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Survival gains needed to offset persistent adverse treatment effects in localised prostate cancer
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, an...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Nature Publishing Group
2012
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3324299/ https://www.ncbi.nlm.nih.gov/pubmed/22274410 http://dx.doi.org/10.1038/bjc.2011.552 |
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author | King, M T Viney, R Smith, D P Hossain, I Street, D Savage, E Fowler, S Berry, M P Stockler, M Cozzi, P Stricker, P Ward, J Armstrong, B K |
author_facet | King, M T Viney, R Smith, D P Hossain, I Street, D Savage, E Fowler, S Berry, M P Stockler, M Cozzi, P Stricker, P Ward, J Armstrong, B K |
author_sort | King, M T |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-3324299 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2012 |
publisher | Nature Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-33242992013-02-14 Survival gains needed to offset persistent adverse treatment effects in localised prostate cancer King, M T Viney, R Smith, D P Hossain, I Street, D Savage, E Fowler, S Berry, M P Stockler, M Cozzi, P Stricker, P Ward, J Armstrong, B K Br J Cancer Clinical Studies 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. Nature Publishing Group 2012-02-14 2012-01-24 /pmc/articles/PMC3324299/ /pubmed/22274410 http://dx.doi.org/10.1038/bjc.2011.552 Text en Copyright © 2012 Cancer Research UK https://creativecommons.org/licenses/by/4.0/This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material.If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Clinical Studies King, M T Viney, R Smith, D P Hossain, I Street, D Savage, E Fowler, S Berry, M P Stockler, M Cozzi, P Stricker, P Ward, J Armstrong, B K Survival gains needed to offset persistent adverse treatment effects in localised prostate cancer |
title | Survival gains needed to offset persistent adverse treatment effects in localised prostate cancer |
title_full | Survival gains needed to offset persistent adverse treatment effects in localised prostate cancer |
title_fullStr | Survival gains needed to offset persistent adverse treatment effects in localised prostate cancer |
title_full_unstemmed | Survival gains needed to offset persistent adverse treatment effects in localised prostate cancer |
title_short | Survival gains needed to offset persistent adverse treatment effects in localised prostate cancer |
title_sort | survival gains needed to offset persistent adverse treatment effects in localised prostate cancer |
topic | Clinical Studies |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3324299/ https://www.ncbi.nlm.nih.gov/pubmed/22274410 http://dx.doi.org/10.1038/bjc.2011.552 |
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