Physicians Urged to Find Ways to Determine Patients' Preferences About Cancer Treatment

Physicians need to find more effective ways to determine theirpatients' preferences about cancer treatment, according to aneditorial in the November 7, 1994 issue of the Journal of theNational Cancer Institute.

"Patient preferences about treatment vary widely, regardlessof age, and we need to learn how to better elicit them,"said Jane C. Weeks, MD, MSC, of the Division of Cancer Epidemiologyand Control at Dana-Farber Cancer Institute, author of the editorial.

Dr. Weeks has devoted considerable time to studying patterns ofcare and the process of decision-making in oncology. Recent studiesof national data bases have found some unsettling differencesin care on the basis of nonmedical issues, such as geography,insurance status, and age. For instance, older patients tend toreceive less aggressive care than younger ones, but it has beenunclear whether this reflects their own preferences or age discrimination.

Dr. Weeks' editorial accompanies a paper by Suzanne B. Yellen,PHD, of Rush Cancer Institute, entitled "Age and ClinicalDecision-Making in Oncology Patients." The Yellen study soughtto determine how age influenced treatment choices and tradeoffs.

Investigators asked 248 cancer patients of all ages to make hypotheticaldecisions about treatment after reading two sets of vignettes.The first set was designed to determine whether age influencespatients' acceptance of cancer therapy. The second gauged patients'willingness to trade quality of life for increased survival. Theresearchers found that elderly patients were as willing to choosechemotherapy as younger patients, but they required a greatersurvival advantage before choosing a toxic regimen over a lesstoxic one.

The study showed something else. According to Dr. Weeks, "Perhapsthe most striking feature of the data presented by Yellen et alis not the differences in preferences across age groups, but thewide variability in preferences within age groups." Thisvariation springs from highly personalized views on what is valuablein life, and what sacrifices someone is willing to make in exchangefor achieving a goal. It cannot be intuitively determined fromsomeone's age alone.

The challenge for oncologists is to present medical informationwhile eliciting treatment and tradeoff preferences from a patient--noeasy task, especially in an era of managed care, when physiciansare under pressure to see more patients in less time. "Weneed to find new tools to help us solicit patient values,"stated Dr. Weeks. For instance, a patient preference survey couldhelp guide physicians and patients through a decision-making process."Given time pressure nowadays, we can't necessarily relyon the old approaches to physician/patient communication any more,"she said.

"This whole area needs more research," Dr. Weeks writes.In the meantime, she advises physicians to ask about patient values."This study shows that if you don't ask, you won't know."