Survival gains needed to offset persistent adverse treatment effects in localised prostate cancer

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dc.contributor.author King, MT
dc.contributor.author Viney, R
dc.contributor.author Smith, DP
dc.contributor.author Hossain, I
dc.contributor.author Street, D
dc.contributor.author Savage, E
dc.contributor.author Fowler, S
dc.contributor.author Berry, MP
dc.contributor.author Stockler, M
dc.contributor.author Cozzi, P
dc.contributor.author Stricker, P
dc.contributor.author Ward, J
dc.contributor.author Armstrong, BK
dc.date.accessioned 2012-10-12T03:34:55Z
dc.date.issued 2012-02-14
dc.identifier.citation British Journal of Cancer, 2012, 106 (4), pp. 638 - 645
dc.identifier.citation British Journal of Cancer, 2012, 106 (4), pp. 638 - 645
dc.identifier.issn 0007-0920
dc.identifier.other C1 en_US
dc.identifier.uri http://hdl.handle.net/10453/18819
dc.description.abstract 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. © 2012 Cancer Research UK. All rights reserved.
dc.description.abstract 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. © 2012 Cancer Research UK. All rights reserved.
dc.language eng
dc.language eng
dc.relation.isbasedon 10.1038/bjc.2011.552
dc.title Survival gains needed to offset persistent adverse treatment effects in localised prostate cancer
dc.type Journal Article
dc.description.version Published
dc.parent British Journal of Cancer
dc.parent British Journal of Cancer
dc.journal.volume 4
dc.journal.volume 106
dc.journal.number 4 en_US
dc.publocation London, UK en_US
dc.identifier.startpage 638 en_US
dc.identifier.endpage 645 en_US
dc.cauo.name BUS.Faculty of Business en_US
dc.conference Verified OK en_US
dc.for 140208 Health Economics
dc.personcode 950324
dc.personcode 020117
dc.personcode 020120
dc.personcode 031002
dc.personcode 944572
dc.percentage 100 en_US
dc.classification.name Health Economics en_US
dc.classification.type FOR-08 en_US
dc.edition en_US
dc.custom en_US
dc.date.activity en_US
dc.location.activity en_US
dc.description.keywords preferences
dc.description.keywords preferences
dc.description.keywords prostate cancer
dc.description.keywords prostate cancer
dc.description.keywords quality of life
dc.description.keywords quality of life
dc.description.keywords survival benefit
dc.description.keywords survival benefit
dc.description.keywords trade-off
dc.description.keywords trade-off
dc.description.keywords utility
dc.description.keywords utility
pubs.embargo.period Not known
pubs.organisational-group /University of Technology Sydney
pubs.organisational-group /University of Technology Sydney/Faculty of Business
pubs.organisational-group /University of Technology Sydney/Faculty of Business/Economics
pubs.organisational-group /University of Technology Sydney/Faculty of Science
pubs.organisational-group /University of Technology Sydney/Strength - Health Economics and Research Evaluation
pubs.organisational-group /University of Technology Sydney/Strength - Health Economics and Research Evaluation
pubs.organisational-group /University of Technology Sydney/Strength - Study of Choice
pubs.organisational-group /University of Technology Sydney/Strength - Study of Choice
utslib.copyright.status Closed Access
utslib.copyright.date 2015-04-15 12:17:09.805752+10
pubs.consider-herdc true
utslib.collection.history School of Mathematical Sciences (ID: 340)
utslib.collection.history Closed (ID: 3)
utslib.collection.history School of Mathematical Sciences (ID: 340)
utslib.collection.history School of Mathematical Sciences (ID: 340)


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