NIV 2014

Introduction: When making treatment decisions regarding chemotherapy, harms and benefits of therapy should be carefully considered. Individual patients weigh these harms and benefits differently and mostly make a treatment decision in consultation with the treating physician. The willingness to accept chemotherapy for both patients and healthcare professionals in the Netherlands is unknown. The primary aim of this prospective survey was to assess minimal required benefits to accept chemotherapy and compare these between patients with and without cancer and healthcare professionals. In addition, in view of the recent concerns about rising expenditure for cancer treatments, the opinion of patients and healthcare professionals about maximally acceptable costs for society were examined.

Methods: Preferences were examined using a questionnaire consisting of two hypothetical scenarios based on a classical study [1]. Subjects were asked to indicate the minimal benefit in terms of chance of cure, life prolongation and relief of symptoms they would require to undergo such chemotherapy. In two other scenarios, opinions about monthly costs for chemotherapy treatment were examined.

Results: 139 patients with cancer, 82 patients without cancer and 155 healthcare professionals completed the survey. Minimal benefits to make chemotherapy acceptable did not differ between cancer and non-cancer patients, with respect to chance of cure (mean 57%), life prolongation (median 24 months) and symptom relief (mean 50%), healthcare providers were likely to accept chemotherapy at lower thresholds (p<0.01). Education level was an important explanatory variable and the differences between patients and healthcare providers disappeared when correction for education level was applied. Opinions about the maximum acceptable costs for chemotherapy displayed a large spread within the groups. The maximum cost that healthcare professionals considered acceptable was lower in comparison to both cancer and non-cancer patients.

Conclusion: The minimal benefit to accept chemotherapy is not different in cancer and non-cancer patients, but is beyond what generally can be achieved. Healthcare professionals were willing to accept chemotherapy for less benefit. This difference may be attributed to difference in education level between the groups. Healthcare professionals rated the maximal acceptable societal cost for chemotherapy lower than patients.

[1] Slevin ML, Stubbs L, Plant HJ, Wilson P, Gregory WM, Armes PJ, et al. Attitudes to chemotherapy: comparing views of patients with cancer with those of doctors, nurses, and general public. BMJ. 1990;300:1458-60