Patient preferences for adjuvant interferon alfa-2b treatment.

Abstract

PURPOSE:

Although trials of adjuvant interferon alfa-2b (IFN alpha-2b) in high-risk melanoma patients suggest improvement in disease-free survival, it is unclear whether treatment offers improvement in overall survival. Widespread use of adjuvant IFN alpha-2b has been tempered by its significant toxicity. To quantify the trade-offs between IFN alpha-2b toxicity and survival, we assessed patient utilities for health states associated with IFN therapy. Utilities are measures of preference for a particular health state on a scale of 0 (death) to 1 (perfect health).

PATIENTS AND METHODS:

We assessed utilities for health states associated with adjuvant IFN among 107 low-risk melanoma patients using the standard gamble technique. Health states described four IFN alpha-2b toxicity scenarios and the following three posttreatment outcomes: disease-free health and melanoma recurrence (with or without IFN alpha-2b) leading to cancer death. We also asked patients the improvement in 5-year disease-free survival they would require to tolerate IFN.

RESULTS:

Utilities for melanoma recurrence with or without IFN alpha-2b were significantly lower than utilities for all IFN alpha-2b toxicities but were not significantly different from each other. At least half of the patients were willing to tolerate mild-moderate and severe IFN alpha-2b toxicity for 4% and 10% improvements, respectively, in 5-year disease-free survival.

CONCLUSION:

On average, patients rate quality of life with melanoma recurrence much lower than even severe IFN alpha-2b toxicity. These results suggest that recurrence-free survival is highly valued by patients. The utilities measured in our study can be applied directly to quality-of-life determinations in clinical trials of adjuvant IFN alpha-2b to measure the net benefit of therapy.

• Authors: K L Kilbridge, J C Weeks, A J Sober, F G Haluska, C L Slingluff, M B Atkins, D E Sock, J M Kirkwood, R F Nease
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 19 Issue 3 Pg. 812-23 (Feb 01 2001) ISSN: 0732-183X [Print] United States
• PMID: 11157035 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antineoplastic Agents
• Interferon alpha-2
• Interferon-alpha
• Recombinant Proteins

Topics

• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Agents (adverse effects, therapeutic use)
• Attitude to Health
• Chemotherapy, Adjuvant
• Disease-Free Survival
• Female
• Humans
• Interferon alpha-2
• Interferon-alpha (adverse effects, therapeutic use)
• Male
• Melanoma (drug therapy)
• Middle Aged
• Neoplasm Recurrence, Local (drug therapy)
• Patient Satisfaction
• Quality of Life
• Recombinant Proteins
• Risk Factors
• Surveys and Questionnaires
• Survival Rate