of the treatment, and having dependents (eg, children) living at home were important determinants of patients’ preferences. Furthermore, qualitative data suggested that cognitive/affective and specialist-related determinants might have a large impact on patients’ treatment preferences.

CONCLUSION: Our results show that patients’ preferences cannot fully be explained on the basis of treatment-related determinants and patient and clinical characteristics. More research is needed in the area of cognitive/affective and specialist-related determinants because of the lack of quantitative results. Furthermore, we recommend carrying out larger studies in which the (internal) relationships between determinants and preferences are assessed in the context of a cognitive cost-benefit model.

Supported by a grant from the Dutch Cancer Society (Grant 2000-2334).

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

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